Aortic graft infections: is there still a role for axillobifemoral reconstruction?

Infection of an aortic prosthesis is a severe condition with high morbidity and mortality rates. Surgical treatment of an infected aortic graft focuses on treatment of the infection and maintaining or restoring perfusion of the lower limbs. Traditionally, this is done by removing the graft, extensive debridement, and constructing an extra-anatomic bypass, usually an axillobifemoral bypass (AXBF). The disappointing early results of these extra-anatomic bypass reconstructions prompted various surgeons to develop new surgical treatment options to secure lower limb perfusion. With the upcoming role of in situ reconstructions, AXBF is being scrutinized. Patients with an infected aortic graft are often critically ill, and the interplay of patient fitness and seriousness of the disease must lead to a tailor-made treatment strategy. Most in situ reconstructions have surpassed AXBF in almost every aspect. After having held the position of gold standard for years, AXBF is now part of a wide array of treatment options with limited indications.