Graft excision and extra-anatomic revascularization: the treatment of choice for the septic aortic prosthesis

Graft excision and extra-anatomic revascularization is the treatment of choice for the septic aortic prosthesis. From 1979 to 1988, 20 patients underwent resection of aortic grafts and extra-anatomic bypass for the treatment of graft infections (No. 11) and aorto-enteric fistulas (No.9). The mean time interval from primary aortic surgery to the reoperative procedure was 65 months (range 1-192 months). Three patients died (one less than 30 days) after the secondary procedure for a mortality rate of 15%. One patient developed infection of the extra-anatomic bypass graft which resulted in an above-knee amputation. This was the only major limb loss in this series. A second patient developed contralateral buttock necrosis when he had unilateral axillary-femoral bypass without femoral-femoral bypass because of a previous above-knee amputation on the affected side. Major complications occurred in 7 patients (35%). Mean duration of follow-up after the reoperative aortic procedure was 44 months (range 6-120 months). One patient suffered aortic stump blowout 7 months after repair of an aortic duodenal fistula. Aortic graft excision and extra-anatomic revascularization of the lower extremities can be performed with low mortality and risk of limb loss and should remain the treatment of choice for aorto-enteric fistulas and infected aortic prostheses. Bilateral groin revascularization is important even in patients who have had a previous lower extremity amputation to provide pelvic blood flow.