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Published on: May 30, 2016
Femoral Vein Reconstruction for Aortic Infections
Zachary S Pallister1, Jayer Chung1
1Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
Abstract:
While rare, abdominal aortic infections remain one of the most technically and emotionally challenging cases that a vascular surgeon may face. Secondary infections of either endovascular, or open aortic reconstructions range from 0.2% to 8%. Primary aortic infections are much more rare. Diagnosis can be elusive, depending upon the virulence of the causative microbes, and extent of the infection. Patients are often brittle, with immunocompromise and malnutrition prevalent in this patient population. The gold standard diagnostic test remains a computed tomographic angiogram. The mainstay of management requires vascular control, and wide debridement of all infected materials and revascularization. Multiple methods exist to reconstruct the vascular supply. The neo-aortoiliac system (NAIS) is attractive as it utilizes the patient's own femoral veins to reconstruct the vascular supply after the infection has been extirpated. The procedure is demanding upon the patient and surgeons alike. Also, the rarity of aortic infections limit experiences the literature to centers of excellence. However, the NAIS resists infection well, leaving the patient without any remaining foreign bodies. No further costs for conduit are incurred. Moreover, multiple experiences show excellent durability. While comparative effectiveness literature remains sparse, we believe the NAIS to be the optimal method of revascularization for select patients. In this article, we will review the use of NAIS for primary and secondary aortic infections. In particular, we will emphasize procedural details to help enable the reader to apply this procedure most effectively to their own patients.
Insights
Abdominal aortic infections are rare but challenging. The neo-aortoiliac system (NAIS) offers durable, infection-resistant revascularization for select patients, avoiding foreign materials.
Area of Science:
- Vascular Surgery
- Infectious Diseases
- Surgical Reconstruction
Background:
- Abdominal aortic infections, though rare, present significant surgical challenges.
- Infection rates for aortic reconstructions range from 0.2% to 8%, with primary infections being exceedingly rare.
- Diagnosis is often delayed due to microbial virulence and patient comorbidities like malnutrition and immunocompromise.
Purpose of the Study:
- To review the application of the neo-aortoiliac system (NAIS) for managing primary and secondary abdominal aortic infections.
- To highlight procedural nuances of the NAIS to facilitate its broader adoption by surgeons.
- To present the NAIS as a potentially optimal revascularization strategy for select patients with aortic infections.
Main Methods:
- Review of literature and clinical experience with the neo-aortoiliac system (NAIS).
- Emphasis on surgical techniques for vascular control, debridement, and reconstruction using autologous femoral veins.
- Computed tomographic angiography (CTA) as the gold standard for diagnosis.
Main Results:
- The neo-aortoiliac system (NAIS) utilizes the patient's own veins, eliminating foreign material and associated infection risks.
- NAIS demonstrates excellent durability and resistance to infection in reported cases.
- The procedure is demanding but offers a cost-effective and robust solution for aortic infection management.
Conclusions:
- The neo-aortoiliac system (NAIS) is a highly effective and infection-resistant method for revascularization in patients with abdominal aortic infections.
- Despite limited comparative data, NAIS is considered optimal for select patients due to its durability and avoidance of prosthetic material.
- Further emphasis on procedural details can enhance the application of NAIS in treating these complex infections.
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