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Freshly harvested cadaveric venous homografts as arterial conduits in infected fields
Insights
Infected prosthetic grafts were completely removed and replaced with cadaveric venous homografts. This innovative approach successfully resolved infections and maintained graft patency in all patients.
Area of Science:
- Vascular Surgery
- Organ Transplantation
- Infectious Disease Management
Background:
- Prosthetic graft infection is a serious complication requiring graft removal.
- Multilevel prosthetic grafts are used for complex peripheral artery disease.
- Proximal inflow and groin anastomoses are common sites for graft infection.
Observation:
- Six patients with infected prosthetic grafts underwent complete graft excision.
- Cadaveric venous homografts (vena cava, iliac, femoral, saphenous veins) were used for reconstruction.
- Infection involved both proximal inflow and groin anastomoses.
Findings:
- Complete graft excision and reconstruction with venous homografts achieved infection resolution in all cases.
- Graft patency and distal perfusion were maintained during the treatment interval.
- Venous homografts served as a temporizing measure, allowing subsequent prosthetic reimplantation in two patients without reinfection.
Implications:
- Freshly harvested large-caliber venous homografts can be used as arterial substitutes in infected fields.
- This technique offers a viable solution for managing complex prosthetic graft infections.
- Venous homograft interposition provides a bridge to definitive prosthetic reconstruction, preventing reinfection.
Abstract:
Six patients with patent multilevel prosthetic grafts (three axillofemoral-femoral grafts, an aortobifemoral graft, an axillofemoral and femoral-anterior tibial graft, and an axillofemoral and femoral-popliteal graft) that demonstrated overt infection involving both the proximal inflow (one infrarenal aorta, five axillary arteries) and groin anastomoses required complete graft excision. Cadaveric inferior vena cava, common and external iliac, common and superficial femoral, and greater saphenous veins were harvested in conjunction with multiple organ donor procedures. Identical anatomic reconstruction within the infected fields was accomplished, with patency and distal perfusion maintained for intervals sufficient to achieve complete resolution of infection in all cases. This interval of revascularization with a venous homograft has served as a temporizing maneuver, which permitted eradication of infection and allowed subsequent reimplantation of prosthetic graft material without associated reinfection in the two instances in which it was required. Use of freshly harvested large-caliber caval, iliac, and femoral homograft veins as arterial substitutes in infected fields has not been previously reported. Case histories and a review of the venous homografting literature are included.