Limb-threatening ischemia complicated by perigenicular infection

Area of Science:

• Vascular Surgery
• Infectious Disease Management
• Limb Salvage Procedures

Background:

• Standard revascularization is often contraindicated in cases of graft infection or perigenicular infection due to high risks.
• Limb-threatening ischemia complicated by infection typically leads to amputation.

Purpose of the Study:

• To evaluate the outcomes of extra-anatomic revascularization in patients with limb-threatening ischemia and perigenicular infection.
• To determine the safety and efficacy of this approach in limb salvage.

Main Methods:

• A retrospective review of 1020 infrainguinal reconstructions identified nine cases with limb-threatening ischemia and perigenicular infection.
• Extra-anatomic bypasses were created from femoral or iliac vessels to distal arteries using vein or PTFE grafts, tunneling away from infected tissue.
• Patient demographics, risk factors, causative organisms, and surgical techniques were analyzed.

Main Results:

• Nine patients (0.9%) with limb-threatening ischemia and perigenicular infection underwent extra-anatomic reconstruction.
• Common risk factors included diabetes mellitus and wound hematoma; Staphylococcus aureus was the predominant pathogen.
• Postoperative complications were minimal (MI, graft thrombosis, osteomyelitis), with no deaths.
• At a mean follow-up of 19 months, primary and secondary patency rates were 66% and 78%, respectively.
• Successful limb salvage was achieved in 66% of cases.

Conclusions:

• Extra-anatomic reconstruction is a safe and effective strategy for limb salvage in the presence of perigenicular infection.
• This technique successfully reestablishes axial flow, avoiding amputation when standard revascularization is not feasible.
• Maintaining arterial flow is achievable even in complex infected wounds.