Management of noninfected prosthetic aortic bypass failures using femoral vein.

OBJECTIVE

The use of femoral-popliteal vein as a conduit to treat infected aortoiliac pathologies has been described extensively and is referred to as the neoaortoiliac system procedure. We examined our center's outcomes after using deep vein as a conduit for the salvage of failed aortofemoral prosthetic bypasses in patients without infection.

METHODS

Procedures using femoral vein as conduit at the University of Arkansas for Medical Sciences between January 2005 and July 2013 were retrospectively reviewed (n = 110). Patients were excluded if the reconstruction was for infectious etiologies (n = 71) or for nonaortofemoral reconstructions (n = 31). Operative variables, complications, and patency rates were collected.

RESULTS

Femoral vein was used to revascularize failed aortobifemoral bypasses in eight patients. Indications included rest pain (n = 7) and short-distance claudication (n = 1). Reconstructions identified two patients each with aortobifemoral bypass or aortofemoral bypass, and one patient each with aortofemoral bypass with femorofemoral bypass, aorotoiliac bypass, iliofemoral bypass with femorofemoral bypass, or ilioprofunda bypass. Mean follow up was 27.5 months. There were no major postoperative complications. Symptoms secondary to deep vein harvest (swelling/dermatitis) developed in three of eight patients. The average ankle-brachial index improved from 0.33 to 0.73 (P = .003), with a limb salvage rate of 100%. Kaplan-Meier analysis found primary patency was 70% at 1 year and 53% at 5 years, which improved to 100% and 75%, respectively, with secondary measures.

CONCLUSIONS

Despite a need for secondary interventions and venous hypertension syndromes, deep vein offers good patency and excellent limb salvage after failed prosthetic aortoiliac bypasses.