Angiologiia i sosudistaia khirurgiia = Angiology and vascular surgery · 2024
Surgical policy and peculiarities of management of patients with infection of an aortofemoral bifurcation synthetic prosthesis.
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Khamitov F F, Matochkin E A, Gadzhimuradov R U, Shimanko A I, Bobylev A A, Kuzubova E A, Gergedava G K
Аннотация
OBJECTIVE: This study was aimed at improving the results of surgical treatment of patients with infected synthetic prostheses in the aortoiliac zone by replacing them with an autovenous graft using in situ technique.
PATIENTS AND METHODS: Analyzed herein are therapeutic outcomes in a total of 78 patients who underwent redo surgery for infection of aortofemoral bifurcation allografts over the period from 2001 to 2023. These patients were initially operated on for atherosclerotic occlusion of the terminal aorta and its branches (Leriche syndrome) or aneurysms of the infrarenal aorta. Prosthetic infection was observed both in the immediate and long-term postoperative periods. After confirmation of the diagnosis and preoperative preparation, all patients were re-operated in the scope of aortofemoral bifurcation autovenous prosthetic repair according to in situ technique. Femoral and internal jugular veins were used as autografts.
RESULTS: In the immediate postoperative period, the following complications were encountered: acute renal failure (ARF), multiple organ system failure (MOSF), and arrosive bleeding. Thrombosis of one of the branches of the autovenous prosthesis developed in two (2.5%) patients, one (1.3%) of whom was subjected to high-level hip amputation. Arrosive bleeding was observed in five (6.4%) cases. Perioperative mortality amounted to 15.3% (12 patients). The remote results were evaluated in 62 patients during a 1-to-12-year follow-up period. Only one patient developed false aneurysms of distal anastomoses, which were operated on successfully. There was no long-term mortality.
CONCLUSION: Thus, the method of removing an infected synthetic bifurcation graft in the aortoiliac position with simultaneous autovenous redo prosthetic repair using femoral and internal jugular veins can be considered as a method of choice of surgical treatment in patients with suppuration of bifurcation prostheses. Editor's comment. The Editorial Council draws the reader' attention to the fact that this work is a continuation of a multi-year study of surgical treatment of patients with suppuration of a synthetic bifurcation prosthesis in the aortoiliac position, analyzing the results of operations performed using the same technique.
PATIENTS AND METHODS: Analyzed herein are therapeutic outcomes in a total of 78 patients who underwent redo surgery for infection of aortofemoral bifurcation allografts over the period from 2001 to 2023. These patients were initially operated on for atherosclerotic occlusion of the terminal aorta and its branches (Leriche syndrome) or aneurysms of the infrarenal aorta. Prosthetic infection was observed both in the immediate and long-term postoperative periods. After confirmation of the diagnosis and preoperative preparation, all patients were re-operated in the scope of aortofemoral bifurcation autovenous prosthetic repair according to in situ technique. Femoral and internal jugular veins were used as autografts.
RESULTS: In the immediate postoperative period, the following complications were encountered: acute renal failure (ARF), multiple organ system failure (MOSF), and arrosive bleeding. Thrombosis of one of the branches of the autovenous prosthesis developed in two (2.5%) patients, one (1.3%) of whom was subjected to high-level hip amputation. Arrosive bleeding was observed in five (6.4%) cases. Perioperative mortality amounted to 15.3% (12 patients). The remote results were evaluated in 62 patients during a 1-to-12-year follow-up period. Only one patient developed false aneurysms of distal anastomoses, which were operated on successfully. There was no long-term mortality.
CONCLUSION: Thus, the method of removing an infected synthetic bifurcation graft in the aortoiliac position with simultaneous autovenous redo prosthetic repair using femoral and internal jugular veins can be considered as a method of choice of surgical treatment in patients with suppuration of bifurcation prostheses. Editor's comment. The Editorial Council draws the reader' attention to the fact that this work is a continuation of a multi-year study of surgical treatment of patients with suppuration of a synthetic bifurcation prosthesis in the aortoiliac position, analyzing the results of operations performed using the same technique.