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Management of Non-infected Prosthetic Aorto-iliac Bypass Failures Using Femoral Vein
Sara C. McKeever, DO, Ahsan T. Ali, MD, Mohammed M. Moursi, MD, Guillermo A. Escobar, MD, Matthew R. Smeds, MD.
University of Arkansas for Medical Sciences, Little Rock, AR, USA.
Objectives: Femoral and popliteal vein as a conduit to treat infected aortic pathologies has been described extensively. We examined the outcomes after using deep vein as a conduit for the salvage of failed prosthetic bypasses in non-infectious cases.
Methods: Patients undergoing procedures using femoral vein as conduit at the University of Arkansas for Medical Sciences between January 2005 and July 2013 were reviewed (n = 113). Patients were excluded if the reconstruction was for infectious etiologies (n=70) or for non-aorto-iliac indications (n=34).
Results: Nine patients had failed aortobifemoral (8) or iliofemoral bypass (1). Indications included rest pain (8) and short distance claudication (1). Reconstruction was with aortobifemoral bypass in 4 patients, aortofemoral bypass in 2 patients, aortoiliac bypass in 1 patient, and ilioprofunda bypass in 2 patients. Mean follow up was 24 months. There were no major postoperative complications. 2/9 patients developed symptoms secondary to deep vein harvest (swelling/dermatitis). Average ankle brachial Index (ABI) improved from 0.32 to 0.71 (p = 0.002). Limb salvage was 100%. Only one limb of an aortobifemoral bypass occluded at 31 months, but did not undergo re-intervention. 4/9 patients underwent subsequent open or endovascular interventions. Conclusions: Despite frequent secondary interventions (44%) and venous hypertension syndromes (22%), deep vein offers good patency and excellent limb salvage after failed prosthetic aorto-iliac bypasses.
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