Cryopreserved Superficial Femoral Vein: The Optimal Conduit for the In Situ Treatment of Aortic Graft Infection?

Nayan Sivamurthy, MD, Jade S. Hiramoto, MD, Darren B. Schneider, MD, Charles  M. Eichler, MD and Linda M. Reilly, MD
Vascular Surgery, UCSF Medical Center, San Francisco, CA

Objective: To evaluate the efficacy of cryopreserved superficial femoral vein (cSFV) as a conduit for in situ aortic reconstruction in the treatment of aortic graft infection (AGI).
Methods: Single institution, retrospective review. Primary endpoints were cure of AGI, and limb salvage. Secondary endpoints were cSFV patency and cSFV related morbidity.
Patient Group: Between 1999 and 2005, 26 patients (15 men, mean age 66±2 years) with prior aortic reconstruction for occlusive (88%) or aneurysmal (12%) disease were treated for an infected aortobifemoral (N=20), thoracobifemoral (N=3), aortobi-iliac (N=2) or bifurcated aortic endograft (N=1). Mean implantation-to-infection interval was 3.7±1.0 years. Eleven patients (42%) had an aortoenteric fistula. cSFV was obtained from Cryolife, Inc. cSFV in situ aortic reconstruction was aortobifemoral (N=12), aortounifemoral + femorofemoral bypass (N=5), aortounifemoral (N=4), aortobi-iliac (N=4), or thoracounifemoral + femorofemoral bypass (N=1).
Results: Perioperative mortality was 11.5% (2 cardiac, 1 AGI-related sepsis). During median follow-up of 13±3 months, there were no additional AGI-related deaths, resulting in an overall AGI cure rate of 88.5%. One year cSFV patency and limb salvage rates were 100% and 95%. Major and minor cSFV related morbidity was 19% and 8% (Table). 6 patients (23%) underwent successful cSFV revision either early (N=3) or late (N=3). There were no recurrent infections involving the cSFV and no deaths related to cSFV conduit complications.
Conclusions: cSFV is a safe and effective conduit for in situ aortic reconstruction in the presence of AGI. Cure of AGI and limb salvage rates are excellent and the major conduit complication rate is reasonable and easily managed. cSFV eliminates the risk of recurrent conduit infection associated with in situ prosthetic reconstruction, as well as the complications associated with harvesting autologous SFV conduit and is more readily available than aortic allograft. cSFV is our conduit of choice for in situ aortic reconstruction for AGI.