Durability of cross-femoral grafts after aortic graft infection: the fate of autogenous conduits.

Purpose: Revascularization for the treatment of aortic graft infection is usually accomplished by remote prosthetic axillofemoral bypass combined with cross-femoral bypass. When infection at the femoral level precludes placement of a prosthetic cross-femoral graft, we have used a variety of autogenous tissue conduits to restore circulation to the contralateral leg. To determine which of these conduits offers the most durable reconstruction, we have reviewed 78 patients treated for aortic graft infection.

Methods: Between 1980 and 1991 we used either autogenous saphenous vein (ASV, n = 34), endarterectomized superficial femoral artery (SFA, n = 14), or direct ilioiliac anastomosis (iliac, n = 10) to provide cross-femoral flow. We compared the performance of these tissue conduits with a concurrent patient group with aortic graft infection in whom a prosthetic cross-femoral graft was used (prosthetic, n = 20).

Results: Follow-up was available for 98.7% of patients, average 3.8 +/- 2.9 years, and was not different between the four groups. Bleeding complications occurred exclusively in the ASV group (n = 3, 8.8%) and were all in the perioperative period. In addition one ASV and one iliac conduit developed multiple false aneurysms. Hemodynamic conduit failure (thrombosis or stenosis) occurred in nine (26.5%) ASV conduits, six (42.8%) SFA conduits, and one iliac conduit, but not in the prosthetic group. When all of these adverse events were combined for each conduit group, both ASV and SFA conduits had a higher rate of conduit failure when compared with the prosthetic conduits (p < 0.05, log-rank test). Limb loss resulting from cross-femoral conduit failure occurred in six (17.6%) patients in the ASV group, four (28.6%) patients in the SFA group, and one patient each in the iliac and prosthetic groups. These differences were not significant.

Conclusions: We conclude that ASV and SFA conduits do not provide stable long-term cross-femoral revascularization and should be regarded as bridge grains until femoral infection is eradicated. When femoral infection mandates their use, frequent postoperative conduit surveillance is required. If ASV or SFA caliber is marginal, consideration should be given to the use of a larger autogenous conduit, such as superficial femoral vein.