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Thoracofemoral bypass: a feasible alternative for the management of aortic graft infection
Edward Andraos, Maham Rahimi
Houston Methodist, Houston, TX

OBJECTIVES:
Graft infection has an extremely low incidence of less than 0.5% and comparable between open and endovascular abdominal aortic repair. i,ii Vascular practice guidelines for infected endografts endorses either a two staged approach if the patient is stable (excision of infected prostheses with extra-anatomic byass) or in situ reconstruction in the presence of minimal contamination. However, despite advances in infected aortic graft management, 5-year mortality remains between 30-60% with reinfection rates as high as 25%.iii, iv
METHODS: In our video, we demonstrate our clinical experience with thoracofemoral bypass. The indications for this procedure in our selected patients are infected abdominal aortic stent grafts, failed aortobifemoral bypass. One of our two selected patients only had viable profunda femoris arteries for distal bypass.
RESULTS: The focus of this video aims to display our techniques of tunneling the grafts, the variability in graft choice, and feasibility of this procedure in patients with only profunda outflow vessel. Our patients had an uncomplicated postoperative course and remain infection free with patent grafts at one year surveillance.
CONCLUSIONS: The management of patients with aortic graft re-infections is troublesome and options are limited. Thoracofemoral bypass is a feasible alternative to add to a vascular surgeon's armamentarium.
I. Heinrich BJ, Fairman RM. How to manage infected aortic endografts. J Cardiovasc Surg (Torino) 213;54: 595-604.
II. Vogel TD, Symons R, Flum DR. The incidence and factors associated with graft infection after aortic aneurysm repair.J Vasc Surg 2008 47:264-9. III. Oderich GS, Bower TC, Hofer J, Kalra J, Duncan AA, Wilson JW et al. In situ Rifampin soaked graft with omental coverage and antibiotic suppression are durable with low reinfection with aortic graft enteric erosion or fistula. J Vasc Surg 2011 53; 99-106.
IV. Charlton-Ouw KM, Azizzadeh A, Safi HJ et al. Reinfection after resection and revascularization of infected infrarenal abdominal aortic grafts. J Vasc Surg, Volume 59, Issue 3, 684-692.


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