Extra anatomical cryopreserved homograft solution for recurrent femoropopliteal bypass infection

• Published in: Annals of vascular surgery. Brief reports and innovations 2024-06, Vol.4 (2), p.100292, Article 100292
• Main Authors: Settembrini, Alberto M, Foresti, Leonardo, Cannizzo, Giuseppe, Romagnoli, Silvia, Bissacco, Daniele, Trimarchi, Santi
• Format: Article
• Language: English
• Subjects: Extra-anatomic bypass; Homograft; Peripheral bypass; Vascular graft excision; Vascular graft infection
• ISSN: 2772-6878; 2772-6878
• DOI: 10.1016/j.avsurg.2024.100292

•Extra-anatomical homograft bypass can be an option in peripheral graft infections.•Extra-anatomical routing can be considered in hostile and infected surgical fields.•Homograft must be considered an alternative to autologous vein in graft infections.•Targeted antibiotic therapy is mandatory in peripheral graft infections management.•A close follow-up must be performed in these patients. Introduction Vascular graft infections (VGIs) are challenging and potentially life-threatening complications following femoropopliteal bypasses. The treatments of choice in peripheral VGIs are antimicrobial therapy, surgical excision, and in-situ reconstruction with an autologous superficial vein. An extraanatomical homograft bypass and antimicrobial therapy could be resolutive in patients presenting with recurrent VGIs and unavailable autologous veins. Case Report We present the case of a 74-year-old Caucasian man with a history of a below-the-knee (BTK) right femoropopliteal bypass using polytetrafluoroethylene (PTFE) for chronic peripheral artery disease (Rutherford Grade 3). He presented at the emergency department with septic arthritis of the right knee involving the previous PTFE femoropopliteal bypass. The graft was excised, and an insitu saphenous vein BTK femoropopliteal bypass was performed. Due to multiple recurrences of graft infection of the proximal anastomosis, an extra-anatomical cryopreserved arterial homograft reconstruction from the external iliac artery to the profunda femoral artery was necessary as a definitive treatment. At three years follow-up the patient is alive, with patency of both vascular reconstructions. Conclusion Despite aggressive treatment, managing vascular graft infections can be challenging, typically requiring a blend of surgical and medical interventions. Patient-specific surgical approaches, such as graft removal, infected tissue debridement andextra-anatomical reconstruction with biological grafts is crucial. In those patients with unavailable autologous veins, consideration could be given to a cryopreserved homograft due to its resistance against infections.