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Neo Aortoiliac System (NAIS) for Treating Aortic Graft Infections: Long-term Results in 187 Patients

G. Patrick Clagett¹, Ahsan T. Alⁱ², Sophia Serrano¹, Jenny Hocking¹, J. Gregory Modrall¹, Victor D' Addio¹, Eva Scoggins¹, R. James Valentine^.1
1University of Texas Southwestern at Dallas, Dallas, Texas;²University of Arkansas for Medical Sciences, Little Rock, Ark.

OBJECTIVES: Graft excision and in situ reconstruction with large caliber femoral popliteal vein (FPV) grafts have been reported as successful treatment of aortic graft infection (AGI) in several small series. The goal of this study was to evaluate long-term (72-month) outcomes in large cohort of patients treated for AGI.

METHODS: From 1990-2006, 187 patients (age: 63.5±10.7) with AGI were treated with in-situ reconstructions using 332 FPV grafts.
RESULTS: Surgery was performed for 143 infected aortofemoral bypasses, 21 infected aortic-iliac grafts and 23 infected ax-fem bypasses. Poly-microbial cultures were present in 37% while 15% showed no growth. There were 57% gram positive, 34% gram negative, 15% anaerobes and 18% fungal infections. While 30-day mortality was 10.4%, procedure- related mortality was 14.3%. Independent risk factors for death on multivariable analysis were: [Table 1]. The mean SVS run off resistance score was 4.4±2.3. Concomitant distal bypass was necessary in 16.8% of the cases. Major amputations were performed for 8% (14). Graft re-infections rate was 2.8% (5). Cumulative primary patency at 72 months was 74.3±5.7%; secondary/assisted primary patency was 88.4±4.6%. Five-year survival was 47.1±7.8%.

CONCLUSIONS: These results compare favorably with other methods of AGI treatment. Principle advantages include acceptable perioperative mortality, low amputation rate, superior durability with excellent long-term patency and freedom from secondary interventions and recurrent infections.

AUTHOR DISCLOSURES: G. Clagett, None; A.T. Ali, None; S. Serrano, None; J. Hocking, None; J. Modrall, None; V. D' Addio, None; E. Scoggins, None; R. Valentine, None.