Page 19 - Vasoclick emagazine Issue2

Vasoclick, Edition 2
Discussion
Graft infection following aortic reconstruction
can cause mortality (10-25%) and limb loss
(10-25%). A similar incidence is also reported
with mycotic aneurysms. The traditional
methods of graft excision with extra-anatomic or
in situ bypass carry a graft-failure rate of almost
35% and re-infection rates between 10-23%.
4
Greater saphenous vein shows poor patency and
up to 60% failure rates when used for in-situ
reconstruction. 5
FPV has several advantages for autogenous
reconstruction post arterial and prosthetic graft
infections with primary patency of 83-91%,
secondary patency of up to 100% at 5 years
(range: 7.4 months to 10 years), and limb salvage
rates of more than 85%. The five-year survival for
the FPV by-pass was also better than the
prosthetic replacement (60-70% vs 47-56%).
4
More than one study has shown no
late-treatment-related mortality due to the
complete absence of graft re-infection. Any
4,5
unresolved infection was successfully shown to
be treated with further FPV grafts and rates of
re-infection if reported were low. 4
FPV is also an ideal conduit for major venous
reconstructions due to its durability, availability,
size, and length. But there is inconsistency
6
regarding the incidence of post-FPV-harvest
morbidities like pain and swelling. This variation
is attributed to a lack of standards for length of
vein harvested, preoperative venous evaluations,
and postoperative care. The venous morbidity
7
associated with FPV harvest has now been
shown to be more likely caused by the harvest of
18
popliteal vein and associated with :
7
1. Significant reflux disease in the veins
remaining after FPV harvest
2. Absence of collateral veins from the
popliteal vein to profunda femoris vein or
common femoral vein
Based on these findings, an anatomic “safe”
length of FPV to be harvested was determined
which included one valve in the distal profunda
femoris stump (to prevent reflux) and one
significant collateral vein (more than 2 mm in
diameter) in the popliteal vein stump superior to
the valve. In the given study, this length of FPV
harvested varied from an average of 40 cm in
women to 50 cm in men when 15 cm of the
popliteal vein in men and 13 cm in women was
harvested distal to the inferior edge of the
adductor hiatus. 7
Conclusion:
FPV is a useful, almost universally available, and
durable option for a potential conduit. 1
FPV has been shown to be an excellent conduit
for arterial reconstruction in the presence of
prosthetic graft infection and provides better
long-term survival. 4
Although the morbidity related to vein harvest
and system complications are high with FPV
conduits, it can be explored further for use in
vascular reconstruction. 1
Studies suggest that the length of vein
harvested, remaining deep veins after FPV
harvest, and the collateral vessels between the
popliteal vein and profunda femoris vein can
prevent post-harvest morbidity. 7
References:
1) Aru RG, Horsley NB, Endean ED. Contemporary use of
the femoropopliteal vein in vascular reconstructions. Ann
Vasc Surg. 2022;79:145-152.
doi:10.1016/j.avsg.2021.07.019
2) Hirsch JA, Leslie-Mazwi TM, Nicola GN, et al. Current
procedural terminology; a primer. J Neurointerv Surg.
2015;7(4):309-312. doi:10.1136/neurintsurg-2014-011156
3) CPT Advisor. Adjunctive use of the superficial femoral
vein for vascular reconstructions. Sean P. Roddy.
https://www.jvascsurg.org/arti-
cle/S0741-5214(12)00483-1/pd-
f#:~:text=The%20add%2Don%20CPT%20code,edition%20
of%20the%20CPT%20manual. Accessed June 2022
4) Ehsan O, Gibbons CP. A 10-year experience of using
femoro-popliteal vein for re-vascularisation in graft and
arterial infections. Eur J Vasc Endovasc Surg.
2009;38(2):172-179. doi:10.1016/j.ejvs.2009.03.009
5) Daenens K, Fourneau I, Nevelsteen A. Ten-year experi-
ence in autogenous reconstruction with the femoral vein
in the treatment of aortofemoral prosthetic infection. Eur
J Vasc Endovasc Surg. 2003;25(3):240-245.
doi:10.1053/ejvs.2002.1835
6) Hagino RT, Bengtson TD, Fosdick DA, Valentine RJ,
Clagett GP. Venous reconstructions using the superficial
femoral-popliteal vein. J Vasc Surg. 1997;26(5):829-837.
doi:10.1016/s0741-5214(97)70097-1
7) Santilli SM, Lee ES, Wernsing SE, Diedrich DA, Kuskows-
ki MA, Shew RL. Superficial femoral popliteal vein: An
anatomic study. J Vasc Surg. 2000;31(3):450-455.