Use of Omniflow® II in Infected Vascular Grafts with Femoral Anastomotic Dehiscence

Ann Vasc Surg. 2020 May:65:160-165. doi: 10.1016/j.avsg.2019.10.050. Epub 2019 Oct 24.

Abstract

Background: Vascular graft infection with anastomotic dehiscence requires immediate surgical intervention to preserve life and limb. We present our experience of using the Omniflow® II biosynthetic vascular prosthesis (LeMaitre Vascular) in the emergency repair of vascular graft dehiscence at the femoral anastomosis.

Methods: A retrospective review of consecutive patients presenting with femoral anastomotic dehiscence in a single centre was conducted. All patients were revascularized using an in situ Omniflow II graft. Patient demographics, affected graft type, microbiology, and antibiotic regimes were documented. Primary outcome measures were limb salvage, patency rates, and mortality.

Results: Five patients presented with acute femoral false aneurysm and four of five with significant hemorrhage. Infected grafts included one aortobifemoral, two femoral crossover, one axillobifemoral, and one infrainguinal reversed vein graft. All were revascularized with an in situ Omniflow II graft following the excision of the infected graft material. The median followup was 50 months. Limb salvage was achieved in 8 of 9 threatened limbs, and none required further intervention for re-infection. One graft occluded at 5 months. Two of five patients died during followup (one at 12 months, one at 50 months).

Conclusions: Omniflow II provides a useful "off-the-shelf" conduit for the urgent revascularization of infected femoral dehiscence.

MeSH terms

  • Aged
  • Anastomosis, Surgical
  • Aneurysm, False / diagnosis
  • Aneurysm, False / microbiology
  • Aneurysm, False / mortality
  • Aneurysm, False / surgery*
  • Aneurysm, Infected / diagnosis
  • Aneurysm, Infected / microbiology
  • Aneurysm, Infected / mortality
  • Aneurysm, Infected / surgery*
  • Blood Vessel Prosthesis / adverse effects*
  • Blood Vessel Prosthesis Implantation / adverse effects*
  • Blood Vessel Prosthesis Implantation / instrumentation*
  • Blood Vessel Prosthesis Implantation / mortality
  • Databases, Factual
  • Device Removal* / adverse effects
  • Device Removal* / mortality
  • Female
  • Femoral Artery / diagnostic imaging
  • Femoral Artery / surgery*
  • Humans
  • Male
  • Middle Aged
  • Prosthesis Design
  • Prosthesis-Related Infections / diagnosis
  • Prosthesis-Related Infections / microbiology
  • Prosthesis-Related Infections / mortality
  • Prosthesis-Related Infections / surgery*
  • Retrospective Studies
  • Risk Factors
  • Surgical Wound Dehiscence
  • Time Factors
  • Treatment Outcome
  • Vascular Patency