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We analized the early and late postoperative complications that occurred after 693 bypass operations (574 anatomic and 119 extra-anatomic) performed in 10 consecutive years (1997-2006). The bypass graft failures (infection + thrombosis) treatment and the subsequent evolution of the patients were detected by analyzing patients’ readmissions made to solve these major post-bypass complications. The follow-up period extended up to 12 years after the primary arterial bypass reconstruction. In this period we registered: 89 secondary arterial reconstructions for early and late graft thrombosis; 8 healings after removal of the infected prostheses, followed by extraanatomic bypass operations (7 obturator bypass + 1 axillo-bifemoral bypass). The most frequent vascular prosthesis infection sites were the Scarpa triangle and the thoraco-abdominal subcutaneous segment of the axillo(bi)-femoral graft. Major amputations after extraanatomic bypass operations: at 4 years postoperatively for axillo(bi)-femoral operations the amputation rate was 17.6%, while for crossover operations it was 7.5%. Perioperatory mortality after anatomic bypass operations = 2 intraoperatory and 8 postoperatory (1.38%/574 operations); perioperatory mortality after extraanatomic bypass operations: 2 postoperatory deaths (1.68%/119 operations), 1 after axillo-femoral prosthesis infection and 1 after acute myocardial infarction. In order to reduce the graft major complication rate after extraanatomic bypass operations we took the following measures: 1. When there are arterial occlusive lesions distal to the femoral tripod we ensured an adequate outflow which favores the long-term patency of the extraanatomic graft; this goal was obtained by 2 methods: by enlargement profundoplasty and/or by performing an additional distal bypass towards the popliteal artery or towards the subgenicular arteries. The distal subgenicular anastomosis was made between a venous graft and the distal outflow artery for reducing the intimal hyperplasia. 2. For crossover bypass operations we often used autologous vein grafts; 3. In crossover ilio-femoral bypass operation with venous graft we avoid the graft compression in its path through abdominal wall by passing the graft through a stable caliber hole made in a polypropylene closure mesh of the abdominal wall. 4. We promote the tunneling of the axillo-femoral prosthesis through the subaponeurotic muscular tissue because this tissue better protects the prosthetic graft against infection. 5. In order to reduce the groin prosthesis infections, we prefer performing ilio-femoral crossover bypass instead of femoro-femoral one. 6. The obturator bypass remains a valuable tratment for groin infected prosthesis.
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2. Biancari F, Lepantalo M: Extra-anatomic bypass surgery for critical leg ischemia. A review. J Cardiovasc Surg. 1998; 39: 295-301
3. Daumerie G, Fleisher LA: Perioperative [beta]-blocker and statin therapy. Curr Opin Anaesthesiol, 2008;21(1):60-5. doi: 10.1097/ACO.0b013e3282f35ea5
4. Rutherford RB: Extra-anatomic Bypass, in Rutherford R. B. (ed.): Vascular Surgery, 2000: 990-992
5. Yasa KP, Christopher Ryalino C: Extra-Anatomic Axillofemoral Bypass After Failed Stenting for Aortoiliac-Occlusive Disease in a Patient with Severe Comorbidities. Am J Case Rep. 2020; 21: e925009-1–e925009-5. Published online 2020 Aug 17. doi: 10.12659/AJCR.925009
6. Hertzer NR, Bena JF , Karafa MT: A personal experience with direct reconstruction and extra-anatomic bypass for aortoiliofemoral occlusive disease. J Vasc Surg. 2007; 45 (3):533-535
7. Dosluoglu HH, Kittredge J, Cherr GS: Use of Cryopreserved Femoral Vein for In Situ Replacement of Infected Femorofemoral Prosthetic Artery Bypass. Vasc Endovasc Surg. 2008 Feb-Mar;42(1):74-8. doi: 10.1177/1538574407308204
8. Zetrenne S, Wirth GA, McIntosh BC, Evans G R D, Narayan D: Managing Extracavitary Prosthetic Vascular Graft Infections. Ann Plast Surg. 2006;57(6): 57(6):677-82. doi: 10.1097/01.sap.0000226928.10734.ae
9. Molacek J, Treska V, Houdek K, Opatrný V, Certik B, Baxa J: Use of a Silver-Impregnated Vascular Graft: Single-Center Experience. Antibiotics (Basel). 2022; 11(3), 386; https://doi.org/10.3390/antibiotics11030386
10. Berard X, Déglise S, Alonso F, Saucy F, Meda P, Bordenave L, Corpataux JM, Haefliger JA: Role of hemodynamic forces in the ex vivo arterialization of human saphenous veins. J Vasc Surg. 2013 May; 57(5):1371-82. doi: 10.1016/j.jvs.2012.09.041
11. Owens CD, Ho KJ, Conte MS: Lower extremity vein graft failure: a translational approach. Vasc Med. 2008 Feb;13(1):63-74. doi: 10.1177/1358863X07083432
12. Fatourou EM, Paraskeva KI, Seifalian AM, Hamilton G, Mikhailidis DP: The role of established and emerging risk factors in peripheral vascular graft occlusion. Expert Opin Pharmacother. 2007 May; 8(7):901-11. doi: 10.1517/14656518.104.22.1681
13. Sharrock M, Antoniou SA, Antoniou GA: Vein Versus Prosthetic Graft for Femoropopliteal Bypass Above the Knee: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Angiology. 2019; 70(7):649-661. doi: 10.1177/0003319719826460. Epub 2019 Jan 31
14. Farber A, Menard MT, Conte MS, Kaufman JA, Powell RJ, Choudhry NK, HamzaTH, Assmann SF, Creager MA, Cziraky MJ, Dake MD, Jaff MR, Reid D, Siami FS, Sopko G, White CJ, Max van Over, Strong MB, Villarreal MF, McKean M, Azene E, Azarbal A, Barleben A, Chew DK, Clavijo LC, Douville Y, Findeiss L, Garg N, Gasper W, Giles KA, Goodney PP, Hawkins BM, Herman CR, Kalish AJ, Koopmann MC, Laskowski IA, Mena-Hurtado C, Motaganahalli R, Rowe VL, Schanzer A, Schneider PA, Siracuse JJ, Venermo M, Rosenfield K: Surgery or Endovascular Therapy for Chronic Limb-Threatening Ischemia. N Engl J Med. 2022 Dec 22;387(25):2305-2316. doi: 10.1056/NEJMoa2207899. Epub 2022 Nov 7
15. Muresan M, Jimborean O, Jimborean G, Neagoe R, Bancu S, Muresan S, Borz C: Crossover iliofemoral bypass graft through tension-free abdominall wall-repair mesh. Ann Ital Chir. Digital edition 2017; 6pii: S0003469X17026434
16. Wilson WR, Bower TC , Creager MA, Sepideh Amin-Hanjani, O’Gara PT, Lockhart PB, Darouiche RO, Basel Ramlawi, Derdeyn CP, Bolger AF, Levison ME, Kathryn A. Taubert KA, Baltimore KA, Baddour LM: Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: A Scientific Statement From the American Heart Association. Circulation. 2016; 2016 Nov 15;134(20):e412-e460. doi: 10.1161/CIR.0000000000000457. Epub 2016 Oct 13.
17. Levin SR, Arinze N, Siracuse JJ: Lower extremity critical limb ischemia: A review of clinical features and management. Trends Cardiovasc Med. 2020 Apr; 30(3):125-130. doi: 10.1016/j.tcm.2019.04.002. Epub 2019 Apr 15.
18. Holdsworth PJ, Riddell PS, Leveson SH: Distal femoropopliteal bypass using a composite graft of PTFE and non-reversed saphenous vein. Ann R Coll Surg Engl. 1989 Jan; 71(1): 4–6
19. Desai TR, Meyerson SL, Skelly CL, MacKenzie KS, Bassiouny HS, Katz D, McKinsey JF, Gewertz BL, Schwartz LB: Patency and limb salvage after infrainguinal bypass with severely compromised ("blind") outflow. Arch Surg. 2001 Jun;136(6):635-42. Doi: 10.1001/archsurg.136.6.6357.
20. LoGerfo FW, Quist WC, Nowak MD, Crawshaw HM, Haudenschild CC: Downstream anastomotic hyperplasia. A mechanism of failure in Dacron arterial grafts. Ann Surg. 1983 Apr; 197(4): 479–483. doi: 10.1097/00000658-198304000-00018Y
21. Handa R, Sharma S: Vascular graft failure of leg arterial bypasses - a review. J Hypertens Cardiol 2014; 1(3):17-21. https://doi.org/10.14302/issn.2329-9487.jhc-14-404
22. Al-Omran M, Tu JV, Johnston W, Mamdani MM et al: Outcome of revascularization procedures for peripheral arterial occlusive disease in Ontario between 1991 and 1998: A population-based study. J Vasc Surg 2003, 38, 279-288
23. Rinckenbach S, Guelle N, Lillaz J, Al Sayed M, Ritucci V, Camelo G: Femorofemoral bypass as an alternative to a direct aortic approach in daily practice: appraisal of its current indications and midterm results. Ann Vasc Surg. 2012 Apr;26(3):359-64. doi: 10.1016/j.avsg.2011.04.011. Epub 2011 Nov 1.
24. Johnson WC, Corson J, Vollman RW, Weisel RW , Davis RC , O'Hara ET, Nabseth DC, Mannick JA: A comparison of the late patency rates of axillobilateral femoral and axillounilateral femoral grafts. Surgery, 1977, 81 (1):33-8, 38-40
25. Martin D, Katz SG: Axillofemoral bypass for aortoiliac occlusive disease. Am J Surg, 2000, 180(2):100-103
26. Hertzer NR , Bena JF , Karafa MT: A personal experience with direct reconstruction and extra-anatomic bypass for aortoiliofemoral occlusive disease, J Vasc Surg. 2007; 45(3):527-535; discussion 535. doi: 10.1016/j.jvs.2006.09.065
27. De Carlo M, Schlager O, Mazzolai L, Brodmann M, Espinola-Klein C, Staub D, Aboyans V, Sillesen H, Debus S, Venermo M, Belch J, Ferrari M, De Caterina R: Antithrombotic therapy following revascularization for chronic limb-threatening ischaemia: a European survey from the ESC Working Group on Aorta and Peripheral Vascular Diseases. Eur Heart J Cardiovasc Pharmacother. 2023 Apr 10;9(3):201-207. doi: 10.1093/ehjcvp/pvac055
28. Kurzer M, Belsham PA, Kark AE: The Lichtenstein repair for groin hernias. Surg Clin North Am. 2003 Oct; 83(5):1099-117. doi: 10.1016/S0039-6109(03)00134-8
29. Nguyen LL, Conte MS, Menard MT, Gravereaux EC, Chew DK, Donaldson MC, Whittemore AD, Michael Belkin M: Infrainguinal vein bypass graft revision: factors affecting long-term outcome. J Vasc Surg. 2004 Nov;40(5):916-23. doi: 10.1016/j.jvs.2004.08.038
30. Pereira C, Gururaj S: Onlay Versus Sublay Mesh Repair for Incisional Hernias: A Systematic Review. Cureus. 2023. doi: 10.7759/cureus.34156
31. Kurzer M, Kark A, Selouk S, Belsham P: Open Mesh Repair of Incisional Hernia Using a Sublay Technique: Long-Term Follow-up. World J Surg. 2008; 32(1):31-36; discussion 37. doi: 10.1007/s00268-007-9118-z
32. Exton RJ, Galland RB: Major groin complications following the use of synthetic grafts. Eur J Vasc Endovasc Surg. 2007 Aug; 34(2):188-90. doi: 10.1016/j.ejvs.2007.03.012. Epub 2007 May 18
33. Williams IM, Milling MAP, Shandall AA: Vascularised muscular flaps and arterial graft infection in the groin. Eur J Vasc Endovasc Surg. 2003 May;25(5):390-5. doi: 10.1053/ejvs.2002.1890
34. Patel A, Taylor SM, Langan EM 3rd, Snyder BA, Cull DL, Sullivan TM, Youkey JR, Gray BH, Carsten CG 3rd: Obturator bypass: a classic approach for the treatment of contemporary groin infection. Am Surg. 2002 Aug;68(8): 653-9
35. Dubouis A, Gatinot A, Foret T, Rinckenbach S, Salomon Du Mont L: Obturator Bypass Remains a Useful Option. Ann Vasc Surg. 2023 Jul; 93:1-8. doi: 10.1016/j.avsg.2022.05.048. Epub 2022 Aug 1