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Use of superficial femoral artery to treat an infected great vessel prosthetic graft
Use of superficial femoral artery to treat an infected great vessel prosthetic graft Charles E. Fields, MD, and Thomas C. Bower, MD, Rochester, Minn We report a patient treated for infection of an ascending aorta to bilateral common carotid artery bypass graft. The superficial femoral arteries were used for the reconstruction after local treatment failed. The patient is free from infection and the grafts are patent 4 years after operation. We believe this is the only report in the literature in which the superficial femoral arteries were used to reconstruct an infected great vessel graft. (J Vasc Surg 2004;40:559-63.)
CASE REPORT A 34-year-old woman with a history of Takayasu arteritis was transferred to our hospital for management of an infected, bifurcated prosthetic graft from the ascending aorta to each distal cervical common carotid artery. (Fig 1). The initial operation was performed because of global cerebrovascular symptoms with evidence of bilateral cerebral infarcts on computed tomography (CT) scans. Two months later she had a right neck wound infection. Incision and drainage had been performed at the referring institution. On arrival her temperature was 36.5°C, heart rate was 115 bpm, and right and left arm blood pressures were 108/80 mm Hg. Neurologic findings were normal. The subclavian pulses were normal. The remainder of the vascular examination was unremarkable. The right graft limb was visible at the base of the neck wound. Takayasu arteritis had been diagnosed when the patient was 24 years of age, on the basis of constitutional symptoms, elevated erythrocyte sedimentation rate, and arteriographic findings. She was treated for 2 years with steroids. She remained asymptomatic until the cerebrovascular symptoms developed, which prompted the bypass operation. She had a 20 pack-year history of smoking. There was no family history of atherosclerosis or vasculitis. Medications at the time of transfer included several antibiotic agents and aspirin. Laboratory data showed a white blood cell count of 7 ⫻ 109/L (normal, 3.5-10.5 ⫻ 109/L), and erythrocyte sedimentation rate of 20 mm/hr (normal, 0-29 mm/hr). A CT scan showed no perigraft fluid or stranding along any segment of the graft. An arteriogram demonstrated patent aortocarotid and right subclavian artery grafts, with no evidence of pseudoaneurysm. The native subclavian arteries were not stenotic. A transthoracic echocardiogram showed a left ventricular ejection fraction of 40%. Initial management included irrigation and debridement of the neck wound. Cultures from the wound and blood showed no growth of bacteria. The exposed graft was replaced with a 7-mm polyester interposition graft from the base of the neck to the mid-neck. The carotid bifurcation was not exposed. The graft was From the Division of Vascular Surgery, Mayo Clinic. Competition of interest: none. Reprint requests: Thomas C. Bower, MD, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (e-mail: [email protected]). 0741-5214/$30.00 Copyright © 2004 by The Society for Vascular Surgery. doi:10.1016/j.jvs.2004.05.027
wrapped circumferentially with a right pectoralis major muscle flap. The patient was discharged home with oral ciprofloxacin therapy. The patient returned 2 months later with low-grade fever, elevated white blood cell count, and a nonpulsatile, erythematous, fluctuant mass over the manubrium. A CT scan of the neck and chest showed an abscess at the base of the neck, with perigraft stranding (Fig 2). There was no pseudoaneurysm. The abscess was drained, and the cavity was irrigated and debrided. Wound cultures grew methicillin-resistant coagulase-negative Staphylococcus aureus. The patient received wound care and intravenous antibiotics for 2 weeks. Ankle-brachial indices and segmental pressures were normal. The patient was taken to the operating room for removal of all prosthetic material. The right and left superficial femoral arteries (SFAs) were harvested in their entirety, and replaced with 6-mm ringed expanded polytetrafluoroethylene (PTFE) interposition grafts. The SFAs were approximately 5 to 6 mm in diameter, and the great saphenous veins were 4 mm or less in diameter. The leg incisions were closed at this time. Next the left subclavian artery was isolated through a supraclavicular incision. A segment of SFA was sewn end-to-side to the subclavian artery. The external and internal carotid arteries were dissected free through another incision. The SFA graft was passed behind the sternocleidomastoid muscle, and the supraclavicular incision was closed. The left limb of the aortocarotid graft at the base of the neck was poorly incorporated in the soft tissue. It was transected, oversewn, and pushed into the mediastinum. Soft tissue was closed over the tract. The SFA graft was sewn end-toend to the carotid bifurcation. The wounds were irrigated copiously and closed. The right-sided neck incision was reopened, preserving the pectoralis muscle flap. The right limb of the aortocarotid graft was poorly incorporated, and there was purulent material at the base of the neck. This area was thoroughly irrigated and debrided. Gowns, gloves, and instruments were changed. The right internal and external carotid arteries were dissected free. The sternum was reopened. The proximal graft in the mediastinum was well incorporated. The right carotid stump pressure measured 85 mm Hg. There were no electroencephalographic changes with test clamping of the right graft limb. We still elected to reconstruct the right carotid bifurcation, because it had a normal outward appearance, the patient was young, and we did not want the entire cerebral circulation reliant on only the left carotid and vertebral arteries. All of the previous graft material was removed. A
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Fig 1. A, Configuration of the patient’s graft at presentation. B, Interposition graft placed at first operation. C, Placement of pectoralis major muscle flap. Copyrighted by and used with permission of Mayo Foundation for Medical Education and Research. superficial femoral artery graft was placed from the ascending aorta to the right carotid artery. The origin of the old prosthetic graft was completely removed, and the aortic wall was debrided to healthy tissue. The upper portion of the aortotomy was closed primarily. Another short segment of SFA was used as a side arm off of this graft to the right subclavian artery. An intraoperative duplex scan showed all grafts patent with normal flow velocities. The pectoralis muscle flap was used to cover the graft in the right side of the neck. The skin and subcutaneous tissues were closed except for a small area at the base of the right side of the neck where the graft was not visible. This area was packed with antibiotic-soaked gauze. A 32F chest tube and a large round Jackson-Pratt drain were placed in the mediastinum. A right-angled and a straight 32F chest tube were placed in the right pleural space. The postoperative course was uncomplicated. The patient received vancomycin intravenously for 28 days, and was discharged home with oral minocycline. The patient had no symptoms at 4-year follow-up. A magnetic resonance angiogram 4 years after operation is shown in Fig 3. Serial duplex scans have exhibited less than 50% stenoses at the distal right carotid anastomosis and at the origin of the left PTFE graft anastomosis in the thigh.
DISCUSSION Direct great vessel reconstructions are safe and durable in selected patients. However, a prosthetic graft infection in this area has devastating consequences. Treatment options are limited. The first decision in this case was whether to treat the right-sided neck infection locally or to excise and replace all of the prosthetics. We initially chose to keep the treatment simple, inasmuch as only a short segment of graft was exposed and there were no signs of infection in the rest of the graft. There was no pseudoaneurysm, and blood and wound cultures were negative. Experience with localized prosthetic graft infections in the extremity and neck sup-
ported this decision.1-4 However, recurrent infection developed in the more proximal graft limb, which warranted a more extensive reconstruction. The second decision we faced was in situ versus remote reconstruction. The only “remote” options for treatment were reconstruction of both carotid arteries based solely on the left subclavian artery, or a left subclavian-carotid bypass graft followed by resection of the right limb without replacement, because the stump pressure and electroencephalographic tracing supported the risk for stroke as low. The use of a femoroaxillary artery bypass was not considered because of the patient’s young age. The third decision was the choice of conduit. Options included SFA, superficial femoral or saphenous vein, homograft, or native aortoiliac segment after it was replaced with prosthetic. The SFA was chosen because of lower risk for aneurysmal degeneration, it afforded a better size match with her carotid arteries, and it has been shown to resist infection better than vein when the carotid artery requires replacement in contaminated fields in head and neck cancer resections. The SFA was first used as an autologous vascular graft by Stoney and Wylie in 1970. These grafts were primarily endarterectomized segments of chronically occluded arteries.5 Non-endarterectomized SFA has been used for carotid replacement in head and neck cancer operations.6,7 Several authors believe this graft is more durable and infectionresistant than vein grafts in this location. Sessa et al7 described excellent durability in 30 patients operated on to treat head and neck cancers who required carotid replacement. In 9 of these patients a pharyngeal fistula developed, but there were no suture line blowouts. In addition, the risk for aneurysmal degeneration of autogenous arterial grafts is low compared with vein grafts.
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Fig 2. Representative sections from the preoperative computed tomography scan of the neck and chest. A, Large single arrow identifies abscess in right side of the neck. B, Double arrow identifies the right and left limbs of the graft, and perigraft fluid and stranding.
This is particularly important in young patients, such as ours, with an anticipated normal life expectancy. Aneurysms have occurred in aortocoronary, infrainguinal, and renal artery vein grafts.8-10 In renal artery vein grafts there is a 16% incidence of aneurysmal degeneration.10 Saphenous veins used for carotid subclavian position bypasses have also shown inferior patency owing to kinking.11 Reconstruction of the innominate artery with superficial femoral vein has been described with good results, and could have been used. However, most were cervical-based procedures, and not from the ascending aorta. These authors reported no experience with the use of these grafts in patients with Takayasu disease.12 This operation is also not without morbidity, with chronic lower extremity edema
developing in 30% and edema extensive enough to require long-term lower extremity compression in 17%.13 Iliac artery homografts could have been used, but this would have required laparotomy and increased the morbidity of the procedure.14 Cryopreserved arterial grafts could have also been used; however, there has been some concern regarding repeat infection and aneurysmal degeneration of these grafts.15 Finally, rifampin-bonded prosthetics have been used for local graft infection,16 but we believed this was not an option, because local treatment had already failed. We recognize that our patient is at some risk for infection of the PTFE superficial femoral interposition grafts. However, this is easier to treat than infection of a prosthetic
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Fig 3. Composite picture of magnetic resonance angiograms obtained at 4-year follow-up, and artistic rendition of the final reconstruction. Copyrighted by and used with permission of Mayo Foundation for Medical Education and Research.
aortoiliac graft, had these native arteries been harvested for the reconstruction. In addition, the patient exhibited no systemic signs of infection and was receiving suppressive antibiotic therapy, and we believed the risk for infection of the PTFE grafts was low. The long-term patency of aboveknee PTFE grafts was equivalent in several studies, and patency in this patient is probably even better, because the lower extremity runoff vessels are without significant atherosclerosis. Long-term graft surveillance and antibiotic therapy will be critical to detect graft problems or occult signs of reinfection and to suppress bacterial growth. However, the patient has done well. In conclusion, we believe that SFA for replacement of small-diameter infected prosthetic grafts is an option to be considered. REFERENCES 1. Cherry KJ Jr, Roland CF, Pairolero PC, Hallett JW Jr, Meland NB, Naessens JM, et al. Infected femorodistal bypass: is graft removal mandatory? J Vasc Surg 1992;15:295-303. 2. Calligaro KD, Veith FJ, Gupta SK, Ascer E, Dietzek AM, Franco CD, et al. A modified method for management of prosthetic graft infections involving an anastomosis to the common femoral artery. J Vasc Surg 1990;11:485-92.
3. Oderich GS, Panneton JM, Cherry KJ Jr, Hofer JM, Johnson CH, Olsen KD, et al. Carotid artery reconstruction combined with myocutaneous flap coverage: a complex and durable rescue operation. Ann Vasc Surg 2002;16:579-85. 4. Perler BA, Vander Kolk CA, Dufresne CR, Williams GM. Can infected prosthetic grafts be salvaged with rotational muscle flaps? Surgery 1991;110:30-4. 5. Stoney RJ, Wylie EJ. Arterial autografts. Surgery 1970;67:18-25. 6. Jacobs JR, Arden RL, Marks SC, Kline R, Berguer R. Carotid artery reconstruction using superficial femoral arterial grafts. Laryngoscope 1994;104(6 Pt 1):689-93. 7. Sessa CN, Morasch MD, Berguer R, Kline RA, Jacobs JR, Arden RL. Carotid resection and replacement with autogenous arterial graft during operation for neck malignancy. Ann Vasc Surg 1998;12:229-35. 8. Kalimi R, Palazzo RS, Graver LM. Giant aneurysm of saphenous vein graft to coronary artery compressing the right atrium. Ann Thorac Surg 1999;68:1433-7. 9. Cassina PC, Hailemariam S, Schmid RA, Hauser M. Infrainguinal aneurysm formation in arterialized autologous saphenous vein grafts. J Vasc Surg 1998;28:944-8. 10. Stanley JC, Ernst CB, Fry WJ. Fate of 100 aortorenal vein grafts: characteristics of late graft expansion, aneurysmal dilatation, and stenosis. Surgery 1973;74:931-44. 11. Ziomek S, Quinones-Baldrich WJ, Busuttil RW, Baker JD, Machleder HI, Moore WS. The superiority of synthetic grafts over autologous veins in carotid-subclavian bypass. J Vasc Surg 1986;3:140-5.
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12. Modrall JG, Joiner DR, Seidel SA, Jackson MR, Valentine RJ, Clagett GP. Superficial femoral-popliteal vein as a conduit for brachiocephalic arterial reconstructions. Ann Vasc Surg 2002;16:17-23. 13. Wells JK, Hagino RT, Bargmann KM, Jackson MR, Valentine RJ, Kakish HB, et al. Venous morbidity after superficial femoral-popliteal vein harvest. J Vasc Surg1999;29:282–9; discussion 289-91. 14. Ruotolo C, Plissonnier D, Bahnini A, Koskas F, Kieffer E. In situ arterial allografts: a new treatment for aortic prosthetic infection. Eur J Vasc Endovasc Surg 1997;14(suppl A):102-7.
15. Noel AA, Gloviczki P, Cherry KJ Jr, Safi H, Goldstone J, Morasch MD, et al. Abdominal aortic reconstruction in infected fields: early results of the United States cryopreserved aortic allograft registry. J Vasc Surg 2002;35:847-52. 16. Young RM, Cherry KJ Jr, Davis PM, Gloviczki P, Bower TC, Panneton JM, et al. The results of in situ prosthetic replacement for infected aortic grafts. Am J Surg 1999;178:136-40. Submitted Dec 13, 2003; accepted May 13, 2004.
CORRECTION In: “Effect of improved endograft design on outcome of endovascular aneurysm repair” (Torella F. J Vasc Surg 2004;40:216-21). In Table V, the values for procedure-related complications are incorrect. The correct figures are 159 (6%) for current devices and 123 (10%) for withdrawn devices (P ⬍.0001).
CASE REPORT A 34-year-old woman with a history of Takayasu arteritis was transferred to our hospital for management of an infected, bifurcated prosthetic graft from the ascending aorta to each distal cervical common carotid artery. (Fig 1). The initial operation was performed because of global cerebrovascular symptoms with evidence of bilateral cerebral infarcts on computed tomography (CT) scans. Two months later she had a right neck wound infection. Incision and drainage had been performed at the referring institution. On arrival her temperature was 36.5°C, heart rate was 115 bpm, and right and left arm blood pressures were 108/80 mm Hg. Neurologic findings were normal. The subclavian pulses were normal. The remainder of the vascular examination was unremarkable. The right graft limb was visible at the base of the neck wound. Takayasu arteritis had been diagnosed when the patient was 24 years of age, on the basis of constitutional symptoms, elevated erythrocyte sedimentation rate, and arteriographic findings. She was treated for 2 years with steroids. She remained asymptomatic until the cerebrovascular symptoms developed, which prompted the bypass operation. She had a 20 pack-year history of smoking. There was no family history of atherosclerosis or vasculitis. Medications at the time of transfer included several antibiotic agents and aspirin. Laboratory data showed a white blood cell count of 7 ⫻ 109/L (normal, 3.5-10.5 ⫻ 109/L), and erythrocyte sedimentation rate of 20 mm/hr (normal, 0-29 mm/hr). A CT scan showed no perigraft fluid or stranding along any segment of the graft. An arteriogram demonstrated patent aortocarotid and right subclavian artery grafts, with no evidence of pseudoaneurysm. The native subclavian arteries were not stenotic. A transthoracic echocardiogram showed a left ventricular ejection fraction of 40%. Initial management included irrigation and debridement of the neck wound. Cultures from the wound and blood showed no growth of bacteria. The exposed graft was replaced with a 7-mm polyester interposition graft from the base of the neck to the mid-neck. The carotid bifurcation was not exposed. The graft was From the Division of Vascular Surgery, Mayo Clinic. Competition of interest: none. Reprint requests: Thomas C. Bower, MD, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (e-mail: [email protected]). 0741-5214/$30.00 Copyright © 2004 by The Society for Vascular Surgery. doi:10.1016/j.jvs.2004.05.027
wrapped circumferentially with a right pectoralis major muscle flap. The patient was discharged home with oral ciprofloxacin therapy. The patient returned 2 months later with low-grade fever, elevated white blood cell count, and a nonpulsatile, erythematous, fluctuant mass over the manubrium. A CT scan of the neck and chest showed an abscess at the base of the neck, with perigraft stranding (Fig 2). There was no pseudoaneurysm. The abscess was drained, and the cavity was irrigated and debrided. Wound cultures grew methicillin-resistant coagulase-negative Staphylococcus aureus. The patient received wound care and intravenous antibiotics for 2 weeks. Ankle-brachial indices and segmental pressures were normal. The patient was taken to the operating room for removal of all prosthetic material. The right and left superficial femoral arteries (SFAs) were harvested in their entirety, and replaced with 6-mm ringed expanded polytetrafluoroethylene (PTFE) interposition grafts. The SFAs were approximately 5 to 6 mm in diameter, and the great saphenous veins were 4 mm or less in diameter. The leg incisions were closed at this time. Next the left subclavian artery was isolated through a supraclavicular incision. A segment of SFA was sewn end-to-side to the subclavian artery. The external and internal carotid arteries were dissected free through another incision. The SFA graft was passed behind the sternocleidomastoid muscle, and the supraclavicular incision was closed. The left limb of the aortocarotid graft at the base of the neck was poorly incorporated in the soft tissue. It was transected, oversewn, and pushed into the mediastinum. Soft tissue was closed over the tract. The SFA graft was sewn end-toend to the carotid bifurcation. The wounds were irrigated copiously and closed. The right-sided neck incision was reopened, preserving the pectoralis muscle flap. The right limb of the aortocarotid graft was poorly incorporated, and there was purulent material at the base of the neck. This area was thoroughly irrigated and debrided. Gowns, gloves, and instruments were changed. The right internal and external carotid arteries were dissected free. The sternum was reopened. The proximal graft in the mediastinum was well incorporated. The right carotid stump pressure measured 85 mm Hg. There were no electroencephalographic changes with test clamping of the right graft limb. We still elected to reconstruct the right carotid bifurcation, because it had a normal outward appearance, the patient was young, and we did not want the entire cerebral circulation reliant on only the left carotid and vertebral arteries. All of the previous graft material was removed. A
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Fig 1. A, Configuration of the patient’s graft at presentation. B, Interposition graft placed at first operation. C, Placement of pectoralis major muscle flap. Copyrighted by and used with permission of Mayo Foundation for Medical Education and Research. superficial femoral artery graft was placed from the ascending aorta to the right carotid artery. The origin of the old prosthetic graft was completely removed, and the aortic wall was debrided to healthy tissue. The upper portion of the aortotomy was closed primarily. Another short segment of SFA was used as a side arm off of this graft to the right subclavian artery. An intraoperative duplex scan showed all grafts patent with normal flow velocities. The pectoralis muscle flap was used to cover the graft in the right side of the neck. The skin and subcutaneous tissues were closed except for a small area at the base of the right side of the neck where the graft was not visible. This area was packed with antibiotic-soaked gauze. A 32F chest tube and a large round Jackson-Pratt drain were placed in the mediastinum. A right-angled and a straight 32F chest tube were placed in the right pleural space. The postoperative course was uncomplicated. The patient received vancomycin intravenously for 28 days, and was discharged home with oral minocycline. The patient had no symptoms at 4-year follow-up. A magnetic resonance angiogram 4 years after operation is shown in Fig 3. Serial duplex scans have exhibited less than 50% stenoses at the distal right carotid anastomosis and at the origin of the left PTFE graft anastomosis in the thigh.
DISCUSSION Direct great vessel reconstructions are safe and durable in selected patients. However, a prosthetic graft infection in this area has devastating consequences. Treatment options are limited. The first decision in this case was whether to treat the right-sided neck infection locally or to excise and replace all of the prosthetics. We initially chose to keep the treatment simple, inasmuch as only a short segment of graft was exposed and there were no signs of infection in the rest of the graft. There was no pseudoaneurysm, and blood and wound cultures were negative. Experience with localized prosthetic graft infections in the extremity and neck sup-
ported this decision.1-4 However, recurrent infection developed in the more proximal graft limb, which warranted a more extensive reconstruction. The second decision we faced was in situ versus remote reconstruction. The only “remote” options for treatment were reconstruction of both carotid arteries based solely on the left subclavian artery, or a left subclavian-carotid bypass graft followed by resection of the right limb without replacement, because the stump pressure and electroencephalographic tracing supported the risk for stroke as low. The use of a femoroaxillary artery bypass was not considered because of the patient’s young age. The third decision was the choice of conduit. Options included SFA, superficial femoral or saphenous vein, homograft, or native aortoiliac segment after it was replaced with prosthetic. The SFA was chosen because of lower risk for aneurysmal degeneration, it afforded a better size match with her carotid arteries, and it has been shown to resist infection better than vein when the carotid artery requires replacement in contaminated fields in head and neck cancer resections. The SFA was first used as an autologous vascular graft by Stoney and Wylie in 1970. These grafts were primarily endarterectomized segments of chronically occluded arteries.5 Non-endarterectomized SFA has been used for carotid replacement in head and neck cancer operations.6,7 Several authors believe this graft is more durable and infectionresistant than vein grafts in this location. Sessa et al7 described excellent durability in 30 patients operated on to treat head and neck cancers who required carotid replacement. In 9 of these patients a pharyngeal fistula developed, but there were no suture line blowouts. In addition, the risk for aneurysmal degeneration of autogenous arterial grafts is low compared with vein grafts.
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Fig 2. Representative sections from the preoperative computed tomography scan of the neck and chest. A, Large single arrow identifies abscess in right side of the neck. B, Double arrow identifies the right and left limbs of the graft, and perigraft fluid and stranding.
This is particularly important in young patients, such as ours, with an anticipated normal life expectancy. Aneurysms have occurred in aortocoronary, infrainguinal, and renal artery vein grafts.8-10 In renal artery vein grafts there is a 16% incidence of aneurysmal degeneration.10 Saphenous veins used for carotid subclavian position bypasses have also shown inferior patency owing to kinking.11 Reconstruction of the innominate artery with superficial femoral vein has been described with good results, and could have been used. However, most were cervical-based procedures, and not from the ascending aorta. These authors reported no experience with the use of these grafts in patients with Takayasu disease.12 This operation is also not without morbidity, with chronic lower extremity edema
developing in 30% and edema extensive enough to require long-term lower extremity compression in 17%.13 Iliac artery homografts could have been used, but this would have required laparotomy and increased the morbidity of the procedure.14 Cryopreserved arterial grafts could have also been used; however, there has been some concern regarding repeat infection and aneurysmal degeneration of these grafts.15 Finally, rifampin-bonded prosthetics have been used for local graft infection,16 but we believed this was not an option, because local treatment had already failed. We recognize that our patient is at some risk for infection of the PTFE superficial femoral interposition grafts. However, this is easier to treat than infection of a prosthetic
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Fig 3. Composite picture of magnetic resonance angiograms obtained at 4-year follow-up, and artistic rendition of the final reconstruction. Copyrighted by and used with permission of Mayo Foundation for Medical Education and Research.
aortoiliac graft, had these native arteries been harvested for the reconstruction. In addition, the patient exhibited no systemic signs of infection and was receiving suppressive antibiotic therapy, and we believed the risk for infection of the PTFE grafts was low. The long-term patency of aboveknee PTFE grafts was equivalent in several studies, and patency in this patient is probably even better, because the lower extremity runoff vessels are without significant atherosclerosis. Long-term graft surveillance and antibiotic therapy will be critical to detect graft problems or occult signs of reinfection and to suppress bacterial growth. However, the patient has done well. In conclusion, we believe that SFA for replacement of small-diameter infected prosthetic grafts is an option to be considered. REFERENCES 1. Cherry KJ Jr, Roland CF, Pairolero PC, Hallett JW Jr, Meland NB, Naessens JM, et al. Infected femorodistal bypass: is graft removal mandatory? J Vasc Surg 1992;15:295-303. 2. Calligaro KD, Veith FJ, Gupta SK, Ascer E, Dietzek AM, Franco CD, et al. A modified method for management of prosthetic graft infections involving an anastomosis to the common femoral artery. J Vasc Surg 1990;11:485-92.
3. Oderich GS, Panneton JM, Cherry KJ Jr, Hofer JM, Johnson CH, Olsen KD, et al. Carotid artery reconstruction combined with myocutaneous flap coverage: a complex and durable rescue operation. Ann Vasc Surg 2002;16:579-85. 4. Perler BA, Vander Kolk CA, Dufresne CR, Williams GM. Can infected prosthetic grafts be salvaged with rotational muscle flaps? Surgery 1991;110:30-4. 5. Stoney RJ, Wylie EJ. Arterial autografts. Surgery 1970;67:18-25. 6. Jacobs JR, Arden RL, Marks SC, Kline R, Berguer R. Carotid artery reconstruction using superficial femoral arterial grafts. Laryngoscope 1994;104(6 Pt 1):689-93. 7. Sessa CN, Morasch MD, Berguer R, Kline RA, Jacobs JR, Arden RL. Carotid resection and replacement with autogenous arterial graft during operation for neck malignancy. Ann Vasc Surg 1998;12:229-35. 8. Kalimi R, Palazzo RS, Graver LM. Giant aneurysm of saphenous vein graft to coronary artery compressing the right atrium. Ann Thorac Surg 1999;68:1433-7. 9. Cassina PC, Hailemariam S, Schmid RA, Hauser M. Infrainguinal aneurysm formation in arterialized autologous saphenous vein grafts. J Vasc Surg 1998;28:944-8. 10. Stanley JC, Ernst CB, Fry WJ. Fate of 100 aortorenal vein grafts: characteristics of late graft expansion, aneurysmal dilatation, and stenosis. Surgery 1973;74:931-44. 11. Ziomek S, Quinones-Baldrich WJ, Busuttil RW, Baker JD, Machleder HI, Moore WS. The superiority of synthetic grafts over autologous veins in carotid-subclavian bypass. J Vasc Surg 1986;3:140-5.
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12. Modrall JG, Joiner DR, Seidel SA, Jackson MR, Valentine RJ, Clagett GP. Superficial femoral-popliteal vein as a conduit for brachiocephalic arterial reconstructions. Ann Vasc Surg 2002;16:17-23. 13. Wells JK, Hagino RT, Bargmann KM, Jackson MR, Valentine RJ, Kakish HB, et al. Venous morbidity after superficial femoral-popliteal vein harvest. J Vasc Surg1999;29:282–9; discussion 289-91. 14. Ruotolo C, Plissonnier D, Bahnini A, Koskas F, Kieffer E. In situ arterial allografts: a new treatment for aortic prosthetic infection. Eur J Vasc Endovasc Surg 1997;14(suppl A):102-7.
15. Noel AA, Gloviczki P, Cherry KJ Jr, Safi H, Goldstone J, Morasch MD, et al. Abdominal aortic reconstruction in infected fields: early results of the United States cryopreserved aortic allograft registry. J Vasc Surg 2002;35:847-52. 16. Young RM, Cherry KJ Jr, Davis PM, Gloviczki P, Bower TC, Panneton JM, et al. The results of in situ prosthetic replacement for infected aortic grafts. Am J Surg 1999;178:136-40. Submitted Dec 13, 2003; accepted May 13, 2004.
CORRECTION In: “Effect of improved endograft design on outcome of endovascular aneurysm repair” (Torella F. J Vasc Surg 2004;40:216-21). In Table V, the values for procedure-related complications are incorrect. The correct figures are 159 (6%) for current devices and 123 (10%) for withdrawn devices (P ⬍.0001).