Repeated reconstructive operations for infection of synthetic prostheses in the aorto-ilio-femoral position

Introduction. The Aim. Improving the results of surgical treatment of patients with infection of the aortobedreno-bifurcation prosthesis.

Materials and methods. In the V.V. Veresaev City Clinical Hospital from 2002 to 2022, 70 patients were re-operated on the aorto-iliac-femoral zone due to infection of aorto-femoral bifurcation prostheses (68 patients) and endografts (2 patients). 15 (21.4%) patients underwent primary surgery for aneurysms of the infrarenal aorta, the rest due to occlusive stenotic lesions of the abdominal aorta and iliac arteries. In 37 (84%) patients, primary operations were performed for occlusive-stenotic lesions of the aorto-iliac zone. 38 (69%) of 55 patients with occlusive-stenotic lesions of the abdominal aorta and limb arteries were operated due to chronic ischemia of the 3rd and 4th degree.

Results. In the immediate postoperative period, 7 (10%) patients died. The main cause of death was sepsis with multiple organ failure – 6. In one observation, a patient with sepsis on the 4th day after surgery developed a clinical picture of peritonitis, which was caused by acute ulcers of the jejunum with perforation. Thrombosis of one of the branches of the prosthesis developed in 3 (4.2%) cases. In all observations, blood circulation in the extremities was restored.

Conclusion. The method of choice for infection of synthetic prostheses and endoprostheses in the aorto-iliac-femoral position is the use of the principles of active surgical treatment, with complete removal of the infected synthetic prosthesis with simultaneous in-situ replacement with autovenous shunts from the superficial femoral veins, active pre- and postoperative antibiotic therapy.

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