AB205. SOH25_AB_331. Case report: radical aortic reconstruction using autologous deep veins following infected aorto-bifemoral graft explantation

Background: Management of vascular graft infections presents a formidable challenge, particularly in patients with limited revascularization options. This report highlights a novel approach to reconstructing the aortic bifurcation and iliac arteries using autologous deep venous tissue after the explantation of an infected aortic-bifemoral graft in a 79-year-old female.

Case Description: We describe the case of a patient who initially underwent an open aorto-bifemoral bypass for bilateral aortoiliac occlusive disease. Postoperatively, she developed a graft infection with bilateral groin wound dehiscence and systemic sepsis, necessitating urgent removal of the infected graft. Traditional options such as prosthetic grafts or homografts were deemed unsuitable due to the high risk of reinfection. Consequently, autologous deep venous tissue was selected for reconstruction. The procedure involved harvesting deep veins from the lower limbs, ensuring adequate length and caliber to recreate the aortic trunk and common iliac arteries. The autologous veins were carefully anastomosed in an end-to-end fashion to restore arterial continuity while preserving distal perfusion. This approach minimized the risk of reinfection by eliminating the need for synthetic or cadaveric graft materials in a septic field.

Conclusions: Postoperatively, the patient demonstrated a successful restoration of limb perfusion but, unfortunately, had a difficult postoperative course. This case underscores the versatility and efficacy of autologous deep venous grafts in complex vascular reconstructions, particularly in infection-prone settings. It highlights a potential life-saving strategy for managing high-risk cases where conventional methods are contraindicated, emphasizing the importance of surgical innovation in contemporary vascular surgery.

Keywords: Aorta; bifurcation; complications; case report