Reconstruction of the aortoiliac system with autologous superficial femoral vein for severe infectious abdominal aortic aneurysm:safety and efficacy analysis of the first cases in China
WANG Qi
YANG Jue
PAN Tian-yue
FANG Yuan
ZHU Ting
WANG Lixin
KAN Yuanqing
ZHOU Min
CHEN Zhangzhang
DONG Zhihui
FU Wei-guo
YUE Jia-ning
Abstract：Objective To evaluate the safety and efficacy of neo-aortoiliac system(NAIS)reconstruction using an autologous superficial femoral vein in the treatment of infectious abdominal aortic aneurysm(IAAA).Methods A retrospective analysis was conducted on the clinical data of 12 patients with IAAA who underwent NAIS surgery at Zhongshan Hospital,Fudan University,from 2022 to 2024.The analysis included preoperative diagnosis,intraoperative management,and postoperative care.All patients met the diagnostic criteria for IAAA,and intraoperative pathogen identification combined with susceptibility testing was performed to guide individualized antibiotic regimens.Follow-up assessments evaluated surgical outcomes and long-term prognosis.Results Among the 12 patients,11 had confirmed pathogen diagnoses,including 7 with multidrug-resistant organisms.All patients successfully underwent surgery.One patient died on postoperative day 10 due to anastomotic rupture,while the remaining 11 survived until the end of the follow-up period.The average ICU stay was 6.2 days,and the mean total hospital stay was 23 days.The duration of antibiotic therapy ranged from 2 to 37 weeks,with an average of 17.2 weeks.The mean follow-up duration was 64.9 weeks(13-130 weeks).Among the 11 surviving patients,10 were free from antibiotic dependency without infection recurrence,while one still required long-term oral antibiotic therapy as of November 2024.No cases of compartment syndrome or post-thrombotic syndrome were reported,although 5 patients complained of venous insufficiency symptoms.CT imaging follow-up revealed no graft-related aneurysmal changes.Conclusion NAIS surgery offers an effective strategy for in situ revascularization in IAAA,particularly for patients with high infection burdens,multidrug-resistant organisms,or poor responses to antibiotic therapy.Despite the extensive surgical trauma,antibiotic dependency was significantly reduced,and long-term outcomes were favorable.NAIS surgery can be considered one of the preferred treatment options for severe IAAA after a comprehensive evaluation of patient fitness and infection complexity.
Keywords：infectious abdominal aortic aneurysmautologous superficial femoral veinneo-aortoiliac system reconstructionNAIS surgeryinfection burdenantibiotic therapyvascular reconstructionlong-term outcomes
Publication Date：2024-12-01
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：7( 1382-1388 )