[Outcomes of endoprosthetic repair of abdominal aortic aneurysm]. / Rezul'taty éndoprotezirovaniia anevrizmy briushnogo otdela aorty.

AIM: The study was aimed at assessing efficacy and safety of endovascular treatment of abdominal aortic aneurysms based on 11-year experience with implantation of stent grafts. PATIENTS AND METHODS: We retrospectively analysed outcomes of treatment of 242 patients with abdominal aortic aneurysm during the period from 2008 to 2019. Of these, 210 (86.78%) were males, mean age 69.32±7.36 years. Diagnosis was made using colour duplex scanning and contrast-enhanced multislice spiral computed tomography, with implanting the following stent grafts: Ella - 44, Ovation Prime - 33, Anaconda - 13, Endurand - 77, Aortix - 2, Zenith - 33, Seal - 39, with one endoprosthesis placement failed. Assessing safety of the operation, we took into consideration lethality due to aortic rupture/thrombosis. Efficacy was taken to mean technical success of the operation (implantation of all components of the endograft without switch to open surgery), the number of reoperations. RESULTS: Technical success of the operation was achieved in 98.35% of cases. In 1 case due to pronounced arterial calcification for technical reasons we failed to position the stent graft and in another case - the contralateral leg of the Ella prosthesis. The early postoperative period revealed: type A1 endoleak - 3.7%, type IB - 4.13%, type IIA - 6.6%, type IIB - 4.54%, type III - 0.83%, type IV - 0.83%. Repeat operations were performed in 20 (8.2%) patients within 30 days after the intervention and in 32 (13.22%) in the remote period. In the early postoperative period two conversions were performed: 1) iliorenal bypass grafting for restoration of blood flow through the renal artery occluded by endoprosthesis wall; 2) evacuation of retroperitoneal haematoma due to rupture of the common femoral artery. Lethality during the whole period of follow up amounted to 32 (13.22%) cases. Of these, due to aortic complications 4.54% (n=11) and due to accompanying pathology 8.67% (n=21). A direct correlation was revealed between the aortic diameter and duration of the operation which in turn increases the risk of complications requiring re-operation or resulting in a lethal outcome (RR - 1; 95% CD 1- 1; p=0.026). CONCLUSION: Our experience showed high safety and efficacy of stent graft implantation in treatment of patients with abdominal aortic aneurysms and high surgical risk.

[Autoarterial remodeling of the common carotid artery bifurcation in treatment of stenotic lesions]. / Autoarterial'noe remodelirovanie bifurkatsii obshchei sonnoi arterii v lechenii stenoticheskikh porazhenii.

Carotid endarterectomy is the main operation carried out for prevention of ischaemic stroke in haemodynamically significant stenoses of the bifurcation of the common carotid artery. Despite the literature data demonstrating some advantages of eversion carotid endarterectomy over the classical technique there arises a series of complicated, as yet unsolved problems. This concerns the control of the distal portion of an atherosclerotic plaque in prolonged lesions of the internal carotid artery, the absence of a temporary bypass graft, necessity of prosthetic repair of the internal carotid artery in detachment of the distal border of the plaque. We suggested a new technique of carotid endarterectomy making it possible to widen visual removal of atheromatous masses from the internal carotid artery, to improve the control of the distal portion of the plaque in a prolonged lesion of the internal carotid artery. We carried out a comparative assessment of efficacy and safety of the new method of carotid endarterectomy versus the classical variant in a randomized study. The proposed technique of carotid endarterectomy turned out to be compatible by safety and demonstrated similar results with the classical carotid endarterectomy by the number of ischaemic strokes, transitory ischaemic attacks, and myocardial infarctions in the early and remote postoperative periods. When comparing the groups by efficiency, the primary efficacy endpoint, including cases of restenosis >50% according to the findings of ultrasonographic examination of the brachiocephalic arteries, all cases of ischaemic events (acute impairments of cerebral circulation, transitory ischaemic attacks), as well as the presence of the clinical picture of cranial nerve paresis demonstrated a significant advantage of the new technique versus the comparison group at the expense of a lower incidence of restenoses in the area of the operation during the whole period of follow up. In the group of autoarterial remodelling, the composite endpoint of outcomes occurred in 6 patients (6.1%) and in the group with the classic carotid endarterectomy - in 19 (19.6%) patients, p=0.005.

[Robotic-assisted operations for pathology of the aortoiliac segment: own experience]. / Robot-assistirovannye operatsii pri patologii aorto-podvzdoshnogo segmenta: nash opyt.

AIM: The present study was aimed at assessing the results of a total of 40 vascular operations carried out using the robotic-assisted da Vinci surgical system. PATIENTS AND METHODS: Between January 2013 and September 2019, a total of 40 robotic-assisted vascular operations were performed at the Department of Vascular Pathology and Hybrid Technologies of the Centre of Vascular and Hybrid Surgery. Of these, 31 interventions were carried out for occlusion of the aortoiliac segment and 9 for removal of an aneurysm of the infrarenal portion of the abdominal aorta. The patients were arbitrarily divided into 2 groups: the first group included those subjected to aortofemoral bypass grafting procedures for atherosclerotic steno-occlusive lesions of the aorta and iliac arteries, whereas the second group comprised the patients who underwent aneurysmoectomies with linear prosthetic repair of the abdominal aorta. RESULTS: Altogether, elective robotic-assisted operations were successfully performed in 38 (95%) cases. Conversion to a laparotomic approach was required in 2 (5%) patients. The mean time of creating an anastomosis with the abdominal aorta amounted to 51 minutes (range 30-90), being 42±4.75 min for aortofemoral bypass grafting and 83±5.00 min for aneurysmoectomies with linear prosthetic repair of the abdominal artery. The average blood loss was 316 (range 50-1000) ml, amounting to 280±209 ml and 438±322 ml for group I and group II, respectively. With the exception of one case, all patients spent 24 hours in the intensive care unit to be then transferred to the specialized ward. The average length of hospital stay amounted to 9.8 days. One patient experienced haemorrhage from the central anastomosis in the early postoperative period and was emergently operated on from a laparotomic approach. Four (10%) patients developed nonlethal complications which were treated conservatively. During the 30-day follow-up period, no lethal outcomes, thromboses, nor infections of the prostheses were observed. CONCLUSION: From a practical point of view, the major advantages of using the robotic-assisted complex include minimal surgical trauma, reduced blood loss, a wide range of high-precision movements of the manipulators, 3-D visualization with a 5-fold magnification, thus making it possible to create a vascular anastomosis sufficiently fast in very tight spaces in the body. Our experience with laparoscopic robotic-assisted surgery demonstrated feasibility of using this technique for treatment of pathology of the aortoiliac segment.

Stenting of the carotid artery with CGuard and Acculink stents: interim results of a randomized trial. / Stentirovanie sonnoi arterii stentami CGuard i Acculink: promezhutochnye rezul'taty randomizirovannogo issledovaniia.

AIM: The study was undertaken to evaluate safety and efficacy of carotid stents Acculink (open-cell carotid stent) and CGuard (closed-cell type stent) in treatment of patients presenting with atherosclerotic lesions of carotid arteries. PATIENTS AND METHODS: The study enrolled a total of 50 patients diagnosed with haemodynamically significant stenosis of the carotid artery and divided into two groups of 25 patients each. Group One patients received Acculink stents and Group Two patients underwent implantation of CGuard stents. Ultrasonographic examination was performed in all patients before and after surgery, as well as at 6 and 12 months thereafter; magnetic resonance imaging of the brain was carried out before and after surgery (at 24-48 postoperative hours and on POD 30). The entire period of follow up included 5 examinations of each patient by a neurologist. The obtained findings were statistically analysed using the Statistica 12 software (StatSoft, USA). The level of deviation of the null hypothesis of the absence of differences between the groups was regarded as significant at p<0.05. RESULTS: The technical success of the operation amounted to 100% in both groups. There were no complications (such as haematoma, arterial dissection, etc.) in the area of the approach in either group. The findings of ultrasonographic examination of the extracranial portion of the carotid arteries demonstrated a significant difference in the form of a decrease in the degree of narrowing of the operated vessel (p<0.05) as compared with its initial parameters. The number of the detected foci of acute cerebral ischaemia in the postoperative period (24-48 h) amounted to: in the Acculink group - 14 (56%), in the CGuard group - 12 (48%), p>0.77. Of these, multiple foci in Group One were encountered significantly more often than in Group Two (p=0.02). The patients with the Acculink stent implanted were found to develop 2 (4%) episodes of acute cerebral circulation impairment: the first one occurring after 24 hours and the second one at 28 days after stenting, with no such complications observed in Group Two patients. CONCLUSION: Comparing the two stents (Acculink and CGuard) demonstrated no advantages with respect to safety and efficacy of either stent in endovascular treatment of patients with atherosclerotic lesions of brachiocephalic arteries.

[Endoprosthetic repair of the aorta for an infrarenal aneurysm combined with occlusion of one of the iliac arteries]. / Éndoprotezirovanie aorty pri anevrizme infrarenal'nogo otdela v sochetanii s okkliuziei odnoi iz podvzdoshnykh arterii.

Described herein is a clinical case report regarding successful endovascular treatment of a patient presenting with an abdominal aortic aneurysm combined with occlusion of one of the iliac arteries. Cases concerning elimination of such pathology appear to be reported only sporadically in the available literature. The patient underwent reconstructive repair in two stages. The first stage comprised recanalization with stenting of the occluded iliac artery on the right and implantation of the Zenith stent graft. The findings of intraoperative check angiography showed no evidence of endoleak, with the preserved patency of both the stent graft and iliac arteries on the right. The second stage consisted of balloon angioplasty of stenosis of the external iliac artery on the left. The results of the follow-up examination at 3 years showed that the iliac arteries on both sides and the aortic endograft were free from significant stenoses, with no evidence of endoleaks.

[Endovascular interventions for stenoses and occlusions of the brachiocephalic trunk]. / Éndovaskuliarnye vmeshatel'stva pri stenozakh i okkliuziiakh brakhiotsefal'nogo stvola.

The study was undertaken to evaluate the efficacy and safety of endovascular interventions in the treatment of stenoses and occlusions of the brachiocephalic trunk (BCT). Described in the article are the results of retrospectively analysing the efficacy of endovascular interventions performed in a total of forty-five patients presenting with lesions of the BCT. Depending on the type of the BCT lesion, the patients were divided into 2 groups: Group One consisted of 28 patients diagnosed with stenoses of the BCT and Group Two included 17 patients found to have occlusions of the BCT. The outcomes of the interventions were assessed with due regard for the findings obtained by angiography, ultrasonographic duplex scanning of the brachiocephalic vessels, as well as by the examination of the patient's neurological status. The remote results were evaluated at follow-up terms ranging from 6 months to 4 years. No ischaemic strokes, myocardial infarctions, nor lethal outcomes were observed during 30 days after the intervention. In the early postoperative period, there occurred 1 (3.6%) case of transitory ischaemic attack in Group One, with also 1 (5.9%) case thereof encountered in Group Two. Within the time frame of the follow-up period (48 months), recurrent occlusion of the stented segment of the BCT was registered in 2 (7.1%) patients from Group One and in 1 (5.8%) patient from Group Two (p=0.87). The primary patency rate at 4 years in Group One and Group Two patients amounted to 86.8 and 88.3%, respectively (p=0.84). A conclusion thus drawn was as follows: endovascular intervention for stenoses and occlusions of the BCT is an effective and safe method of preventing acute cerebral circulation impairments in the vertebrobasilar basin.

[Treatment of type IB endoleak after endoprosthetic repair of infrarenal aneurysm]. / Lechenie éndolika IV tipa posle éndoprotezirovaniia infrarenal'noi anevrizmy.

The article deals with a case report regarding successful surgical management of late type IB endoleak caused by dislocation of the leg of the stent graft, occurring three years after endoprosthetic repair of an aneurysm of the aortic infrarenal portion with the COOK stent graft, aneurysmectomy with prosthetic repair of the right common femoral artery using the linear vascular graft Intergard 8Ч20. The patient underwent surgical treatment: endoprosthetic repair of the iliac branch ZSLE-24-90-90 ZT of the Zenith Spiral AAA stent graft. The findings of the check-up angiography and ultrasonographic examination revealed no evidence of endoleak, with the stent graft's patency preserved. The early postoperative period was marked with moderate manifestations of asthenic syndrome. The patient was discharged in a satisfactory condition. Cases concerning removal of similar complication in the remote period following endoprosthetic repair of the aorta are mentioned sporadically in the available literature.

[Staged implantation of an abdominal stent graft]. / Étapnaia implantatsiia abdominal'nogo stent-grafta.

The article deals with a case report regarding successful surgical management of a patient presenting with an anatomically complicated aneurysm of the aortic infrarenal portion and iliac arteries. The first stage consisted in performing implantation of the Ovation Prime stent graft into the abdominal aorta. One month later, the second stage carried out for residual type IB endoleak consisted in implantation of the iliac components of the stent graft into the external iliac arteries on the right and the left. The postoperative period turned out uneventful. The findings of the check ultrasonographic examination showed no evidence of endoleak, with the stent graft's patency preserved. The patient was discharged in a satisfactory condition. The check multispiral computed tomography performed 30 days after the operation also demonstrated complete isolation of the aneurysm of the aorta and iliac arteries from blood flow, with the graft's being patent. The presented herein clinical case report is of sporadic occurrence and is of practical importance for extending the indications for aortic endoprosthetic repair.

[Efficacy and safety of temporary bypass grafting in carotid endarterectomy]. / Éffektivnost' i bezopasnost' vremennogo shuntirovaniia pri karotidnoi éndarteréktomii.

The authors analysed interrelationship between the use of temporary bypass grafting during operations of carotid endarterectomy and the frequency of the development of ischaemic complications (stroke and transitory ischaemic attacks in the early postoperative period). It was shown that in the group wherein a temporary bypass graft was established only by the criterion of decreasing retrograde pressure ischaemic complications were encountered in ten (4.4%) patients and in the group wherein temporary shunts were established by the criterion of a simultaneous decrease in cerebral oxygenation and retrograde pressure - in two (0.9%) patients (OR 5.28; 95% CI 1.22-24.38; p=0.03). It was demonstrated that using temporary bypass grafting in cases of isolated assessment of the parameters of cerebral oxygenation and retrograde pressure increased the frequency of the development of shunt-related ischaemic complications as compared with the patients in whom shunts were not used due to lack of a synchronous decrease in these parameters (13.5 vs 1.5%, respectively; OR 10.0; 95% CI 1.1-82.2; p=0.039). The findings of the carried out retrospective analysis suggested that the main predictor of the development of the outcome 'stroke + transitory ischaemic attack' was the use of a temporary internal shunt during the main stage of the operation (p<0.00001).

Biochemical markers in blood serum of patients undergoing various methods of carotid endarterectomy. / Biokhimicheskie markery syvorotki krovi pri razlichnykh metodakh karotidnoi éndarteréktomii.

The authors studied the concentration of CRP, sE-selectin, sP-selectin, sICAM-1, sICAM-3, sVCAM-1, sPECAM and endothelin-1 in blood serum of patients presenting with stenotic lesions of carotid arteries and undergoing various methods of carotid endarterectomy (CEAE): eversion CEAE (Group I) and CEAE using a xenopericardium patch (Group II). Within the time frame of the study, patients in both groups were found to have an elevated CRP level in the early postoperative period, having returned to the baseline values at 6 postoperative months, as well as an increase in the concentration of endothelin-1 at six months after surgery and a decrease of the sE-selectin concentration in the early postoperative period. The level of sP-selectin in Group II patients was noted to increase considerably six months after correction of stenosis. The content of sICAM-1 and sVCAM-1 did not differ in the early postoperative and baseline periods, and was noted to decrease 6 months after the operation. Group II patients demonstrated a decrease in the sPECAM concentration during postoperative day one, followed by returning to the initial values six months after CEAE. The above-mentioned biochemical markers may be used during the postoperative follow-up period for early detection and appropriate correction of endothelial dysfunction and hyperplasia of the intima of the zone of reconstruction.

[Ways to improve immediate and remote results of carotid endarterectomy].

The authors analysed the results of carotid endarterectomy in a total of 469 patients with the use of simultaneous assessment of the oxygen status and collateral blood flow of the brain in order to determine feasibility of placing a temporary bypass, carried out at the Centre of Vascular and Hybrid Surgery of the Novosibirsk Scientific Research Institute of Circulatory Pathology named after Academician E.N. Meshalkin in 2008-2012. It was shown that it is more appropriate to use a temporary bypass based on simultaneous assessment of the oxygen status and collateral blood flow of the brain: in synchronous decrease of the degree of cerebral oxygenation during tentative occlusion by more than 20% of the baseline level, or in absolute values of cerebral oxygenation below 40% and simultaneous decrease of retrograde pressure below 40 mm Hg. It was determined that simultaneous assessment of tolerance of the brain to ischaemia significantly decreased the incidence of using a temporary bypass from 16 to 3% (χ2=22.51; p<0.00001), accompanied by a tendency towards a decrease in the incidence of perioperative stroke from 2.6 to 0.8% (odds ratio 0.30; 95% CI 0.06-1.55; p=0.15). Long-term results of carotid endarterectomy after 4 years showed that a decrease in the number of temporary shunts did not influence cumulative survival (log-rank test; p=0.73), the incidence of stroke (log-rank test; p=0.68) and patency of the reconstructed carotid arteries in the remote period (log-rank test; p=0.70). It was determined that in the remote period of carotid endarterectomy restenoses of reconstructed carotid arteries were encountered statistically significantly less often in the group of eversion carotid endarterectomy as compared with classic carotid endarterectomy (OR 0.23; 95% CI 0.07-070; p=0.009) and with prosthetic repair of the internal carotid artery (OR 0.13; 95% CI 0.02-0.83; p=0.03).

[Results of endovascular interventions in patients with occlusive stenotic lesions of arteries of the aortoiliac segment].

Presented herein are the results of endovascular interventions performed in a total of 220 patients with chronic ischaemia of lower limbs and occlusive and stenotic lesions of the aortoiliac arterial segment. Group One patients (n=155) underwent angioplasty with stenting (a total of 186 interventions performed) and Group Two patients (n=65) were subjected to recanalization of the occlusion zone with stenting (65 interventions). The remote results were assessed in all patients within the terms of up to 4 years. In Group One patients, restenosis of the stented segments within the mentioned terms of follow up was revealed in 11 (7.1%) cases, thrombosis - in 5 (3.2%) cases. In Group Two patients restenosis was detected in 3 (4.6%) cases and thrombosis of the stented segment in 6 (9.2%) cases. In the both groups, restenosis >50% or thrombosis of the stented segment developed significantly more often with the length of the stented segment exceeding 100 mm (p=0.01 in Group One and p=0.0077 in Group Two). Primary patency of the stented segments at 12 and 24 months after the intervention in Group One amounted to 97.5±1.5 and 92.3±3.3% and in Group Two 92.7±3.6 and 81.9±6.6%, respectively. A conclusion was made that endovascular interventions may be a method of choice in occlusive and stenotic lesions of the aortoiliac-segment arteries. Extended length of the lesion of iliac-segment arteries (more than 100 mm) deteriorates the rates of primary patency after stenting.

[Experience with cryopreserved homografts used in aortofemoral position in infection of vascular prostheses].

The authors share herein their experience in reconstructive interventions on the aortofemoral segment in infection of the implant in three 59-to-69-year-old male patients. Infection of the prosthesis was diagnosed by the clinical data, findings of MSCT angiography and duplex scanning of the infrarenal portion of the aorta and arteries of lower limbs. Pseudoaneurysms of distal anastomoses were revealed in two cases. All secondary reconstructions were performed with the use of a cryopreserved aortic bifurcation homograft in the in situ position with simultaneous removal of the infected implant. The results of inoculation from the removed implants yielded Staphylococcus aureus in two cases and Staphylococcus epidermidis in one case. One patient died 6 months later due to causes not related to the operative intervention, in the remaining two cases during one year no findings suggesting reinfection or steno-occlusive lesion of the aortofemoral segment have been revealed.

[Hybrid operative interventions in patients with multi-level atherosclerotic lesions of lower-limb arteries].

The authors share their experience gained in hybrid surgical interventions for multi-level steno-occlusive lesions of the aortoiliac and infrainguinal segments in a total of 96 patients presenting with chronic ischaemia of the lower limbs. The postoperative-period complications included haematomas observed in 9 (9.4%) cases and 6 (6.3%) instances of lymphorrhea occurring in the area of the postoperative wound. There were no lethal outcomes in the immediate postoperative period. The remote results were assessed at follow-up terms varying from 6 to 53 months in 75 (79.7%) patients. Thrombosis of the bypass graft was registered in 6 cases and thrombosis of the stented iliac segment was encountered in 3 cases, which required amputation of the lower limb in 5 (6.7%) patients.

[Short- and long-term results of various methods of reconstruction of carotid artery bifurcation].

AIM: comparative assessment of immediate and remote outcomes of various methods of reconstruction of the zone of bifurcation of the common carotid artery in stenotic lesions. MATERIAL AND METHODS: the authors carried out retrospective and prospective analysis of a total of 457 reconstructive operations on the bifurcation of the common carotid artery in 432 patients presenting with haemodynamically significant stenoses. Depending on the type of reconstruction of the carotid artery bifurcation, the patients were subdivided into four groups: group I - eversion carotid endarterectomy (CEA) - 157 (34.4%) operations, group II - CEA with xenopericardial patch plasty - 211 (46.2%) operations, group III- CEA with polytetrafluoroethylene (PTFE) patch plasty - 61 (13.3%) operations, group IV - CEA with original autoarterial remodelling of the bifurcation of the common carotid artery - 28 (6.1%) operations. We evaluated both immediate and remote (from 6 month to 4 years) results of surgical treatment. RESULTS: clinical efficacy of carotid endarterectomy in prevention of ischaemic stroke in the remote period after surgery amounted to 97.8%. Strokes developed in 2.2% of cases. It was shown that after using a xenopericardium patch the incidence rate of the development of restenosis proved statistically significantly lower than after using a PTFE patch. It was confirmed that CAE with autoarterial remodelling of the common carotid artery bifurcation or eversion CEA are accompanied by a significantly lower incidence rate of restenosis development in remote terms of follow up as compared to the methods of CAE with xenopericardial or PTFE patches (p<0.01). It was determined that coronary revascularization carried out by indications as the first stage statistically significantly decreases the incidence rate of acute myocardial infarction both in the immediate and remote terms of follow up after CEA.

[Results of endoprosthetic reconstruction in patients with aneurysm of the infrarenal portion of the aorta].

The authors herein share their experience with implantation of endografts in a total of 41 patients for an aneurysm of the infrarenal portion of the aorta. Of these, there were 34 (83%) men and 7 (17%) women, with the average age amounting to 71±7 years. All patients were found to have a history of coronary artery diseases (CAD) and arterial hypertension. The first stage in 15 (36.6%) cases consisted of stenting of coronary arteries and in 8 (19.5%) cases of coronary aortic bypass grafting. Seven patients were within 6 months diagnosed as having developed thrombosis of the stent-graft s branch, treated by recanalization with stenting in 5 cases, and by femoro-femoral cross-over bypass in 2 cases. One patient was found to have stenosis due to bending of the left branch of the stent-graft corrected by stenting; two patients showed endoleak (in one case that of type 2 due to retrograde blood flow from lumbar arteries and in the second case that of type 3 due to impairment of the stent-graft covering integrity). Thromboembolism into the distal bed during implantation of stent-grafts was verified in 3 cases, with two of them requiring thrombectomy. One more patient was diagnosed as having dissection of the intima of the iliac artery, treated by stenting of the arterial segment involved. There were no other complications, nor lethal outcomes.

[Oxygen status of the brain and quality of life in remote terms after carotid endarterectomy].

The authors assessed efficacy of eversion carotid endarterectomy and its effect on dynamics of the oxygen status of the brain and quality of life of 122 patients at terms from 6 months to 4 years after surgical treatment. It was shown that positive effect from the operation is preserved in 94% of cases, lethality in the remote terms amounted to less than 1%, acute impairment of cerebral circulation on the side of revascularization was registered in 2.5% of cases, haemodynamically significant restenoses in the zone of vascular reconstruction in 2.5%. Revascularization results in increased efficacy of the oxygen supply of the brain and the level of quality of life, including in patients with a history of ischaemic stroke.

Hybrid in situ replacement for Samson group V Staphylococcus aureus aortic graft infection.

Aortic prosthesis replacements including extra-anatomical bypass procedures, in situ revascularisations with the neoaortoiliac system, antibiotic bounded prostheses or allogeneic grafts have high graft reinfection rates. We described a case of a 68-year-old man with Samson group V Staphylococcus aureus infection of his aortobifemoral graft. He underwent an explantation of the infected graft, wound debridement and a hybrid in situ allogeneic aortoiliofemoral replacement. During surgery one of the limbs of the cryopreserved human aortic allogeneic graft was anastomosed with the endarterectomised left common iliac artery, which later was angioplastied and stented. The closed system Jackson-Pratt drains were used to prevent perigraft fluid collection. The groin wound was treated with the vacuum-assisted closure dressing. On review in 6 months he remained symptom free. We conclude that a hybrid management of infected aortic prosthesis may reduce graft reinfection.