Bypass axilofemoral para pacientes con infección de prótesis aórtica. Experiencia en nuestro centro con el uso de la prótesis biosintética Omniflow II(R) y revisión de la bibliografía / Extraanatomic axillofemoral bypass in patients with aortic graft infection. Experience in our center with the use of Omniflow II(R) biosynthetic prosthesis and review of the bibliography

La infección abdominal de una prótesis aórtica en pacientes portadores de bypass aórticos, aortoilíacos o aortofemorales unilaterales o bilaterales es una de las complicaciones más temibles que a nivel vascular podemos encontrar dada su alta morbilidad y, sobre todo, su alta mortalidad. Su manejo siempre va a ser difícil y acompañado por lo general de mal pronóstico, pues su tratamiento quirúrgico requiere una indicación, un estudio y una programación individualizados en cada paciente. Sea cual sea la actitud terapéutica inicial, conservadora o agresiva, la resolución final de la infección va a llevar aparejada la exéresis de la prótesis infectada y la revascularización de las extremidades inferiores mediante técnicas y materiales diversos. En cuanto a las técnicas a emplear podemos optar por el empleo de una vía ortoanatómica o extraanatómica y actuar en un tiempo o en dos. Entre los materiales a emplear tenemos los injertos autólogos con vena, como los de elección en caso de disponer de ellos, o de otros materiales alternativos en caso contrario, de los que encontramos publicado en la literatura el uso de una prótesis biosintética. Describimos nuestra experiencia en el manejo de estos pacientes mediante el empleo de la prótesis Omniflow II(R) por vía extraanatómica

Abdominal infection of an aortic prosthesis in patients with aortic, aortoiliac or aortofemoral bypass is one of the most feared vascular complications that we can find, because its high morbidity and, above all, its high mortality. Its handling is always going to be difficult and usually accompanied by poor prognosis because surgical treatment requires an indication, study and programming individualized for each patient. Whatever the initial therapeutic approach, conservative or aggressive, the final resolution of the infection will be accompanied by the excision of the infected prosthesis and revascularization of the lower limbs using different techniques and materials. As for the techniques employed, we can choose to use an ortho-anatomic or extra-anatomic reconstruction and to act in one or two times. Among the materials used we have the autologous venous grafts, as those of choice in case of having them, or alternative materials otherwise, of which are reported in the literature the use of a biosynthetic prosthesis. We describe our experience in the management of these patients by using the Omniflow II(R) prosthesis extraanatomically

Novel Use of the PECS II Block in Major Vascular Surgery: A Case Report.

Patients presenting for major vascular surgery are often elderly, medically complex, and at increased risk for general anesthesia-related complications. A search of the published literature produced no citation regarding PECS II block in the setting of extra-anatomic bypass procedures. We present a case report describing the use of the deep injection of the PECS II block in this context. Although further investigation is needed to determine the role of truncal blocks in major vascular surgery, our case illustrates that peripheral nerve blocks, combined with continuous spinal anesthesia, may be used as an alternative to general anesthesia for axillofemoral-femoral bypass.

Comparison of long-term outcome after endovascular therapy versus bypass surgery in claudication patients with Trans-Atlantic Inter-Society Consensus-II C and D femoropopliteal disease.

BACKGROUND: Although endovascular therapy (EVT) has advanced, few reports have compared EVT and bypass surgery in claudication patients with femoropopliteal disease. The present study used data from a multicenter registry in Japan to analyze outcomes of EVT and bypass surgery for claudication patients with Trans-Atlantic Inter-Society Consensus (TASC)-II C and D femoropopliteal lesions. METHODS AND RESULTS: Of 1,156 patients who underwent revascularization, 696 patients were treated for intermittent claudication. A total of 263 patients with femoropopliteal lesion were classified into TASC-II C and D. The primary and secondary patency rates of the EVT and bypass surgery groups were analyzed. The overall complication rate was 14.4% in the bypass surgery group and 3.5% in the EVT group (P<0.01). The 1- and 5-year primary patency rates were 82.1% and 69.4% in the bypass surgery group and 67.8% and 45.2% in the EVT group, respectively. Although the bypass surgery group had a higher primary patency rate than the EVT group (P<0.01, log-rank test), secondary patency rates did not differ significantly between the two groups. CONCLUSIONS: Although bypass surgery is clearly feasible for claudication patients with TASC-II C and D femoropopliteal disease, EVT is also a good option because of its lower complication rate and good secondary patency rate in patients in poor condition for bypass.