For high-risk patients, axillofemoral bypass (extra-anatomic
technique) and percutaneous angioplasty are also viable alternatives (2, 3).
Aortic endograft infection (AGI) is a serious complication of aortic repair, and treatment involves prolonged antimicrobial drug therapy and complete or partial graft explantation with subsequent in situ or extra-anatomic
For surgical treatment, the approaches included in situ reconstructions, extra-anatomic
bypass, and endovascular stent repair.
For frankly infected grafts, surgical explantation with in situ reconstruction, or extra-anatomic
bypass for high-risk patients has been shown to be feasible .
Recently, we successfully treated a young man affected by end-stage liver disease with grade 3b PVT performing an extra-anatomic
jump graft from the right colic vein.
Current treatment approaches of PADF are en bloc resection and reconstruction with aortic graft, extra-anatomic
bypass, and endovascular repair.
Unstable patients might benefit from stent graft (Level 4, Recommendation C); stable patients with aortoenteric fistula should receive staged procedure with extra-anatomic
bypass first (Level 2c, Recommendation B); and finally stable patients without aortoenteric fistula (patients that do not have direct communication between proximal anastomosis and bowel but infected paraanastomotic sinus) should receive in situ revascularization using autogenous superficial femoral vein or aortoiliac allograft (Level 2c, Recommendation C) (2).
Sandmann, "Mycotic aneurysms of the thoracic and abdominal aorta and iliac arteries: experience with anatomic and extra-anatomic
repair in 33 cases," Journal of Vascular Surgery, vol.
Open surgery techniques involve simple arterial ligation or ligation associated with femorofemoral bypass, direct suture, extra-anatomic
bypass surgery, or angioplasty by patch .
femorofemoral bypass graft was constituted surgically in order to cure the claudication.
The vascular defect can be repaired by an open approach: local reconstruction, ligature of the vessel with or without extra-anatomic
reconstruction (this reconstruction includes a femoro-femoral crossover bypass).
(7) Therefore, the authors of recently published treatment algorithms advocate endovascular therapy as a temporizing measure to stabilize the patient until the surgeon can perform a further workup to determine the risk of a cerebrovascular accident after occlusion or the need for an extra-anatomic