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We report the use of a unique hybrid technique to treat a patient with a painful aneurysm extending both above and below the inguinal ligament. The patient was at high surgical risk, and endovascular treatment was not possible due to the absence of an appropriate vascular access site. Under local anesthesia, this aneurysm was treated using both a stent graft and a traditional Dacron graft for the iliac and femoral portions, respectively. Simultaneously, a popliteal aneurysm was treated endovascularly through a jump graft, which was used to bypass a short occlusion at the origin of the superficial femoral artery. Hybrid techniques can be an alternative approach in high-risk patients where endovascular procedures cannot be applied.

Infection of aortoiliac endografts is, to date, a rare complication of endovascular surgery. Staphylococcus species are the most common responsible pathogens, just as in cases with infected grafts after open aortic surgery. We report a case of a 65-year-old man with a history of diabetes mellitus and bladder cancer who developed stent-graft infection 3 years after endovascular treatment for a 5.6 cm abdominal aortic aneurysm. The diagnosis of endograft infection was established radiologically by computed tomographic scans. After intravenous administration of antibiotics and fluids to improve his clinical condition, the patient underwent surgical excision of the infected prosthesis and a bifurcated rifampicin-impregnated Dacron graft was placed in situ. Cultures from the purulent fluid around the aorta and from the endograft revealed development of Candida albicans. To our knowledge, this is the first case of an infected endograft due to a fungus. The patient died from septic shock 3 days postoperatively in the intensive care unit.

Objective: The re-establishment of patency in a stenosed or thrombosed native arteriovenous fistula (AVF) is fundamental to regaining adequate hemodialysis through the same cannulable vein. Many surgeons have been reluctant to use even small segments of synthetic grafts in AVF revisions because of a perception that these would lead to poor results; however, studies comparing various treatment options are scarce. This study compared the use of short (<6 cm) polytetrafluoroethylene (PTFE) segments with pure autologous repair in stenosed or thrombosed native fistulas., Methods: The cumulative postintervention primary patency rates of two groups of hemodialysis patients receiving different surgical revision operations of their vascular accesses were prospectively compared. Group I (n = 30) comprised patients who presented with stenosed or thrombosed native fistulas and received short (2 to 6 cm) interposition PTFE grafts placed after the stenosed or thrombosed outflow vein segment was resected. These short PTFE grafts were not used for cannulation. Group II (n = 29) comprised patients who presented with dysfunctional or failed AVFs and underwent various types of pure autogenous corrections. AVF dysfunction or thrombosis was detected with clinical examination and color duplex ultrasound scanning. In all cases, on-table arteriography-fistulography was performed before surgical repair. Access adequacy was assessed in all patients postoperatively after the first puncture and every month thereafter (mean follow up 16.7 months)., Results: No statistically significant difference in patency was observed between the two groups. Postintervention cumulative patencies were 100%, 88%, and 82% for group I and 90%, 82%, and 71% for group II at 6, 12, and 18 months, respectively ( P = .8)., Conclusions: Short (<6 cm) interposition PTFE segments used for the revision of failing or failed AVFs compare favorably to purely native repair and do not alter the autologous behavior of the initial access. These short PTFE revisions resulted in satisfactory midterm primary patency without further consumption of the venous capital by harvesting segments of vein from other locations and without compromising more proximal access sites. This practice is recommended and is justified as part of an aggressive access salvage policy addressed by many authors so far.

One of the most serious complications in vascular surgery is infection of the vascular arterial prosthesis (VAP) which might lead to loss of limb or even death. Very often infected prostheses are combined with infectious infiltration of the adjacent tissues or even necrosis and their loss. This paper deals with the experience in the management of 5 patients suffering from infection of vascular arterial prostheses in various locations, for by-passing abdominal aorta and distal arteries with loss or necrosis of the skin and tissues adjacent to the graft. Removal of the infected graft was performed in all of the cases, together with wide debridement of the infested area and placement of a new graft, coursing far from the infected area for revascularization of the affected limb. The cleaned infected area was covered at a first or second stage by applying plastic procedures utilizing musculocutaneous tissue transfer. The results were quite satisfactory. We conclude that the management of infected vascular arterial prostheses, when these are combined with loss of adjacent tissues, is a challenge for the Vascular Surgeon. Their removal, extended cleaning and covering of the area by means of plastic procedures with tissue transfer, proved to be effective in the management of this problem.