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Background: The aim of this study was to retrospectively analyze early and late outcomes of infrainguinal revascularization performed with the Omniflow-II ® (LeMaitre Vascular, Inc., Burlington, MA, USA) biosynthetic vascular graft (BVG) for complex femoro-popliteal obstructive disease., Methods: Over a 10-year period, this BVG was used in 110 patients who underwent infrainguinal femoro-popliteal or femoro-distal bypass. Early (intraoperative and <30 days) results were analyzed in terms of death, thrombosis, amputations and reinterventions. Follow-up results were analyzed in terms of primary and secondary graft patency, and amputation-free survival., Results: We performed 87 (79.1%) above-the-knee bypass, 20 (18.2%) below-the-knee bypass, and 3 (2.7%) tibial artery bypass. In-hospital mortality was not observed. Mean follow-up was 66±37 months (range, 3-150). Estimated primary patency rate at 1, 2 and 5-years of follow-up was 77%±4 (95%CI: 68-84), 73%±5 (95%CI: 63.5-83), and 59%±6 (95%CI: 47-70.5) respectively. Predictors of primary patency loss were the presence of critical limb ischemia (P=0.048; HR: 2.1; 95%CI: 1.01-4.28), and the necessity of below-the-knee bypass (P=0.012; HR: 2.4; 95%CI: 1.22-4.75). Aneurysmal degeneration of the BVG was detected in 4 (3.6%) patients, an infected BVG occurred in 3 (2.7%) patients. The amputation-free survival was 96%±2 (95%CI: 91-99), 93%±3 (95%CI: 86-96), and 76%±5 (95%CI: 66-84) at 1, 2 and 5-years respectively., Conclusions: In our experience, Omniflow-II ® is a valid first-line alternative for infrainguinal revascularization when the ipsilateral autologous saphenous vein is not available. Aneurysmal degeneration was lower than previously reported with alternative BVGs, and the incidence of BVG infection was acceptably low.

We present two cases of partial graft removal and cryopreserved arterial homograft insertion for treatment of patent axillobifemoral (AXB) polytetrafluoroethylene (PTFE) prosthesis with infection confined only to a part of the graft. In the first patient, infection was confined to the left inguinal site; in the second, there was a cutaneous fistula in the middle prosthetic thoracic tract. Neither patient presented signs of systemic sepsis and radio immunological tests were positive only in a confined tract. After surgery, both patients showed early recovery and currently (mean follow-up 21-month) they are disease-free. Selective partial graft removal appears to give satisfactory results and may reduce the risk of complications compared with total graft removal Moreover, arterial homograft shows greater resistance to infection compared to alloplastic materials, when autologous veins are not available and/or not suitable.

Background: This study was designed to determine the use of bifurcated and not reversed saphenous vein in different cases., Case Description: We report two cases treated in the department of vascular surgery (Busto Arsizio, Varese, Italy) in which different arterial tracts had to be revascularized at the same time using not reversed autologus greater bifurcated saphenous vein. They are two different clinical situations (infection and very distal revascularization) treated by the same surgical technique. The two patients were subjected to angiographic examination in the pre- and postoperative period. During their follow-up, we carried out noninvasive surveillance (Doppler c.w.). The second were also subjected to bacterial culture and antibiogram to establish an adequate antibiotic therapy. The mean follow-up was 22 months: during this period rest pain disappeared and the trophic lesion recovered., Conclusions: In our experience, the use of not reversed and bifurcated vein was haemodynamically valid and able to maintain an arterial blood flow on the receiving arteries.

Critical ischemia is a pathology which requires the collaboration of a number of specialists and is often burdened by high morbidity and mortality rates. There are several possible therapeutic solutions, although each has its limits. The authors present a series of operated cases and compare the results of two different but alternative surgical methods (in situ and reversed saphena by-pass) depending on the patient's conditions. Perioperative and long-term results were comparable in both groups of patients.