Autogenous paneled femoral vein grafts for mycotic thoracic aortic aneurysms

Objective

Mycotic thoracic aortic aneurysms (MTAAs) are rare. The most common management has been aortic resection, wide debridement, and in-line reconstruction using prosthetic grafts. We have used autogenous femoral vein (FV) for the repair of all MTAA in our institution since 2017. This is the initial description of this technique, and the first comparative study of autogenous vein compared with prosthetic for MTAAs.

Methods

This is a single-center retrospective cohort study of all patients with MTAA who underwent operative repair. Patients were assigned to the FV or prosthetic grafts cohorts. Perioperative and long-term outcomes were collected. Univariate logistic regression models were fitted to quantify the strength of differences between the cohorts.

Results

Nineteen patients were included. The first 9 consecutive patients had prosthetic grafts, whereas the 10 subsequent patients were treated with FV grafts. Patients in the FV cohort were more likely to have positive intraoperative cultures (90% vs 33.3%; P = .02), receive intraoperative transfusions (10 vs 8 units; P = .08), and have a longer operation (629 vs 500 minutes; P = .07). There was a trend toward improved in-hospital (0 vs 33%; P = .09) and long-term mortality (10% vs 55.6%; P = .57) in the FV cohort. Patients in the FV cohort were more likely to be discharged home (90% vs 44.4%; P = .05).

Conclusions

Paneled autogenous FV repair is a durable and safe treatment for patients with MTAA. There were no in-hospital deaths in our series and there have been no long-term complications related to the vein graft repair.