Modified Technique for Recovering Aortoiliac Homografts

Abstract

Background

Infection of the prosthetic aortic graft bypass remains one of the most serious complications of aortoiliac bypass grafts. Use of an aortoiliac allograft as a replacement for an infected prosthetic graft is an effective treatment for this problem. However, the availability of aortoiliac grafts is affected by the high rate of procurement errors experienced during recovery. This overall error rate nationally averaged 32.5% in 2006, of which nearly a third (9.6%) were related to tears of the intima at or below the bifurcation of the abdominal aorta.

Objective

To analyze the potential of a new aortoiliac graft recovery method in reducing the error rate.

Method

A modified technique of aortoiliac graft recovery was used to minimize the possibility of intimal tears. The essence of this technique is to change the sequence of mobilization of the graft, starting from the zone of low resistance, which is at the iliac arteries, and continuing upward to the abdominal aorta, which has higher resistance because of the greater thickness of the aortic wall. An additional modification of the standard technique is to use a tourniquet to raise the aortic edges.

Conclusion

The aortoiliac graft has various resistances to tearing owing to the different wall thicknesses of the aorta and the iliac arteries. Mobilization of the abdominal aorta before dissection of the iliac arteries creates a high risk of tears at and around the bifurcation of the aorta and the iliac arteries.