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Aortoiliofemoral Bypass

Management of aortic graft infection has historically been associated with the highest mortality rates and considerable risk of limb amputation. However, several recent large series have demonstrated a significant improvement in outcomes, with mortality rates ranging from 10% to 17% and limb amputation rates ranging from 4% to 12%. A common denominator underlying this improved outcome has been the staging of operative management. Whereas formerly the infected graft was explored and resected as the initial step and then extra-anatomic bypass performed, current evidence supports preceding graft excision with extra-anatomic revascularization. This reduces the duration of peripheral ischemia, operative blood loss, and association complications. One can stage the procedure by one or several days. Although there is little evidence that the new extra-anatomic graft will experience thrombosis because of competitive flow or become secondarily infected during the interval, …