EndoVAC hybrid therapy for salvage of patients with infected femoral artery reconstructions

Background
EndoVAC hybrid therapy for infected femoral artery reconstructions consists of endovascular relining with a stent graft, surgical debridement and vacuum-assisted wound closure (VAC), and may be considered as a bailout procedure. The aim of this study was to analyze differences in risk factors of patients receiving EndoVAC compared to standard VAC therapy for perivascular infected femoral artery reconstructions, and to describe the technique, complications and outcome of EndoVAC therapy.

Methods
Retrospective analysis of 183 patients receiving VAC or EndoVAC therapy for perivascular infections in the groin from January 2004 to December 2017 was performed. Failure of wound treatment was defined as a wound not healed within four months, visible graft material or native artery after one month, bleeding from the wound leading to discontinuation of treatment, death or amputation due to groin infection.

Results
The EndoVAC patients (n = 13) more often had ischemic heart disease (P = 0.008), more late wound infections after index operation (P < 0.001), had more often undergone previous ipsilateral groin incisions (P = 0.006) and presented more often with hemorrhage/femoral pseudoaneurysm (P < 0.001), compared to the standard VAC patients (n = 170). Major complications after EndoVAC therapy were stent graft occlusion (n = 3), major hemorrhage from the repaired reconstruction (n = 2), major amputation within six months (n = 4) and death due to infected reconstruction (n = 2). Ten (77%) groins healed, eight without major complications.

Conclusion
EndoVAC therapy appears to be a life-saving minimally invasive treatment option in surgical high-risk patients with infected femoral artery reconstruction and disrupted vascular anastomosis.