Results of Obturator Foramen Bypass in Patients with Groin Infection and Arterial Involvement.

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Citation: Annals of Vascular Surgery. 75:144-149, 2021 Aug.PMID: 33848584Institution: MedStar Heart & Vascular Institute | MedStar Union Memorial Hospital | MedStar Washington Hospital CenterDepartment: Surgery/Vascular Surgery | Vascular Surgery Integrated ResidencyForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Aneurysm, False/su [Surgery] | *Aneurysm, Infected/su [Surgery] | *Blood Vessel Prosthesis Implantation/ae [Adverse Effects] | *Blood Vessel Prosthesis/ae [Adverse Effects] | *Femoral Artery/su [Surgery] | *Lower Extremity/bs [Blood Supply] | *Prosthesis-Related Infections/su [Surgery] | Adult | Aged | Amputation | Aneurysm, False/di [Diagnosis] | Aneurysm, False/mi [Microbiology] | Aneurysm, False/pp [Physiopathology] | Aneurysm, Infected/di [Diagnosis] | Aneurysm, Infected/mi [Microbiology] | Aneurysm, Infected/pp [Physiopathology] | Blood Vessel Prosthesis Implantation/is [Instrumentation] | Female | Femoral Artery/mi [Microbiology] | Femoral Artery/pp [Physiopathology] | Humans | Limb Salvage | Male | Middle Aged | Prosthesis-Related Infections/di [Diagnosis] | Prosthesis-Related Infections/mi [Microbiology] | Prosthesis-Related Infections/pp [Physiopathology] | Reoperation | Retrospective Studies | Risk Factors | Time Factors | Treatment Outcome | Vascular PatencyYear: 2021ISSN:
  • 0890-5096
Name of journal: Annals of vascular surgeryAbstract: CONCLUSION: OFB is a safe and effective surgical option in patients who are unable to undergo anatomic tunneling during lower extremity bypass. OFB is associated with favorable rates of primary patency and amputation-free survival at mid-term follow-up. Copyright (c) 2021. Published by Elsevier Inc.METHODS: A multi-hospital, single-entity healthcare system retrospective review was conducted for all patients who underwent OFB between January 2014 through June 2020. Any patient >18 years of age who underwent OFB in the setting of groin infection with a minimum of 30 days follow up was included in the trial. Demographic, operative and clinical characteristics of patients were gathered during chart review. Statistical analysis was performed using Microsoft Excel and R studio.OBJECTIVE: Arterial bypass tunneling via the obturator foramen (OFB) can be performed to circumvent groin infections during lower extremity revascularization. The objective of this study is to report safety and efficacy outcomes of OFB in the setting of infected femoral pseudoaneurysms and infected prosthetic femoral bypass grafts.RESULTS: Seventeen patients underwent OFB during the defined time period. Demographic data are presented in Table 1. Mean American Society of Anesthesiologists' (ASA) score was 3.25. Mean estimated blood loss (EBL) was 500 milliliters (mL). Mean operative time was 307 minutes. Mean follow-up time was 8.5 months (range 0-35 months). 41.2 percent patients underwent fluoroscopic-guided tunneling, and, when compared to blind tunneling, showed no difference in intraoperative complications or operative time (p-value 0.3). 52.9% of patients required ICU admission resulting in a mean number of 0.8 ICU days. Overall mean length of stay (LOS) was 16.8 days. Two major amputations were reported during follow up. Patient mortality within 30 days was 0%. Primary patency within 30 days was 100%. Intravenous drug use (IVDU) was not associated with an increased number of subsequent groin wound procedures (p-value 0.3). IVDU was not associated with concomitant methicillin-resistant Staphylococcus aureus (MRSA) infection (p-value 0.3).All authors: Abramowitz SD, Alfawaz AA, Dunphy KM, Fatima J, Hassey J, Kiguchi MM, Vallabhaneni R, Woo EYOriginally published: Annals of Vascular Surgery. 2021 Apr 10Fiscal year: FY2022Fiscal year of original publication: FY2021Digital Object Identifier: Date added to catalog: 2021-06-07
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Journal Article MedStar Authors Catalog Article 33848584 Available 33848584

CONCLUSION: OFB is a safe and effective surgical option in patients who are unable to undergo anatomic tunneling during lower extremity bypass. OFB is associated with favorable rates of primary patency and amputation-free survival at mid-term follow-up. Copyright (c) 2021. Published by Elsevier Inc.

METHODS: A multi-hospital, single-entity healthcare system retrospective review was conducted for all patients who underwent OFB between January 2014 through June 2020. Any patient >18 years of age who underwent OFB in the setting of groin infection with a minimum of 30 days follow up was included in the trial. Demographic, operative and clinical characteristics of patients were gathered during chart review. Statistical analysis was performed using Microsoft Excel and R studio.

OBJECTIVE: Arterial bypass tunneling via the obturator foramen (OFB) can be performed to circumvent groin infections during lower extremity revascularization. The objective of this study is to report safety and efficacy outcomes of OFB in the setting of infected femoral pseudoaneurysms and infected prosthetic femoral bypass grafts.

RESULTS: Seventeen patients underwent OFB during the defined time period. Demographic data are presented in Table 1. Mean American Society of Anesthesiologists' (ASA) score was 3.25. Mean estimated blood loss (EBL) was 500 milliliters (mL). Mean operative time was 307 minutes. Mean follow-up time was 8.5 months (range 0-35 months). 41.2 percent patients underwent fluoroscopic-guided tunneling, and, when compared to blind tunneling, showed no difference in intraoperative complications or operative time (p-value 0.3). 52.9% of patients required ICU admission resulting in a mean number of 0.8 ICU days. Overall mean length of stay (LOS) was 16.8 days. Two major amputations were reported during follow up. Patient mortality within 30 days was 0%. Primary patency within 30 days was 100%. Intravenous drug use (IVDU) was not associated with an increased number of subsequent groin wound procedures (p-value 0.3). IVDU was not associated with concomitant methicillin-resistant Staphylococcus aureus (MRSA) infection (p-value 0.3).

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