71308 - Assessing Efficacy and Survival of the Neo-Aortoiliac System Bypass (NAIS) Technique at Sahlgrenska University Hospital

Introduction

In-situ reconstruction with the neo-aortoiliac system bypass (NAIS) technique is one option to manage both primary mycotic aneurysms and secondary aortic graft and endograft infections in the abdominal aorta. The aim of this study was to evaluate NAIS procedural outcomes at the Sahlgrenska University Hospital.

Method

The National Quality Registry for Vascular Surgery and local registries were used to identify all patients undergoing NAIS between 2010-2023.

Result

Thirty-two patients (25 males, 17 previous open repairs, 8 previous EVAR and 1 previous FEVAR; 14 presenting with aorto-enteric fistula) operated with NAIS based on autologous veins (n=26) or bovine pericardial grafts (n=6) were reviewed. The median time from the primary aortic intervention to NAIS was 65 months (range 1-217 months). Twenty-nine (94%) had a positive microbial culture. Twenty (63%) patients required suprarenal clamping, and the renal vein was divided in 16 (50%) patients. Periprocedural temporary renal or mesenteric artery endoshunting was performed in 11 patients, and prosthetic material was explanted under supravisceral aortic balloon occlusion in 12 patients.

All but three patients survived 30 days (91%) whereas 26/32 (82%) patients survived until 90 days. Freedom from antimicrobial treatment at 90 days, 6 months and one year were 11/26 (42%), 20/25 (80%) and 21/23 (91%, three patients not yet reaching 1 year follow-up). After a mean follow-up time of 59 (±SD 52.1) months, 22 out of 32 (69%) patients remained alive.

Discussion

The NAIS procedure yielded favorable overall survival outcomes and exhibited a high curative frequency marked by cessation of antimicrobial therapy.