Neoaortoiliac System in Infected Aortic Aneurysms

Introduction: Prosthetic grafts are the standard conduits in aortic reconstructions; however, in the context of infection, even antibiotic-coated prosthetics carry a significant risk of persistent, life-threatening complications. Aortic graft infections, though rare, are associated with high mortality rates of up to 22%. Biological alternatives are increasingly favored. The 2020 ESVS guidelines recommend autologous veins for abdominal and cryopreserved allografts for thoracic infections to avoid synthetic materials in contaminated fields. Xenografts, such as bovine pericardial patches (BPTs), have also shown favorable results. Materials and Methods: This case series evaluates the data of ten patients with infected aortic pathologies treated using vein autografts or tabularized BPTs in a neoaortoiliac system (NAIS) configuration. Patients were followed for short- and long-term outcomes using clinical, biochemical, and radiological assessments. Results: Between 2019 and 2025, ten patients underwent NAIS reconstruction using femoral veins (FV) or BPTs. The mean follow-up period was 25 months. Indications included one aortoenteric fistula, four ruptured infrarenal or juxtarenal aneurysms, and three infected abdominal aortic aneurysms. Graft configurations varied, with the aortobiiliac form of the tabularized bovine patch being most common. Others were a tabularized bovine patch in the tube configuration, FV in the aortobiiliac configuration, and FV as a panel graft in the tubular configuration. One patient developed left limb ischemia postoperatively, for which embolectomy was done, and the flow was restored. However, this patient eventually died due to graft thrombosis 3 months after surgery. The remaining nine patients experienced favorable outcomes with graft patency, limb viability, and infection-free recovery. Imaging, where available, showed no perigraft collections or stenosis. Conclusion: NAIS reconstruction using autologous or xenograft materials offers a viable and effective alternative to prosthetic grafts in infected aortic pathologies. NAIS demonstrates comparable patency rates when minimizing the risk of reinfection, supporting its role as a promising treatment strategy in complex aortic infections.