title: Priority of revascularization in patients with graft enteric fistulas, infected arteries, or infected arterial prostheses.
abstract: Patients with arterial infections, infected arterial prostheses, or graft enteric erosions or fistulas have high amputation and mortality rates after treatment. An unresolved therapeutic question is whether remote ("extra-anatomic") bypass should precede or follow removal of the infected artery or prosthesis. None of the ten patients reported here who had a remote bypass inserted first developed distal limb ischemia or infection of the remote bypass. Literature review of patients with aortic prosthetic infections revealed a mortality of 71% (10/14) if infected graft removal preceded remote bypass and 26% (6/23) if remote bypass was first. Patients with graft enteric erosions or fistulas had a mortality of 53% (40/75) if graft removal was first and 17% (5/29) if remote bypass was first. Subsequent infection of the remote bypass was rare. Therefore, when possible, remote bypass with a prosthetic graft should precede removal of an infected artery, an infected arterial prosthesis, a graft enteric erosion, or a graft enteric fistula.
mesh_terms: D000368:Aged; D001012:Aorta, Abdominal / Q000601:surgery; D001167:Arteritis / Q000601:surgery*; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D004322:Drainage; D005260:Female; D005263:Femoral Artery / Q000601:surgery; D005402:Fistula / Q000209:etiology / Q000601:surgery*; D006801:Humans; D007083:Iliac Artery / Q000601:surgery; D007412:Intestinal Fistula / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery; D012086:Reoperation; D013530:Surgical Wound Infection / Q000601:surgery*