Antibiotic irrigation and conservative surgery for major aortic graft infection.
OBJECTIVE
Traditional surgical treatment for panprosthetic aortic graft infection entails radical excision of the graft, aortic stump closure, and extraanatomic revascularization of the lower limbs. This carries an early mortality rate of 24% to 45%. Amputation rates range from 11% to 37%. Multiple operations and prolonged hospital stay are usual. We have developed a more conservative management technique with the aim of improving outcome.


METHODS
We describe an innovative method of treating the condition with prolonged, high-dose, local antibiotic irrigation therapy, systemic antibiotic treatment, surgical debridement, and graft conservation in a prospectively studied series of 10 patients.


RESULTS
The actual 30-day patient survival rate is 90%, the 1-year survival rate is 80%, and the 4-year survival rate is 67%. Two patients died because of graft infection, and the third died, uninfected, of an unrelated cause. No limbs have been amputated. Only two patients required a second operation. Mean postoperative hospital stay was 32 days. The seven survivors have been closely followed up with regular computed tomography or indium scanning and clinical examination and appear to be free from infection at a mean of 61 months after cessation of irrigation therapy.


CONCLUSIONS
The technique appears to represent a significant improvement in the management of this major complication of vascular surgery.
Department of Surgery, Cambridge, Royal Army Medical College, Millbank, London, United Kingdom.
G E
GE
Morris
P J
PJ
Friend
D J
DJ
Vassallo
M
M
Farrington
S
S
Leapman
C R
CR
Quick
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001011:Aorta / Q000601:surgery*; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery; D001018:Aortic Diseases / Q000188:drug therapy* / Q000601:surgery; D001424:Bacterial Infections / Q000188:drug therapy* / Q000601:surgery; D001807:Blood Vessel Prosthesis; D003131:Combined Modality Therapy; D004322:Drainage; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D011183:Postoperative Complications / Q000188:drug therapy* / Q000601:surgery; D011446:Prospective Studies; D015996:Survival Rate; D007507:Therapeutic Irrigation
D000900:Anti-Bacterial Agents