title: Bacterial and clinical criteria relating to the outcome of patients undergoing in situ replacement of infected abdominal aortic grafts.
abstract: OBJECTIVE
  In a retrospective non-randomised study we assessed the outcome after in situ replacement of infected knitted Dacron abdominal aortic grafts in patients without septicaemia or retroperitoneal abscesses. We also assessed whether the specific bacterial infection influenced outcome.
  
  
  METHODS
  Over the 5 years studied, 18 patients (9 with perigraft infection and 9 with aortoenteric erosion) underwent in situ replacement of aortofemoral grafts. All patients were haemodynamically stable, none required emergency treatment. Preoperative assessment included CT, MRI, leukocyte-labelled scintigraphy, and bacterial cultures whenever possible. Infected grafts were totally excised and replaced in situ with standard PTFE prostheses. Bacterial diagnosis included intraoperative Gram-staining and postoperative graft cultures. None of the patients had retroperitoneal collections or proximal anastomotic dehiscence. All patients had 6 week intravenous antibiotic therapy.
  
  
  RESULTS
  One patient died of myocardial infarction, and another of haemorrhagic shock from proximal anastomotic dehiscence, accounting for a graft-related mortality of 6%. Dehiscence resulted from a polymicrobial infection. Mean 37 month surveillance showed no amputations and no graft-related infections.
  
  
  CONCLUSIONS
  In clinically and bacteriologically selected patients, total in situ replacement of infected abdominal aortic grafts offers an excellent outcome.
authors.affiliation: Department of Vascular Surgery, University of Rome La Sapienza, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Speziale
authors.forename: L
authors.initials: L
authors.lastname: Rizzo
authors.forename: E
authors.initials: E
authors.lastname: Sbarigia
authors.forename: M F
authors.initials: MF
authors.lastname: Giannoni
authors.forename: M
authors.initials: M
authors.lastname: Massucci
authors.forename: C
authors.initials: C
authors.lastname: Maraglino
authors.forename: E
authors.initials: E
authors.lastname: Santoro
authors.forename: P
authors.initials: P
authors.lastname: Fiorani
mesh_terms: D000328:Adult; D000368:Aged; D001012:Aorta, Abdominal / Q000601:surgery*; D001419:Bacteria / Q000302:isolation & purification*; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene; D011183:Postoperative Complications; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000382:microbiology / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D011138:Polytetrafluoroethylene