An aggressive local approach to vascular graft infection.
OBJECTIVE
To present the use of sartorius myoplasty (SM) and superficial femoral vein (SFV) in a graft-sparing approach to vascular graft infection.


METHODS
Twenty-five patients were treated for Szilagyi grade III groin infections during the last 10 years. Fifteen presented early (E), mean 2 months; 10 late (L), mean 6.5 years. Bacteria E/L: Staphylococcus epidermidis 1/7, S aureus 6/0, other gram positive 1/0, gram negative 4/1, mixed 6/0 (one pseudomonas). There were 13 aortofemoral (AF), 5 crossover, and 7 femoral distal reconstructions. SM was used to cover exposed grafts after radical debridement. When the graft was free-floating or bleeding, this segment was removed and replaced with SFV. The remaining infection was controlled with antibiotics.


RESULTS
One of 10 patients treated by SM alone required SFV replacement for bleeding. Four of 9 AFs treated by partial SFV replacement +/- SM had persistent infection treated by complete graft removal in 3. Six grafts were removed electively in lower risk situations. There was no perioperative mortality, and no early or late limb loss.


CONCLUSIONS
This experience supports an attempt at aggressive local treatment in frail patients.
Sladen
J G
JG
Department of Surgery, St. Paul's Hospital, Vancouver, British Columbia, Canada.
Chen
J C
JC
Reid
J D
JD
D000368:Aged; D001807:Blood Vessel Prosthesis; D005260:Female; D005268:Femoral Vein / Q000637:transplantation; D006801:Humans; D008297:Male; D011138:Polytetrafluoroethylene; D016459:Prosthesis-Related Infections / Q000000981:diagnostic imaging / Q000628:therapy; D012086:Reoperation; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed
D011138:Polytetrafluoroethylene