In situ replacement of infected aortic grafts with rifampicin-bonded prostheses: the Leicester experience (1992 to 1998)
OBJECTIVE
Prosthetic graft infection after aortic aneurysm surgery is a life-threatening complication. Treatment options include total graft excision and extra-anatomic bypass grafting or in situ replacement of the graft. The latter option is gaining increasing popularity, but the long-term outcome remains uncertain, particularly in light of the increasing prevalence of methicillin-resistant Staphylococcus aureus (MRSA). We performed a prospective nonrandomized study to assess the outcome after graft excision and in situ replacement with a rifampicin-bonded prosthesis for the treatment of major aortic graft infection.


METHODS
In a 6-year period from January 1992 to December 1997, 11 patients (eight men, three women) with major aortic graft infection underwent total graft excision and in situ replacement with a rifampicin-bonded prosthesis. The median age of the patients was 66 years (range, 49 to 78 years). Four patients had a hemorrhage from an aortoenteric fistula, three had a retroperitoneal abscess, two had graft occlusion, one had a perigraft collection shown by means of computed tomography, and one had a ruptured suprarenal false aneurysm. Organisms were cultured from 10 patients.


RESULTS
MRSA was isolated in two patients, both of whom had originally undergone repair of a ruptured abdominal aortic aneurysm. Two patients died (18.2%) within 30 days, and three patients (27.6%) had nonfatal complications (peritoneal candidiasis, transient renal impairment, and profound anorexia). Two patients died late in the follow-up period. Seven patients remain alive and clinically free of infection.


CONCLUSIONS
The long-term results after total graft excision and in situ replacement with a rifampicin-bonded prosthesis appear to be favorable. However, MRSA aortic graft infection appears to be associated with a poor prognosis.
Department of Vascular Surgery, the Leicester Royal Infirmary, Leicester, United Kingdom.
P D
PD
Hayes
A
A
Nasim
N J
NJ
London
R D
RD
Sayers
W W
WW
Barrie
P R
PR
Bell
A R
AR
Naylor
D000368:Aged; D000904:Antibiotics, Antitubercular / Q000008:administration & dosage*; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D016106:Methicillin Resistance; D011446:Prospective Studies; D016459:Prosthesis-Related Infections / Q000601:surgery*; D012293:Rifampin / Q000008:administration & dosage*; D013203:Staphylococcal Infections / Q000601:surgery*
D000904:Antibiotics, Antitubercular; D012293:Rifampin