title: Gradual Hunterian ligation for infected prosthetic bypass.
abstract: OBJECTIVE
  To review gradual snare occlusion for the management of complex or recurrent graft infection.
  
  
  METHODS
  Medical records of patients treated with gradual snare occlusion following graft infection were reviewed for indication for operation, type of bypass and graft material used. In addition, infecting organism, grade of infection (Szilágyi) and outcome were recorded.
  
  
  RESULTS
  Four femoropopliteal, two extra-anatomic (axillofemoral) and aortobifemoral bypasses were included in this study. All had chronic infection (Szilágyi grade III) with onset of 4 to 24 months and two of which were recurrent. The causative organisms were coagulase-negative staphylococci, Staphylococcus epidermidis and methicillin-resistant Staphylococcus aureus in three patients, with no organism isolated in the remaining cases. There was no loss of limb following gradual snare occlusion but there was only one death due to aortic stump rupture 2 weeks later.
  
  
  CONCLUSIONS
  Gradual snare occlusion is an alternative for the management of chronic or recurrent graft infection.
authors.affiliation: Department of Surgery, Vascular Studies Unit, South Manchester University Hospital, Nell Lane, Manchester, West Didsbury, M20 8LR, UK.
authors.forename: A
authors.initials: A
authors.lastname: Egun
authors.forename: D
authors.initials: D
authors.lastname: Slade
authors.forename: C N
authors.initials: CN
authors.lastname: McCollum
mesh_terms: D000328:Adult; D000368:Aged; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D002908:Chronic Disease; D003131:Combined Modality Therapy; D006083:Graft Occlusion, Vascular / Q000209:etiology / Q000601:surgery; D006801:Humans; D008026:Ligation / Q000379:methods; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000150:complications / Q000601:surgery*; D012008:Recurrence; D013203:Staphylococcal Infections / Q000150:complications / Q000601:surgery*; D013212:Staphylococcus epidermidis; D016896:Treatment Outcome