Management of infected peripheral bypass by selective partial graft removal and arterial homograft insertion. Two case reports.
We present two cases of partial graft removal and cryopreserved arterial homograft insertion for treatment of patent axillobifemoral (AXB) polytetrafluoroethylene (PTFE) prosthesis with infection confined only to a part of the graft. In the first patient, infection was confined to the left inguinal site; in the second, there was a cutaneous fistula in the middle prosthetic thoracic tract. Neither patient presented signs of systemic sepsis and radio immunological tests were positive only in a confined tract. After surgery, both patients showed early recovery and currently (mean follow-up 21-month) they are disease-free. Selective partial graft removal appears to give satisfactory results and may reduce the risk of complications compared with total graft removal Moreover, arterial homograft shows greater resistance to infection compared to alloplastic materials, when autologous veins are not available and/or not suitable.
Locati
P
P
Division of Vascular Surgery, Busto Arsizio General Hospital, Italy.
Socrate
A M
AM
Costantini
E
E
Maggiolo
F
F
D000328:Adult; D000900:Anti-Bacterial Agents; D001157:Arterial Occlusive Diseases / Q000601:surgery; D001419:Bacteria / Q000302:isolation & purification; D001424:Bacterial Infections / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D001672:Biocompatible Materials; D001807:Blood Vessel Prosthesis / Q000009:adverse effects* / Q000382:microbiology; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D020878:Device Removal; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D005263:Femoral Artery / Q000637:transplantation*; D006801:Humans; D007083:Iliac Artery / Q000637:transplantation*; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D012086:Reoperation; D014019:Tissue Donors; D014184:Transplantation, Homologous
D000900:Anti-Bacterial Agents; D001672:Biocompatible Materials; D011138:Polytetrafluoroethylene