Management of aortic graft infection.
BACKGROUND
The optimal method of operative treatment of prosthetic aortic graft infection (PAGI) has been the subject of debate; incidence rates of PAGI are low. Diagnosis of PAGI can be difficult. The aim of this retrospective study is to evaluate our results in treating PAGI in order to try and optimize the treatment of this grave problem.


METHODS
Thirty-eight patients (median age 68.5 years) were treated for PAGI between 1991 and 2000. Management of PAGI was performed with total graft excision and simultaneous extra-anatomic bypass (n=18), total graft excision and in situ repair with a Rifampicin-soaked gelatin-impregnated prosthetic aortic graft (n=8), or a partial excision with in situ repair (n=11). In 1 patient, only local irrigation was performed. The median follow-up was 45 months.


RESULTS
Clinical presentation of PAGI (median interval 3 years) was: discomfort/pain (n=14), gastro-intestinal bleeding (n=11), persisting fever (n=8), or a non-healing wound (n=5). The primary patency rate in patients with extra-anatomic bypass was 67% at 6 months follow-up. In patients with other surgical reconstructions no graft occlusion was encountered. Overall amputation rate was 5%. Recurrent infection of the graft was 15%. The overall early mortality rate in this study was 21%.


CONCLUSIONS
The diagnosis of PAGI is difficult and should be based on a combination of clinical symptoms, laboratory findings and imaging techniques. There are several treatment options that should be tailored to the extent of infection and the patients' physical condition. In a selected group of patients partial excision of the infected graft only can be justified.
Ten Raa
S
S
Department of Vascular Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.
Van Sambeek
M R H M
MR
Hagenaars
T
T
Van Urk
H
H
D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D011788:Quality of Life; D012086:Reoperation; D016019:Survival Analysis; D013997:Time Factors