Surgical management of prosthetic vascular graft infection: comparative retrospective analysis of 30 consecutive cases.
BACKGROUND
Graft infection after vascular prosthetic reconstruction for the treatment of peripheral arterial occlusive disease (PAOD) is a rare but severe complication with poor outcome. The options for surgical treatment are not uniformly accepted and remain controversial.


METHODS
We retrospectively analyzed the histories of 30 patients treated for prosthetic graft infection (Szilagyi grade III) in our hospital between 1994 and 1999 to determine which forms of treatment were best suited for which types of patient. In the majority of cases the initial treatment was lower-extremity bypass surgery. The most frequent location of infection was the groin (73%). Staphylococci (13% of which were methicillin resistant) were the most common type of bacteria. The overall incidence of prosthetic infection was 2.3%.


RESULTS
After confirmation of the infection by computed tomography (CT) or white blood cell scintigraphy, one of the following 5 forms of surgical treatment was performed: 1. Removal of the infected prosthesis and its simultaneous replacement by an autologous vein bypass. 2. Bypass removal and secondary replacement by an autologous vein. 3. Extra-anatomical replacement. 4. Graft removal and primary amputation. 5. Local therapy with debridement and secondary wound healing. In some patients primary amputation after graft infection was necessary to prevent further deterioration with fulminant sepsis. The overall mortality was 17%, the amputation rate was 60%.


CONCLUSIONS
The best results were achieved by early complete removal of the alloplastic material and one-step replacement by either an autologous vein or extra-anatomic bypass. This resulted in a limb salvage rate of 54% and 40% and mortality rates of 9% and 0%, respectively.
Gassel
H J
HJ
Department of Surgery, University Hospital of Würzburg, Germany. heinz-jochen.gassel@mail.uni-wuerzburg.de
Klein
I
I
Steger
U
U
Kellersmann
R
R
Hamelmann
W
W
Franke
S
S
Thiede
A
A
D000368:Aged; D000369:Aged, 80 and over; D001807:Blood Vessel Prosthesis; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D016106:Methicillin Resistance; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery