Local infections after above-knee prosthetic femoropopliteal bypass for intermittent claudication.
BACKGROUND
The use of prosthetic grafts in the treatment of intermittent claudication is still a controversy. Prosthetic bypass for this usually benign condition may in some cases lead to a graft infection. This potentially disastrous complication is difficult to manage.


METHODS
One hundred forty-one consecutive operations done on 129 patients between January, 1990 and December, 2001 in a single university vascular unit have been studied. Lymphatic complications and local infections have been related to preoperative risk factors, complications, secondary procedures, and outcome.


RESULTS
During a mean follow-up period of 42 months, lymph complications occurred after 18 operations, surgical site infection after 11 procedures, and graft infection after 17 operations. Eleven infected grafts were treated successfully without graft excision. Six of these grafts healed with antibiotics only. The risk of developing a local infection was significantly correlated with postoperative lymph fistula. Reoperative surgery was associated with graft infection. Graft infection caused by Staphylococcus aureus always warranted surgery, either local revision or graft excision.


CONCLUSIONS
The present series had a high frequency of graft infections. Our data suggest that a selective approach should be taken towards excision of infected femoropopliteal prostheses. The need for and extent of surgery should be individualized according to the clinical presentation of the graft infection and the type of bacteria involved. We advocate a conservative attitude towards surgical treatment of intermittent claudication.
Pedersen
Gustav
G
Department of Surgery, Haukeland University Hospital, Bergen, Norway. gustav.pedersen@helse-bergen.no
Laxdal
Elin
E
Hagala
Malgorzata
M
Aune
Steinar
S
D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D000792:Angiography; D017130:Angioplasty / Q000009:adverse effects / Q000379:methods*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001807:Blood Vessel Prosthesis; D015331:Cohort Studies; D005260:Female; D005263:Femoral Artery / Q000601:surgery; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000453:epidemiology; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007383:Intermittent Claudication / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011150:Popliteal Artery / Q000601:surgery; D011336:Probability; D011379:Prognosis; D011446:Prospective Studies; D016459:Prosthesis-Related Infections / Q000175:diagnosis* / Q000628:therapy; D012086:Reoperation; D018570:Risk Assessment; D012720:Severity of Illness Index
D000900:Anti-Bacterial Agents