Case study: chronic femoropopliteal prosthetic graft infection with exposed graft.
One of the most feared complications following vascular reconstruction is infection due to the attendant risks of limb loss, sepsis, or death. The reported incidence of infection following infrainguinal prosthetic graft infection is 2.5% with associated mortality rates and amputation rates of 18% and 41%, respectively. There are several options in treating infected prosthetic infrainguinal bypass grafts. Some authors have advocated complete removal of the infected graft with concomitant in situ revascularization using autogenous tissue or extra-anatomic bypass using either autogenous or prosthetic material, depending upon the clinical circumstances. Other authors have advocated attempting graft preservation to decrease the risk of amputation. Infected, thrombosed grafts are generally treated with graft excision alone with care taken to preserve collateral flow. The treatment options may also be influenced by the type of infection, as infections caused by gram-negative bacteria are thought to be more virulent than those associated with gram-positive bacteria. We recently treated a patient with an 18-month history of an exposed prosthetic graft in the groin, which was infected by Proteus mirabilis. Despite the extended period of graft exposure and despite gram-negative bacteria being the causative organism, the patient reported only intermittent drainage of pus from the groin. The management of this unusual infection forms the basis of this report.
McCready
Robert A
RA
Division of Vascular Surgery, Methodist Hospital, Clarian Health Partners, Indianapolis, Indiana, USA. rmccgoirish@aol.com
Bryant
M Ann
MA
Divelbiss
Janet
J
Wack
Matthew F
MF
Mattison
H Reid
HR
D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation; D002908:Chronic Disease; D020878:Device Removal; D005260:Female; D005263:Femoral Artery / Q000601:surgery* / Q000637:transplantation; D006801:Humans; D016491:Peripheral Vascular Diseases / Q000601:surgery*; D011150:Popliteal Artery / Q000601:surgery*; D016459:Prosthesis-Related Infections / Q000000981:diagnostic imaging / Q000209:etiology / Q000382:microbiology / Q000601:surgery*; D011513:Proteus mirabilis / Q000302:isolation & purification; D012086:Reoperation; D013524:Surgical Flaps; D014057:Tomography, X-Ray Computed; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014945:Wound Healing
D000900:Anti-Bacterial Agents