Management of the prosthetic vascular graft infections--the influence of predictive factors on treatment results.
BACKGROUND
This prospective non-randomized single center study evaluated the predictive significance of various factors to the treatment outcomes of the prosthetic vascular graft infections.


METHODS
46 patients with the prosthetic vascular graft infection underwent the treatment. The prosthesis extirpation was performed in 37 cases. The extra-anatomical reconstruction was implanted in 18 and the in situ reconstruction in 12 patients. In 9 patients, only local treatment was applied. The influence of the preoperative factors (patient's age, type of primary procedure, type of infection, positive hemoculture, diabetes mellitus, comorbidity, C-reactive protein, leucocytosis, repeated interventions) on the result of the treatment was evaluated with the multivariate analysis.


RESULTS
On the 30 day, the postoperative mortality was 23.9%. One and three years after the treatment, 72.1 and 57.8% of patients, respectively, survived. C-reactive protein above 90 mg/l (Wilcoxon test p<0.02, Log-rank test p<0.01), and leucocytosis >13 x 10(9)/l (Wilcoxon test p<0.0001, Log-rank test p<0.0004) were significant factors for patients morbidity and mortality. There were no preoperative factors with a statistically significant cut-off value which should be important for the long-term graft patency.


CONCLUSIONS
C-reactive protein and leucocytosis are simple preoperative predictive markers of the treatment results of the prosthetic vascular graft infections. An early and aggressive diagnostic and therapeutic procedure is recommended in patients with the pre-operative levels of CRP higher than 90 mg/l and leucocytosis of 13 x 10(9)/l (Tab. 5, Fig. 3, Ref. 30). Full Text (Free, PDF) www.bmj.sk.
Department of Surgery, University Hospital, Medical Faculty of Charles University of Prague, Pilsen, Czech Republic. treska@fnplzen.cz
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Treska
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Houdek
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Vachtova
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Smid
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Kormunda
D000368:Aged; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D002097:C-Reactive Protein / Q000032:analysis; D020878:Device Removal; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016459:Prosthesis-Related Infections / Q000097:blood / Q000175:diagnosis / Q000601:surgery*; D012086:Reoperation
D002097:C-Reactive Protein