title: Long-term results of vascular graft and artery preserving treatment with negative pressure wound therapy in Szilagyi grade III infections justify a paradigm shift.
abstract: OBJECTIVE
  To present the first long-term results of Szilagyi III vascular infections treated by negative pressure wound therapy (NPWT) with graft preservation.
  
  
  BACKGROUND
  Szilagyi III infections are usually treated by graft/artery excision and secondary vascular/plastic reconstruction. Small series treated with NPWT without graft removal are reported with good short-term to midterm results.
  
  
  METHODS
  The outcomes of 44 polymorbid patients (mean age = 62 years) with Szilagyi III infections from 2002 to 2009 were analyzed. Thirteen of forty-four required intensive care unit treatment. Forty grafts (prosthetic = 24, vein = 3, biological = 13) and 9 native arteries were involved. Negative pressure wound therapy (VAC; KCI International, Amstelveen, Netherlands) was applied directly on grafts/arteries (negative pressure = 50-125 mm Hg) after radical debridement of infected tissue. Antibiotic treatment was initiated and adapted according to microbiology.
  
  
  RESULTS
  Median duration of NPWT was 33 days (IQR: 20-78), of hospital stay 32 (IQR: 20-82) days. All patients survived 30 days. One-year mortality was 16% (7/44). Long-term mortality after a mean follow-up of 43 months (SD: 21) was 41% (18/44). Complete wound healing was achieved in 91% (40/44). In 37 of 44 patients, grafts were preserved long-term without reinfection. There was no statistically significant difference in outcome between the various graft types involved.
  
  
  CONCLUSIONS
  Vascular graft/arterial preserving treatment with NPWT in Szilagyi III infections was safe and effective with a very low short-term mortality. The majority of infected grafts were preserved without reinfection during a mean long-term follow-up of 4 years. This new treatment algorithm avoids major reconstructive surgery and should be used when dealing with Szilagyi III vascular infections.
authors: Clinic for Cardiovascular Surgery, University Hospital of Zurich, Zurich, CH. dieter.mayer@usz.ch
authors: Dieter
authors: D
authors: Mayer
authors: Barbara
authors: B
authors: Hasse
authors: Jeannette
authors: J
authors: Koelliker
authors: Markus
authors: M
authors: Enzler
authors: Frank J
authors: FJ
authors: Veith
authors: Zoran
authors: Z
authors: Rancic
authors: Mario
authors: M
authors: Lachat
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D003646:Debridement; D016894:Endarterectomy, Carotid; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy; D016459:Prosthesis-Related Infections / Q000601:surgery*; D013530:Surgical Wound Infection / Q000601:surgery*; D016896:Treatment Outcome; D014945:Wound Healing; D055815:Young Adult