title: Remnant prosthetic graft in revision or limb-salvage surgery: routine complete excision?
abstract: BACKGROUND
  Prosthetic graft occlusion following vascular reconstruction is a major cause of morbidity commonly necessitating further limb-salvage revascularization or life-saving amputation. It is therefore surprising that there is scant data in the literature regarding the optimal management of any remnant prosthetic grafts left in situ. We present a case series of 3 patients with remnant prosthetic graft infection following revisional arterial reconstruction for limb salvage and a literature review on this topic.
  
  
  METHODS
  Three patients presented to our institution with remnant prosthetic graft infection between March 2012 and January 2013. They had all undergone previous infrainguinal bypass surgery with polytetrafluorethylene (PTFE) grafts, which had subsequently thrombosed. Further limb salvage operations with autogenous long saphenous vein bypass in 2 cases and above-knee amputation in 1 case were performed. In all cases, the focus of infection was confirmed to have originated in the redundant remnant PTFE graft left in situ. These grafts were completely excised and the infected wounds were debrided. All patients made a full recovery.
  
  
  CONCLUSIONS
  Remnant prosthetic grafts left in situ are shown in this series to be a proven nidus for infection. Published data indicate that these infection rates are greatest in revision vascular surgery and when performing amputations. We propose that routine excision of any occluded remnant prosthetic grafts in revision surgery be considered at the time of revascularization to mitigate against the risk of subsequent infection.
authors: Department of Vascular Surgery, St Peter's Hospital, Surrey, UK.
authors: Michael
authors: M
authors: Shenouda
authors: Department of Vascular Surgery, St Peter's Hospital, Surrey, UK. Electronic address: emma.molena@doctors.org.uk.
authors: Emma
authors: E
authors: Molena
authors: Department of Vascular Surgery, St Peter's Hospital, Surrey, UK.
authors: Nonica
authors: N
authors: Maftei
authors: Department of Vascular Surgery, St Peter's Hospital, Surrey, UK.
authors: Tahir
authors: T
authors: Ali
mesh_terms: D000368:Aged; D000671:Amputation, Surgical; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation; D003646:Debridement; D020878:Device Removal; D005260:Female; D006083:Graft Occlusion, Vascular / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D006801:Humans; D023821:Limb Salvage; D008297:Male; D011138:Polytetrafluoroethylene; D011474:Prosthesis Design; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D012086:Reoperation; D012501:Saphenous Vein / Q000637:transplantation*; D013927:Thrombosis / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D011138:Polytetrafluoroethylene