title: Outcome of infrainguinal prosthetic graft infections depending on the surgical management.
abstract: BACKGROUND
  To evaluate the outcome of different therapeutic pathways to manage infrainguinal prosthetic graft infections.
  
  
  METHODS
  In this study a total of 66 patients treated between 1993 and 2009 (48 males and 18 females) were included. Subgroups were formed according to the following options of surgical management: excision of the grafts with or without arterial reconstruction (including prosthetic grafts and vein grafts), primary amputation, and surgical debridement with negative wound pressure therapy. Additionally, mortality, amputation rate, re-infection rate, and microbiological findings were analyzed.
  
  
  RESULTS
  Mean age was 65.64±11.33 y and follow up was 22.21±36.85 mo. Thirty-day survival rate was 89.5%±4.1%, overall limb salvage rate was 82.5%±5.1%. In the group with primary amputation, one patient (20%) died; however, in the group of surgical debridement with negative wound pressure therapy, mortality was nil. In the group with graft excision, seven patients died (14.3%); no difference between the study groups was found (p=0.058). Amputation rate was 10% (n=5), 0% and 20.4% (n=10), respectively, with a higher rate in the primary amputation group (p<0.001). Reinfection rate was 0%, 8.3% (n=1) and 14.2% (n=7) respectively; p=0.822. Also, no difference was found regarding bypass level or revascularization graft material.
  
  
  CONCLUSIONS
  Mortality and amputation rate is still high after infrainguinal prosthetic graft infection. Our strategy to preserve the graft whenever possible showed no difference compared with more aggressive strategies.
authors.affiliation: 1 University of Duesseldorf , Department of Vascular and Endovascular Surgery, Duesseldorf, Germany .
authors.forename: Alexander
authors.initials: A
authors.lastname: Oberhuber
authors.forename: Bernard
authors.initials: B
authors.lastname: Lohr
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Orend
authors.forename: Hubert
authors.initials: H
authors.lastname: Schelzig
authors.forename: Bernd
authors.initials: B
authors.lastname: Muehling
mesh_terms: D000368:Aged; D000671:Amputation, Surgical; D001807:Blood Vessel Prosthesis / Q000382:microbiology*; D003646:Debridement; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy; D016459:Prosthesis-Related Infections / Q000628:therapy*; D012189:Retrospective Studies; D014656:Vascular Surgical Procedures / Q000009:adverse effects*