title: Use of ultrasound debridement as an adjunctive tool for treating infected prosthetic vascular grafts in the lower extremities.
abstract: BACKGROUND
  To evaluate the role of an ultrasound (US) debridement system to treat conservatively patients with poor medical conditions who presented with infection of a prosthetic vascular graft in the lower extremities.
  
  
  METHODS
  Data of all patients who underwent debridement of the grafts and/or surrounding tissue using an ultrasonic generator (Genera, Italia Medica, Milan, Italy) were recorded and retrospectively reviewed. Based on cultures, patients received specific antibiotic therapy. Partial graft removal, sartorius muscle flap rotation, or negative pressure wound treatment (NPWT) was selectively used. Early and late morbidity and mortality and recurrence were analyzed.
  
  
  RESULTS
  Thirteen patients (median age, 72 years; range, 57-92 years; 8 men) were treated (12 Szilagyi grade III and 1 grade II infections) with US debridement without removing the graft (8 cases) or with partial excision and "in situ" reconstruction with a silver prosthetic graft (5 cases). Sartorius flap rotation was associated in 6 and NPWT in 1 case. One patient died perioperatively because of pulmonary edema because of sepsis secondary to treatment failure. Estimated freedom from reinfection was 90.9 ± 9% at 6 months and 77.9 ± 14% at 1 and 2 years. Estimated limb survival was 78.7 ± 13% at 6 months, 65.6 ± 16% at 1 year, and 52.5 ± 18% at 2 years.
  
  
  CONCLUSIONS
  US debridement proved to be a valuable aid in the treatment of patients with infected grafts and poor medical conditions. Used in conjunction with antibiotics, it allowed us to be more conservative without compromising the chance of success.
authors.affiliation: Division of Vascular Surgery, S. Carlo Borromeo Hospital, Milan, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Carmo
authors.affiliation: Division of Vascular Surgery, S. Carlo Borromeo Hospital, Milan, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Mazzaccaro
authors.affiliation: Division of Vascular Surgery, S. Carlo Borromeo Hospital, Milan, Italy.
authors.forename: Iacopo
authors.initials: I
authors.lastname: Barbetta
authors.affiliation: Division of Vascular Surgery, S. Carlo Borromeo Hospital, Milan, Italy. Electronic address: amsettembrini@gmail.com.
authors.forename: Alberto M
authors.initials: AM
authors.lastname: Settembrini
authors.affiliation: Division of Vascular Surgery, S. Carlo Borromeo Hospital, Milan, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Roveri
authors.affiliation: Division of Vascular Surgery, S. Carlo Borromeo Hospital, Milan, Italy.
authors.forename: Miriam
authors.initials: M
authors.lastname: Fumagalli
authors.affiliation: Division of Vascular Surgery, S. Carlo Borromeo Hospital, Milan, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Tassinari
authors.affiliation: Division of Vascular Surgery, S. Carlo Borromeo Hospital, Milan, Italy; Chair of Vascular Surgery, Università di Milano, Milan, Italy.
authors.forename: Piergiorgio G
authors.initials: PG
authors.lastname: Settembrini
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation* / Q000401:mortality; D003646:Debridement / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D004867:Equipment Design; D005260:Female; D006801:Humans; D007558:Italy; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000175:diagnosis / Q000601:surgery*; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D013523:Surgical Equipment; D013997:Time Factors; D016896:Treatment Outcome; D059708:Ultrasonic Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality