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A infecção de próteses endovasculares (stents e endopróteses), ao contrário da cirurgia convencional, permanece pouco divulgada e estudada [1][2][3][4] . Devido ao fato de a grande maioria dos procedimentos endovasculares serem realizados pela via percutânea e de forma minimamente invasiva, a infecção sempre foi considerada uma complicação rara e de proporções menores em comparação à cirurgia convencional 5 . No entanto, com a expansão dos métodos endovasculares e a sua massificação, bem como o uso cada vez mais frequente de endopróteses e stents recobertos, os problemas infecciosos vêm se tornando um problema que merece atenção especial 6,7 . Chalmers et al., em 1993, relataram o primeiro caso com suspeita de infecção em um dispositivo endovascular (stent) 8 . Em 1999, publicou-se o primeiro caso confirmado de infecção de endoprótese 9 . Apesar dos avanços recentes na área endovascular, a patogênese das infecções de stents e endopróteses permanece pouco estudada [10][11][12][13] . Existem poucos estudos na literatura com dados referentes às taxas de incidência de infecção em stents e endopróteses. Estudos da década de 1990 afirmavam que as endopróteses estariam mais expostas à contaminação bacteriana por se encontrarem no lúmen vascular, podendo apresentar, dessa forma, taxas elevadas de infecção [10][11][12][13] . Fiorani et al., em estudo multicêntrico recente, encontraram taxa de 0,4% de infecção em endopróteses aortoilía-cas 14 . Em comparação com a cirurgia aberta, encontra-se menor incidência de infecção em cirurgias endovasculares (0,4 versus 1,3%) 15,16 . Autores afirmam que as taxas de incidência de infecção de endoprótese são subestimadas devido ao acompanhamento mais curto dos pacientes submetidos à cirurgia endovascular, bem como à expectativa de vida ResumoA infecção envolvendo endopróteses é uma complicação pouco frequente, associada a elevadas taxas de mortalidade. A apresentação clínica é geralmente tardia, podendo variar de sintomas inespecíficos até complicações graves como pseudoaneurisma e fístula aortoentérica. O diagnóstico envolve alto índice de suspeição e investigação com exames de imagem e laboratoriais. O tratamento segue os preceitos da infecção de prótese em cirurgia convencional, indicando-se, para a maioria dos pacientes, a excisão cirúrgica acompanhada da revascularização in situ ou extra-anatômica. O tratamento conservador fica reservado para casos selecionados.Palavras-chave: Prótese vascular; infecção; cirurgia geral. AbstractInfection involving stent grafts is an infrequent complication associated with high mortality rates. The clinical presentation is usually delayed and it may vary from nonspecific symptoms to severe complications such as pseudoaneurysm and aorto-enteric fistula. The diagnosis involves a high index of suspicion and investigation with imaging and laboratory exams. The treatment follows the precepts of graft infection in conventional surgery, and surgical excision is recommended for most patients, followed by in situ or extra-anatomic revascularization. Conse...

Purpose: To assess the use of the superficial femoral vein for the reconstruction of the aortoiliofemoral sector in the treatment of prosthetic infections. Methods: From December 1995 to November 1999, 12 patients with infection involving a synthetic vascular prosthesis were submitted to thirteen surgical procedures involving partial or total resection of a synthetic vascular prosthesis and restoration of arterial flow with an in situ femoral vein. Results: The overall operative mortality rate was 15.3% (2 out of 3 patients who underwent total graft replacement and 0 out of 9 patients who underwent unilateral graft replacement). Major amputations related to the surgical procedures were performed in two cases (an 87.5% rate of limb salvage). The series was followed up on average for 22 months (range: 6–65 months). No patient presented clinically significant edema or signs of chronic venous insufficiency in the lower limbs used as donors of autogenous venous grafts. All surviving patients presented complete resolution of the infectious signs and symptoms and none of them presented late thrombosis of the venous graft. Conclusion: The use of the superficial femoral vein is a good surgical alternative for the treatment of prosthetic infections with minimal venous morbidity of the lower limbs used as venous graft donors. The autogenous venous grafts present good long-term patency and excellent adaptation to the aortoiliofemoral position.

Background: Surgical site infection is a severe complication of peripheral vascular surgery with high morbidity and mortality rates. Objective: To evaluate the morbidity and mortality of infections of peripheral artery surgery sites caused by resistant microorganisms. Methods: This was a prospective study of a cohort of patients who underwent peripheral artery revascularization procedures and developed surgical site infections between March 2007 and March 2011. Results: Mean age was 63.7 years; males accounted for 64.3% of all cases. The overall prevalence of bacterial resistance to antimicrobials was 65.7%. The most common microorganism identified was Staphylococcus aureus (30%). Comparison of the demographic and surgical characteristics of both subsets (resistant versus non-resistant) detected a significant difference in length of preoperative hospital stay (9.3 days vs. 3.7 days). The subset of patients with infections by resistant microorganisms had higher rates of reoperation, lower numbers of limb amputations and lower mortality, but the differences compared to the subset without resistant infections were not significant. Long-term survival was similar. Conclusions: This study detected no statistically significant differences in morbidity or mortality between subsets with surgical wound infections caused by resistant and not-resistant microorganisms.