Aortic prosthetic infection: 50 Patients treated by radical or local surgery

Abstract

Fifty patients with aortic prosthetic infection were managed in a period of 10 years from 1983 to 1993. Twenty-five patients had recurrent sepsis after local surgery (group 1) and 22 of these eventually required radical surgery. Twenty-five patients had radical graft excision as the first procedure (group 2). Group 1 contained an excess of patients with local groin symptoms (11 in group 1 versus five in group 2, P = 0.03) and in this group fewer radiological techniques were used to document the extent of graft infection. The perioperative mortality rate was similar in both groups (seven in group 1 versus five in group 2). The number of amputations was also similar (five in group 1 versus four in group 2). The triad of occlusive disease, aortobifemoral bypass and groin symptoms was associated with eight of nine amputations. While the authors would consider using local techniques if the anastomosis was intact, the graft remained patent and infection appeared to be confined to the groin, this combination is uncommon and radical graft excision remains the preferred treatment.

Thoracoabdominal bypass graft with liver retransplantation for the treatment of a pseudoaneurysm of the supraceliac aorta after liver transplantation

“…However, revascularization is not possible when there is a diffuse bacterial contamination. In principle, an infected graft should always be removed and the distal blood flow restored by using an extra‐anatomic bypass (9, 10).…”

“…In vascular surgery, extra‐anatomic bypass represents the preferred method of revascularization in the case of an infected graft (9, 10), especially when major vessels are involved. Less aggressive treatments, such as partial resection of the prosthetic graft or excision and reconstruction by interposition with a vascular prosthesis, usually result in recurrence of the infection and failure to provide adequate distal blood flow.…”

Endovascular Grafting of Traumatic Aortic Aneurysms in Contaminated Fields

“…11,12 All of these techniques have mortality rates ranging from 30% to 70% and extensive morbidity, with amputation rates approaching 30%. [13][14][15][16][17] In studies that reported results of extra-anatomic bypass for abdominal aortic graft infection, the overall patency is ϳ65% at 3 years. 14 The interval between graft implantation and the clinical manifestation of infection is variable, ranging from a few days to many years; in one group of 45 patients, the mean interval was 40.3 months.…”

“…[13][14][15][16][17] In studies that reported results of extra-anatomic bypass for abdominal aortic graft infection, the overall patency is ϳ65% at 3 years. 14 The interval between graft implantation and the clinical manifestation of infection is variable, ranging from a few days to many years; in one group of 45 patients, the mean interval was 40.3 months. 18 Organisms such as Staphylococcus aureus or Escherichia coli usually cause problems within a few weeks or months after graft insertion.…”

“…22 This may be one reason why cultures of aspirated perigraft fluid are positive in only 13% of patients who have positive graft culture after excision. 14 It has been shown that in situ bypass grafts for severe aortic graft infection were followed by 100% reinfection and 38% mortality rates. Some authors 12,23,24 have noted a high rate of suture line breakdown, patch rupture, and bleeding when new autologous tissue patches or grafts are placed in an infected field.…”