Complex treatment of vascular prostheses infections

Abstract

Infections after vascular reconstructions are very rare; however, when they occur, they are associated with a high risk of morbidity. In order to obtain the best results possible, the treatment needs to be initiated as early as possible, from the very first signs of infection, and it needs to be carried out in centers specializing in vascular surgery. The aim of the present study was to assess the incidence of infections in a single university center.This retrospective analysis over a 2-year period is based on the medical reports of hospitalized patients who were diagnosed with infection following revascularization.From 2013 to 2014, a number of 151 open reconstructive surgical procedures were performed. 15 patients suffered from infection (10%) of the vascular reconstruction. Of these patients, 40% have had an aorto-bifemoral bypass, 53%—a femoro-popliteal bypass, and 7% (n = 1)—an axillo-femoral bypass. According to the Samson classification, the patients were categorized as follows: group 2: 6 cases, group 3: 2 cases, group 4: 4 cases, and group 5: 3 cases. The most frequent bacteria found were methicillin-resistant Staphylococcus aureus (MRSA) (n = 6, 40%), followed by S aureus (n = 5, 33%). The treatment options were: application of antibiotics alone without any invasive treatment in 3 patients, local irrigation and debridement in 6 patients, complete explantation of the prosthesis with a new extra-anatomic bypass in 6 cases, and partial excision of the prosthesis, which was replaced and covered with muscle flap, in 3 cases. The amputation rate in our study was 18%, which corresponds to the rates published in the literature.The treatment of infections in vascular surgery needs to be complex and adapted to each individual patient, because infections being in a permanent dynamic state. The treatment needs to be performed in specialized centers that have large experience in vascular surgery, in order for the patient to have the best chances of survival and protection from amputation.

Omental Free Flap Coverage for Extracavitary Vascular Bypass Graft Salvage

“…It is associated with rates of amputation and mortality cited as high as 70% and 75%, respectively. 3 , 4 Optimal treatment includes graft excision, debridement of surrounding tissue, and a prolonged antibiotic course. 5 Graft preservation is reserved for patients in whom explantation poses significant risk of morbidity.…”

“… 5 Graft preservation is reserved for patients in whom explantation poses significant risk of morbidity. 4 As the frequency of endovascular intervention increases, early identification and intervention for PVGI will remain vital to reduce patient morbidity and healthcare costs.…”

Infection of Vascular Prostheses: A Comprehensive Review

“…Several factors account for the onset of VGEIs, including factors related to patients, such as advanced age, male sex, overweight status or obesity, heart disease, immunocompromised status, diabetes, chronic kidney disease (CKD), chronic obstructive pulmonary disease (COPD), nasal colonization with Staphylococcus aureus, bacteremia at the time of graft placement, groin incision, skin wounds in the lower limbs, and prolonged hospitalization [36,37].…”

Imaging Modalities for the Diagnosis of Vascular Graft Infections: A Consensus Paper amongst Different Specialists

“…Standard laboratory tests are usually non-specific: typical findings include leukocytosis (left shift) and a high erythrocyte sedimentation rate. Cultures from wounds or perigraft fluid can be collected in VGI-suspected patients in order to diagnose and guide antibiotic therapy [5].…”