Prosthetic graft infection treated by local surgery - comparative analysis of 64 consecutive cases

Abstract

Background. Vascular prosthesis infection is one of the most severe complications in vascular surgery and is connected with high risk of limb amputation or death. The most common method of treatment is the total removal of the infected prosthesis and at the same time reconstruction of blood vessels using extra-anatomical or allogenic vascular grafts. The extent of these operations makes them of high risk in patients in severe general condition. Due to this problem there is a limitation in operation extent on behalf of local therapy. The aim of this work was to analyze the result of local surgical treatment of vascular graft limited infections.
Material and methods. In the years 1996–2003 sixty-four patients with prosthetic infection were treated by local therapy or partial removal of the graft.
Results. During the observation period, 5% of the patients died and in 7.5% limb amputation was necessary. 92.4% of the patients were primarily cured of their infection but at follow up only 38.7% patients had healed satisfactorily without symptoms of reinfection. Symptoms of reinfection appeared in 53.7% patients within 1–36 months. The infection symptoms recurrence was observed most seldom in patients group after partial removal of the prosthesis without blood vessel reconstruction. Despite 5 cases of the recurrence limited to the groin responding to local therapy techniques, all other cases resulted in the progress of infection.
Conclusions. Local treatment carries a high risk of reinfection, and should only be used for culture-negative grafts or in individuals who do not accept more radical treatment. Irrespective of the treatment method used the patients should be kept under regular clinical and radiological review for the early detection of reinfection diagnosis and the application of a more radical treatment approach.