Background: Vascular prosthesis infection poses one of the most dangerous complications following vascular procedures. Despite the availability of a number of treatment methods, there is still a shortage of a perfect method of treatment concerning these kinds of infections. In this report, our own experience regarding the usage of silver-impregnated prostheses in revascularization procedures within an infected field are presented.
Material and methods: Between the years 2003 and 2007 37 patients were admitted presenting infection of a vascular prosthesis and were treated with surgical procedures in which the infected graft was removed and revascularization was performed with the in situ method, using a silver-impregnated prosthesis (InterGard Silver). The mean age of patients was 61 years and 2 months (47-90 years). On admission to hospital, a patent vascular prosthesis was present in 36 patients (97%). Infection concerned 28 cases in which a vascular prosthesis had been implanted previously in the aorto-ilio-femoral segment (including 13 patients with a bifurcated prosthesis). As well as this, there were 4 cases of extra-anatomic bypasses and 5 patients who presented a prosthesis from the femoro-popliteal segment.
Results: During the early postoperative period, 7 (19%) of the 37 patients died. No death occurred in patients that had undergone replacement of a vascular prosthesis in the femoro-popliteal segment. In 4 patients who had previously undergone an extra-anatomic by-pass grafting, 2 patients died, while among 8 cases who had undergone a partial replacement of an aorto-femoral prosthesis 1 death was noted. The other 4 deaths (20%) concerned a group of patients that underwent an anatomic reconstruction in the aorto-ilio-femoral segment. During the early and late observation periods, reinfection occurred in 11 of the 37 patients who underwent surgery (29%), while 3 of these cases resulted in death.
Conclusions: The usage of silver-impregnated prostheses opens a window of opportunity for revascularization in cases of infection of previously implanted vascular prostheses, but does not guarantee a 100% complete recovery. There is still a lack of a perfect treatment method in patients with vascular prosthesis infection while the result of treatment is significantly dependent on both the presence of concomitant diseases and the patient’s preoperative general condition.