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Treatment of vascular prosthesis infection in aorto-iliac segment
open access
Abstract
Objective: The aim of the study was to present our experience of the last decade in the treatment of aorto-iliac vascular prosthesis infection by means of extra-anatomic bypass, human cryopreserved arterial allograft and silver-bonded prostheses.
Material and methods: Between January 1996 and January 2006, at the Department of General and Vascular Surgery, 76 patients underwent surgical operation due to graft infection. The original graft was implanted in the aorto-iliac segment (aortic prosthesis - 1, aortoiliac/femoral - 18, aortobiiliac/bifemoral - 46, iliofemoral - 11 patients). The mean time interval from primary surgery to infection diagnosis was 66 months. In 75% of cases the infection concerned a patented vascular prosthesis. Graft-enteric fistula was diagnosed in 21 cases. Excision of the infected vascular prosthesis with subsequent revascularization (anatomic reconstruction - 45, extra-anatomic reconstruction - 12) was performed in 57 patients. In the 19 remaining patients, the surgical procedure was limited to the excision of the vascular prosthesis concerned, which was most frequently inactive. In the anatomic reconstruction procedures, human cryopreserved arterial allografts (23), PTFE prostheses (9) or silver-impregnated prostheses (9) were used. The treatment results, correlated with the grade of infection, the prevalence of comorbidities and the method of reconstruction, were analysed.
Results: The overall mortality rate was 36.8%. Amputation of the lower limb was performed in 14% of patients. The perioperative mortality and amputation rates in particular groups were as follows: homograft - mortality 26%, amputation rate 13%; silver-bonded prosthesis and anatomic reconstruction - mortality 23%, amputation rate 7.6%; PTFE prosthesis and anatomic reconstruction - mortality 66%, amputation rate 11%; extra-anatomic reconstruction - mortality 50%, amputation rate 16%. From among patients presenting limitations of surgical procedure to carry out an infected graft excision, 31% died. In the group of 21 patients with graft-enteric fistula 11 deaths (52%) were noted.
Conclusions: 1. Despite the numerous available treatment methods and individualization of surgical management depending on the patient’s condition and surgical treatment possibilities, there is still no perfect method of vascular prosthesis infection treatment. 2. Excision of the infected prosthesis and onestage anatomic revascularization with the application of an arterial allograft or re-infection resistant biomaterial gives one an opportunity to perform the least burdensome operation.
Abstract
Objective: The aim of the study was to present our experience of the last decade in the treatment of aorto-iliac vascular prosthesis infection by means of extra-anatomic bypass, human cryopreserved arterial allograft and silver-bonded prostheses.
Material and methods: Between January 1996 and January 2006, at the Department of General and Vascular Surgery, 76 patients underwent surgical operation due to graft infection. The original graft was implanted in the aorto-iliac segment (aortic prosthesis - 1, aortoiliac/femoral - 18, aortobiiliac/bifemoral - 46, iliofemoral - 11 patients). The mean time interval from primary surgery to infection diagnosis was 66 months. In 75% of cases the infection concerned a patented vascular prosthesis. Graft-enteric fistula was diagnosed in 21 cases. Excision of the infected vascular prosthesis with subsequent revascularization (anatomic reconstruction - 45, extra-anatomic reconstruction - 12) was performed in 57 patients. In the 19 remaining patients, the surgical procedure was limited to the excision of the vascular prosthesis concerned, which was most frequently inactive. In the anatomic reconstruction procedures, human cryopreserved arterial allografts (23), PTFE prostheses (9) or silver-impregnated prostheses (9) were used. The treatment results, correlated with the grade of infection, the prevalence of comorbidities and the method of reconstruction, were analysed.
Results: The overall mortality rate was 36.8%. Amputation of the lower limb was performed in 14% of patients. The perioperative mortality and amputation rates in particular groups were as follows: homograft - mortality 26%, amputation rate 13%; silver-bonded prosthesis and anatomic reconstruction - mortality 23%, amputation rate 7.6%; PTFE prosthesis and anatomic reconstruction - mortality 66%, amputation rate 11%; extra-anatomic reconstruction - mortality 50%, amputation rate 16%. From among patients presenting limitations of surgical procedure to carry out an infected graft excision, 31% died. In the group of 21 patients with graft-enteric fistula 11 deaths (52%) were noted.
Conclusions: 1. Despite the numerous available treatment methods and individualization of surgical management depending on the patient’s condition and surgical treatment possibilities, there is still no perfect method of vascular prosthesis infection treatment. 2. Excision of the infected prosthesis and onestage anatomic revascularization with the application of an arterial allograft or re-infection resistant biomaterial gives one an opportunity to perform the least burdensome operation.
Keywords
vascular prosthesis; infection; graft enteric fistula; atherosclerosis; surgery


Title
Treatment of vascular prosthesis infection in aorto-iliac segment
Journal
Chirurgia Polska (Polish Surgery)
Issue
Pages
1-10
Published online
2006-03-17
Bibliographic record
Chirurgia Polska 2006;8(1):1-10.
Keywords
vascular prosthesis
infection
graft enteric fistula
atherosclerosis
surgery
Authors
Krzysztof Ziaja
Tomasz Urbanek
Jacek Kostyra
Marcin Kucharzewski
Michał Glanowski
Wacław Kuczmik
Marek Kazibudzki
Damian Ziaja