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Vol 8, No 1 (2006)
Published online: 2006-03-17

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Treatment of vascular prosthesis infection in aorto-iliac segment

Krzysztof Ziaja, Tomasz Urbanek, Jacek Kostyra, Marcin Kucharzewski, Michał Glanowski, Wacław Kuczmik, Marek Kazibudzki, Damian Ziaja
Chirurgia Polska 2006;8(1):1-10.

Abstract

Background: Despite the improvement in biomaterials and surgical techniques, vascular prosthesis infection, often ocurring many years after surgery, still remains a significant problem in Outpatient Clinics and Departments of Vascular Surgery.
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.

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Chirurgia Polska (Polish Surgery)