Graft Infection after Vascular Reconstruction Surgery

DOI 5 Citations 19 References

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  • 血行再建術後グラフト感染症の検討

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Thirty-one cases of graft infection after vascular reconstructive surgery over a 21-year period (1984 to 2004) were reviewed. Initial indications for surgery included peripheral arterial disease (n=18), abdominal aortic aneurysm (n=7), and thoracic aortic aneurysm (n=3), among others (n=3). The graft implantation sites were the thoracic aorta (n=3), abdominal aorta (n=13), or an extracavitary artery (n=15). All initial surgeries of the three cases with thoracic aortic graft infection were emergencies. Two were graft replacements and one was an endograft with concomitant abdominal aortic surgery. One patient was saved by intercostal muscle flap rotation, and two died following conservative treatment. Aortoenteric fistula (AEF) developed in five of 13 patients with abdominal aortic infection. The removal of the graft was total in three of five patients, subtotal in one, and partial in one. AEF recurred in two patients. Four patients were saved and one died. Of the other eight patients without AEF, graft removal with extraanatomic bypass was performed in six patients, muscle flap rotation was performed in one and omental flap rotation was performed in one patient. Six patients were saved and two died. In 15 cases of extracavitary arterial graft infection, five patients underwent graft removal with vascular reconstruction: three were saved and two died. Six patients underwent graft removal without vascular reconstruction: three of them were saved, one required amputation and two died. Four patients did not undergo graft removal: three required amputation and one died. In the treatment of graft infection, it is critical to completely remove the infected graft and to extensively debride the surrounding infected tissue, while considering the extent of the infection and the general condition of the patient.

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