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Management of aortic graft infection
S Ten Raa1, M R H M Van Sambeek, T Hagenaars
1Department of Vascular Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.
Background:
The optimal method of operative treatment of prosthetic aortic graft infection (PAGI) has been the subject of debate; incidence rates of PAGI are low. Diagnosis of PAGI can be difficult. The aim of this retrospective study is to evaluate our results in treating PAGI in order to try and optimize the treatment of this grave problem.
Methods:
Thirty-eight patients (median age 68.5 years) were treated for PAGI between 1991 and 2000. Management of PAGI was performed with total graft excision and simultaneous extra-anatomic bypass (n=18), total graft excision and in situ repair with a Rifampicin-soaked gelatin-impregnated prosthetic aortic graft (n=8), or a partial excision with in situ repair (n=11). In 1 patient, only local irrigation was performed. The median follow-up was 45 months.
Results:
Clinical presentation of PAGI (median interval 3 years) was: discomfort/pain (n=14), gastro-intestinal bleeding (n=11), persisting fever (n=8), or a non-healing wound (n=5). The primary patency rate in patients with extra-anatomic bypass was 67% at 6 months follow-up. In patients with other surgical reconstructions no graft occlusion was encountered. Overall amputation rate was 5%. Recurrent infection of the graft was 15%. The overall early mortality rate in this study was 21%.
Conclusions:
The diagnosis of PAGI is difficult and should be based on a combination of clinical symptoms, laboratory findings and imaging techniques. There are several treatment options that should be tailored to the extent of infection and the patients' physical condition. In a selected group of patients partial excision of the infected graft only can be justified.
Insights
Prosthetic aortic graft infection (PAGI) treatment varies, with options including graft excision and bypass or in situ repair. Tailoring treatment to infection extent and patient condition is crucial for managing this rare but serious complication.
Area of Science:
- Vascular Surgery
- Infectious Disease Management
- Graft Reconstruction
Background:
- Prosthetic aortic graft infection (PAGI) is a rare but serious complication.
- Optimal surgical treatment strategies for PAGI remain debated.
- Accurate diagnosis of PAGI can be challenging.
Purpose of the Study:
- To evaluate treatment outcomes for prosthetic aortic graft infection (PAGI).
- To identify factors influencing treatment success in PAGI.
- To optimize management strategies for this critical condition.
Main Methods:
- Retrospective analysis of 38 patients treated for PAGI (1991-2000).
- Surgical approaches included graft excision with extra-anatomic bypass, in situ repair with antibiotic-soaked grafts, or partial excision.
- Median follow-up was 45 months.
Main Results:
- Clinical presentations included pain, GI bleeding, fever, and non-healing wounds.
- Extra-anatomic bypass showed a 67% primary patency at 6 months; no graft occlusion in other reconstructions.
- Early mortality was 21%, with a 15% recurrent infection rate and 5% amputation rate.
Conclusions:
- PAGI diagnosis requires integrating clinical, laboratory, and imaging findings.
- Treatment selection should be individualized based on infection severity and patient health.
- Partial graft excision may be suitable for select patients.