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Removing the infected aortofemoral graft using a two-stage procedure with a delay between the stages
John D S Reid1, P Shaun MacDonald
1Division of Vascular Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada. jreid@providencehealth.bc.ca
Abstract:
This study describes the results of a procedure for removing the infected aortofemoral graft using a two-stage procedure with a delay between the stages. The objective was to lessen the morbidity and mortality associated with removing an infected graft through a single operation. Eight consecutive patients were treated in this manner over a 6-year span. The indications for surgery were infected groin false aneurysms in three, chronic draining sinuses involving the prosthetic graft in four, and an open groin infection involving graft in one. There were five males and three females, with ages ranging 47-83 years (mean = 63). The mean operative time of the first-stage operation was 5.1 hr (range 3.0-7.7), and the mean blood transfusion requirement was 1.7 units. The mean operative time of the second stage operation was 3.5 hr (range 3.5-7.6), and the mean blood transfusion requirement was 2.5 units. In six patients, the hospital course was uncomplicated, with a mean hospital stay of 8.4 days for the initial stage and 9.2 days for the second stage. Two patients had complicated postoperative courses with hospital stays of >30 days. There was no operative or graft-related late mortality. No patients were lost to follow-up. One patient died of unrelated causes with a patent graft at 22 months postsurgery. All other patients remain well with patent grafts, without requiring revisions at a mean follow-up of 33 months (range 6-73). A two-stage approach with a delay between the stages may reduce the morbidity and mortality associated with the removal of an infected aortobifemoral graft.
Insights
This study presents a two-stage procedure for removing infected aortofemoral grafts, reducing complications. This approach demonstrated low mortality and morbidity in eight patients, with most experiencing uncomplicated recovery and patent grafts long-term.
Area of Science:
- Vascular Surgery
- Infectious Disease Management
- Surgical Outcomes Research
Background:
- Infected aortofemoral grafts pose significant risks, with high morbidity and mortality associated with single-stage removal.
- Developing safer surgical strategies for managing prosthetic graft infections is crucial.
Purpose of the Study:
- To evaluate the efficacy and safety of a two-stage surgical approach for removing infected aortofemoral grafts.
- To determine if a staged procedure can reduce operative morbidity and mortality compared to single-stage operations.
Main Methods:
- A retrospective review of eight consecutive patients undergoing a two-stage removal of infected aortofemoral grafts over six years.
- Analysis of operative times, blood transfusion requirements, postoperative complications, hospital stay, and long-term graft patency.
Main Results:
- The two-stage procedure involved a mean operative time of 5.1 hours for the first stage and 3.5 hours for the second, with mean transfusion requirements of 1.7 and 2.5 units, respectively.
- Six out of eight patients had uncomplicated hospital courses, with a mean stay of 8.4 days for the initial stage and 9.2 days for the second.
- No operative or graft-related late mortality was observed; all surviving patients maintained patent grafts at a mean follow-up of 33 months.
Conclusions:
- A two-stage approach with a delay between stages appears to be a safe and effective method for managing infected aortofemoral grafts.
- This staged strategy may significantly lower the morbidity and mortality rates typically associated with infected aortofemoral graft removal.
