[Infrarenal aortic graft infection]

The incidence of vascular replacement infection is reported between 0.5-6.0%. The infection of aortal valve replacement is usually managed by its removal and axilofemoral reconstruction. Replacement removal and reconstruction in situ is another alternative. The aim of our work is to give the comparison of the results obtained with the extra-anatomic reconstruction and alternative techniques.

Between January 1987 and August 2008 1324 abdominal aortal replacements were performed in our department. In 14 patients (1.05%) the infection of the replacement occurred; one of the patients was operated on in another hospital. In eight patients axilobifemoral/axilopoplietal by-pass was applied (Group A). In two patients the whole replacement was removed together with in situ reconstruction (ISR) using a new bifurcation replacement. In two patients a partial resection of the replacement and the resected part substitution or femoro-femoral cross-over by-pass was performed. Three patients were treated with a total or partial replacement removal without the following reconstruction.

In Group A no haemorrhage from the aortal stub occurred. The mean value of surgical management due to the replacement infection was 3.5 (1-6). For Group B the number was 5 (1-16). In Group B there were three reinfections, in Group A none. In both Group A and B one patient died; one thigh amputation was necessary in Group A, two in Group B.

The partial or total removal of the replacement followed with in situ reconstruction is considered a safe and good method solving the infection of the aortal replacement in some patients. The results are comparable to those obtained with extra-anatomic reconstruction that remains the method of choice in patients with virulent infections.