Can prosthetic graft infection be avoided? If not, how do we treat it?

Most arterial prosthetic graft infections can be prevented although a few will inevitably still occur. Maintaining a high index of suspicion for graft infection permits prompt diagnosis which provides the opportunity for early surgical management and improved potential for a good result. Aortic graft infection is best managed with extra-anatomical prosthetic bypass through clean tissue followed by graft excision. Results with this surgical approach are improving. Recently, authors advocating in situ grafting for graft enteric fistula as well as others recommending nonresectional therapy for localized prosthetic graft infections, have obtained encouraging results comparable to the best series of more standard excisional therapy. Because prosthetic graft infection remains a difficult surgical problem, any potentially useful management innovations warrant serious consideration and analysis with extended follow-up.