The management of infected grafts in reconstructive vascular surgery

Aseptic bypass graft and graft-preserving open local treatment have proved to be the 2 suitable procedures for therapy of infected grafts in vascular surgery (stage III Szilagyi) with preservation of the limb extremity. After 685 reconstructive operations (1982 to 1984) for chronic arterial occlusive disease in the supraaortic as well as in the iliac and femoral segments, 9 infections involving the graft (1.31%) occurred. These infections were more common in superficial extra-anatomical bypass. The incidence of inguinal infection was 0.44%. In 2 cases an aseptic bypass with abandonment of the infected vascular segment and in 4 cases open local treatment of the infected graft proved successful in treating the infection and led to secondary wound healing. The transplant had to be abandoned and an amputation performed in 3 patients, one of whom died. That is to say, the infection was successfully treated (with respect to the original aim of the operation) in 66.7% of cases. The aforementioned methods do not represent alternative procedures: the aseptic bypass is considered in retroperitoneal and inguinal infections, whereas the open local treatment is used in cases of superficial extra-anatomical bypass grafts and in the infrainguinal and supraaortic artery segments. The success of the latter treatment, however, depends on several preconditions. In former years, loss of the limb extremity was almost unavoidable and, because of septicemia, the outcome often lethal. By applying the above-discussed principles of management this could be drastically improved.