Prosthesis infection: prevention and treatment

Area of Science:

• Vascular Surgery
• Infectious Diseases
• Biomaterials Science

Background:

• Vascular prostheses create environments promoting bacterial attachment and biofilm formation, increasing surgical site infection risk.
• Current guidelines for managing arterial reconstruction infections are unclear, lacking robust evidence for optimal strategies.
• Graft infection necessitates intervention, with complete removal often indicated for suture line involvement, anastomotic aneurysms, or fistulas.

Purpose of the Study:

• To summarize the incidence and predisposing factors of vascular prosthesis and endograft infections.
• To review current prevention and treatment strategies for infected vascular grafts.
• To analyze the effectiveness of different management approaches, including conservative and resectional options.

Main Methods:

• Literature review summarizing incidence, risk factors, and management of vascular graft infections.
• Analysis of current prevention strategies for prosthesis and endograft infections.
• Evaluation of treatment options, including conservative management and surgical reconstruction techniques.

Main Results:

• In situ reconstruction is generally favored for lower mortality, better patency, and reduced reinfection rates.
• Complete graft excision is mandatory in specific complex scenarios like suture line infection or fistula formation.
• Conservative, non-resectional management is a viable option for select patients with significant comorbidities or high surgical risks.

Conclusions:

• Definitive management of vascular graft infections requires a tailored approach based on individual patient condition and clinical presentation.
• Surgical technique choice depends on center and operator experience, with in situ reconstruction showing promising outcomes.
• Further research is needed to establish clear guidelines for the prevention and treatment of vascular graft infections.