Outcome of infrainguinal prosthetic graft infections depending on the surgical management

To evaluate the outcome of different therapeutic pathways to manage infrainguinal prosthetic graft infections.

In this study a total of 66 patients treated between 1993 and 2009 (48 males and 18 females) were included. Subgroups were formed according to the following options of surgical management: excision of the grafts with or without arterial reconstruction (including prosthetic grafts and vein grafts), primary amputation, and surgical debridement with negative wound pressure therapy. Additionally, mortality, amputation rate, re-infection rate, and microbiological findings were analyzed.

Mean age was 65.64±11.33 y and follow up was 22.21±36.85 mo. Thirty-day survival rate was 89.5%±4.1%, overall limb salvage rate was 82.5%±5.1%. In the group with primary amputation, one patient (20%) died; however, in the group of surgical debridement with negative wound pressure therapy, mortality was nil. In the group with graft excision, seven patients died (14.3%); no difference between the study groups was found (p=0.058). Amputation rate was 10% (n=5), 0% and 20.4% (n=10), respectively, with a higher rate in the primary amputation group (p<0.001). Reinfection rate was 0%, 8.3% (n=1) and 14.2% (n=7) respectively; p=0.822. Also, no difference was found regarding bypass level or revascularization graft material.

Mortality and amputation rate is still high after infrainguinal prosthetic graft infection. Our strategy to preserve the graft whenever possible showed no difference compared with more aggressive strategies.