Management of aortic prosthetic infections

Infections of aortic vascular prostheses remain a dreaded complication. Although removal of the graft has generally been recommended in the literature, the role of lesser procedures, the need for alternate revascularization, and a precise plan of attack are ill defined. We have treated 18 patients with infection of aortic prostheses. Specific risk factors potentially promoting infection included reoperation, septic complications, or gastrointestinal entry at the time of graft placement. Clinical signs of infection included chronic draining sinus in eight patients, localized groin abscess in three patients, groin swelling in four patients, gastrointestinal bleeding in two patients, and pseudoaneurysm in one patient. Treatment by local therapy, including catheter irrigation of sinus tracts, debridement, and local antibiotics, resulted in failure in eight of nine patients. If the sinogram of a groin sinus showed no communication with the body of the graft, resection of a graft limb was successful in 66 percent of the patients. If the sinus communicated with the body of the graft, total resection was mandatory. When total excision was necessary, all patients required revascularization by means of an extraanatomic bypass. The mortality rate was 33 percent and was primarily due to bleeding fistulas. An aggressive approach to this serious problem with early graft excision is encouraged.