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Aortic and peripheral prosthetic graft infection: differential management and causes of mortality
Abstract:
This report of 25 patients with prosthetic graft infection has compared the diagnosis, management, and outcome in 14 patients with infected aortic grafts with 11 patients with infected peripheral grafts (two axillofemorofemoral, five femorofemoral, five femoropopliteal, and one femoral interposition). Peripheral graft infection had a significantly shorter interval to diagnosis compared with aortic graft infection. Total graft removal combined with either autogenous revascularization or extraanatomic bypass using prosthetic graft was performed in all 14 patients with infected aortic grafts. Management of peripheral graft infection consisted of total graft removal in eight patients (four with autogenous revascularization and two with amputation) and partial graft removal in three patients (two with amputation). Mortality and amputation rates for infected aortic grafts were 43 percent and 25 percent, respectively compared with 36 percent and 27 percent for infected peripheral grafts. Recommendations for management of the infected aortic prosthetic graft include total graft removal, but methods and timing of revascularization are dependent on the specific features of the individual case. However, preferred management for the infected peripheral prosthetic graft includes total graft removal and, if indicated, revascularization using autogenous tissue.
Insights
Infected aortic and peripheral prosthetic grafts present distinct diagnostic and management challenges. Prompt diagnosis and complete graft removal are crucial for better outcomes in prosthetic graft infections.
Area of Science:
- Vascular Surgery
- Infectious Diseases
Background:
- Prosthetic graft infections are serious complications following vascular surgery.
- Differentiating between aortic and peripheral graft infections is essential for appropriate treatment.
Purpose of the Study:
- To compare the diagnosis, management, and outcomes of infected aortic grafts versus infected peripheral grafts.
- To provide recommendations for the management of prosthetic graft infections.
Main Methods:
- Retrospective analysis of 25 patients with prosthetic graft infections.
- Comparison of 14 patients with infected aortic grafts and 11 patients with infected peripheral grafts.
- Evaluation of diagnostic intervals, management strategies, and patient outcomes including mortality and amputation rates.
Main Results:
- Peripheral graft infections were diagnosed significantly faster than aortic graft infections.
- All aortic grafts were removed, with revascularization or bypass. Peripheral grafts underwent total or partial removal, with revascularization or amputation.
- Mortality rates were 43% for aortic and 36% for peripheral grafts; amputation rates were 25% and 27%, respectively.
Conclusions:
- Total graft removal is recommended for both aortic and peripheral prosthetic graft infections.
- Revascularization strategies for aortic grafts should be individualized.
- Autogenous tissue revascularization is preferred for infected peripheral grafts when indicated.