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[Infection of vascular sutures: a report on 26 cases (author's transl)]
Abstract:
The authors describe 26 cases of infection after vascular surgery, affecting a Dacron prosthesis in 13 cases and venous grafts in the other 13 patients. The site of infection was usually the region of Scarpa's triangle (15 cases) with the presence of enterobacterium in 40% of cases. The most frequently isolated germ was staphylococcus aureus (20 cases). Infection was revealed by hemorrhage in 17 patients and was evidence of breaking down of the anastomosis. Results of surgical treatment in the two groups were evaluated by using three criteria: --persistence or not of infection, --vital prognosis, --functional prognosis. Surgical treatment methods and possible contamination sources are discussed. When the operative zone is infected, the authors recommend ablation for the prostheses and conservative therapy for venous autografts. The prosthesis was left in place in 5 patients, and only one patient recovered, while two deaths occurred. In the 10 cases where ablation of the prosthesis was performed, however, the infection was cured, and in 4 patients there was revascularization in the infected area. Apart from these cases, conservative therapy was applied in 11 cases and healing occurred in all of them.
Insights
Infections following vascular surgery, particularly with Dacron prostheses, often present with hemorrhage. Surgical site infection management requires prosthesis removal for Dacron grafts but conservative treatment for venous grafts to ensure healing.
Area of Science:
- Vascular Surgery
- Infectious Disease
- Surgical Outcomes
Context:
- Vascular surgery complications include graft infections.
- Dacron prostheses and venous grafts are susceptible to infection.
- Scarpa's triangle is a common infection site, often involving enterobacteria.
Purpose:
- To analyze outcomes of surgical site infections after vascular surgery.
- To compare treatment strategies for Dacron prosthesis versus venous graft infections.
- To evaluate infection persistence, vital prognosis, and functional prognosis.
Summary:
- 26 cases of vascular graft infection were studied, with 13 involving Dacron prostheses and 13 venous grafts.
- Staphylococcus aureus was the most common pathogen; hemorrhage and anastomosis breakdown were frequent presentations.
- Ablation of Dacron prostheses led to cure in all cases, with revascularization in 4. Conservative therapy for venous autografts resulted in healing in all 11 cases.
Impact:
- Recommends prosthesis ablation for Dacron graft infections and conservative therapy for venous autografts.
- Demonstrates superior outcomes with prosthesis ablation for Dacron graft infections compared to conservative management.
- Highlights the importance of tailored treatment strategies for different vascular graft materials to improve patient prognosis.