Delayed aortic prosthetic reconstruction after removal of an infected graft

The amputation morbidity associated with the treatment of vascular graft infection continues to be a major clinical problem. Late amputation associated with failure of extraanatomic bypass initially required to avoid infected tissue beds might be reduced if delayed anatomic aortic prosthetic reconstruction could be safely employed. Two major concerns about this treatment option are the safety of the redo aortic reconstruction and the risk of recurrent infection in the reimplanted graft. Seven patients in whom recurrent limb ischemia or extraanatomic bypass infection developed underwent delayed aortic reconstruction using either an in-line aortic graft or supraceliac aortofemoral bypass at a mean interval of 14.5 months after removal of the infected graft. There were no perioperative deaths, and six of seven patients were well at a mean follow-up of 57 months postoperatively. All grafts remained patent throughout the follow-up period and no further amputations were required. No reimplanted graft became infected, which suggests that a reimplantation interval of 6 to 12 months may be safe. These data indicate that delayed aortic prosthetic reconstruction may be considered a safe and effective treatment option for those patients in whom limb-threatening recurrent ischemia or recurrent extraanatomic graft infection develops after treatment of aortic vascular graft infection.