Incidence of positive inguinal lymph node cultures during peripheral revascularization

Synthetic vascular graft infections occur more commonly at the inguinal incision, and there is contamination of the graft by transection of bacteria-laden lymphatics proximal to a distal extremity infection. In 45 consecutive peripheral revascularizations, significant positive inguinal lymph node cultures were not obtained in 30 normal extremities; two of 15 distally infected extremities demonstrated the same bacteria in the distal infection and the inguinal lymph node. Both patients subsequently developed graft infections. Inguinal lymph nodes proximal to a distal infection may harbor bacteria capable of causing a synthetic vascular graft infection. Consideration should be given to culture-directed rather than routine antibiotic prophylaxis under this circumstance.