Autogenous tissue reconstruction in the management of infected prosthetic grafts

Infection is the most dreaded complication associated with implantation of a prosthetic arterial graft. Although remote bypass followed by complete removal of the infected prosthesis has proven to be a satisfactory method of treatment, in certain instances remote bypass alone is not feasible and other modes of surgical treatment must be employed. This report describes the use of autogenous reconstructions within the infected field, including endarterectomy and replacement of the infected graft with arterial or venous autografts in 24 patients. The key approach in these patients was (1) accurate preoperative assessment of the extent of graft infection, (2) aggressive surgical efforts to remove all infected prosthetic material, and (3) autogenous reconstructions within the infected field to supply critical vascular beds. Three patients died, for a mortality rate of 13%. There were no strokes and only two amputations. Suture lines involving autogenous tissue healed, even when in an infected field. In the aortofemoral group, preservation of aortic continuity is very desirable, when possible. We believe that these techniques provide the maximal potential for salvage of life and limb in the management of this dreaded vascular complication.