Optimal management of inguinal vascular graft infections

Vascular graft infections demand serious attention due to the potential for mortality or limb loss. Management modalities range from conservative wound debridement and drainage to graft resection and extra-anatomical revascularization. A retrospective chart review was conducted to evaluate wound complications in patients who underwent inguinal vascular bypass in an attempt to define the incidence of wound complications and guidelines for their management. Vascular operations involving femoral anastomoses were performed on 1,637 patients; 58 wound infections occurred in 57 patients (3.5%) over an 8-year period at our institution. There were 16 graft infections in 15 of these 57 patients (0.92%). Ten patients were treated with local muscle flaps, 1 with a fasciocutaneous thigh flap, and 5 with graft excision and either extra-anatomical bypass or amputation. Local flap coverage appears to be as effective as graft excision for the treatment of inguinal vascular graft infections. An algorithm for optimal management of these infections is presented.