[Exposed infra-inguinal bypass: conservative treatment or in situ replacement]

Infection or exposure of a infra-inguinal bypass is a severe complication which can lead to death or amputation. With conservative treatments, the bypass is left in situ or replaced with an autologous vein or an allograft. Results in a series of 393 consecutive conservative treatments for infra-inguinal revascularizations were analyzed retrospectively. Sixteen patients were studied and divided into 2 groups: Group 1 included 8 patients who had no bleeding or signs of infection and who were treated locally. Group II included 8 patients with bleeding or signs of infection in whom the bypass was replaced by an in situ autologous vein (n = 4) or an arterial allograft (n = 4). Mortality was 12.5% and the rate of amputation was 12.5%. These percentages are in agreement with reports from other authors who also propose this therapeutic option. Local treatment should be reserved for infection free of complications due to thrombosis, hemorrhage or signs of a septic syndrome. Other cases should benefit from in situ replacement with a vein or an arterial allograft. In some unsuccessful cases there are a few indications for extra-anatomic prosthetic bypasses.