The case against the conservative nonresectional management of infected prosthetic grafts

The perception that there is an expanding role for conservative management of patients with aortic graft infection is unfounded. There is,in fact, a striking paucity of convincing data indicating that outcome following nonresectional therapy for aortic prosthetic graft infection is equivalent to modern-day results utilizing extra-anatomic bypass and graft excision. Drainage with localized antibiotic irrigation and biologic coverage may be attempted in unusual circumstances such as the unfortunate patient with an infected thoracoabdominal aortic graft, in whom graft excision is not feasible. A truly noteworthy development in the treatment of aortic graft infection over the past decade has been the remarkable improvement in results utilizing remote bypass and standard excisional therapy with perioperative mortality and amputation rates less than 10%. In our opinion this approach remains the best and safest option.