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The thrombosed prosthetic graft is a risk for infection of an adjacent graft
B U Marsan1, G R Curl, L Pillai
1Department of Surgery, State University of New York at Buffalo, USA.
Insights
Thrombosed prosthetic grafts near patent bypasses can become infected and spread to adjacent grafts. Removing thrombosed grafts near patent bypasses is recommended to prevent secondary infections.
Area of Science:
- Vascular Surgery
- Infectious Disease
- Biomaterials Science
Background:
- Thrombosed grafts pose a higher infection risk than patent grafts.
- Infection in a thrombosed graft can compromise adjacent patent grafts.
- Understanding this dynamic is crucial for preventing graft failure and systemic infection.
Purpose of the Study:
- To investigate the role of thrombosed grafts in the secondary infection of contiguous patent bypasses.
- To assess the risk of infection spread from thrombosed to patent prosthetic grafts.
- To inform clinical practice regarding the management of thrombosed grafts in proximity to patent bypasses.
Main Methods:
- Retrospective review of operative and medical records from 1990 to 1995.
- Identification of prosthetic arterial bypass infections associated with adjacent thrombosed grafts.
- Analysis of patient demographics, graft types, infection timelines, and treatment outcomes.
Main Results:
- Seven of 22 (32%) prosthetic graft infections originated in thrombosed grafts and spread to adjacent patent grafts.
- All primary infections involved infrainguinal polytetrafluoroethylene (PTFE) grafts used for limb salvage.
- Secondary infections often involved inflow procedures, with high mortality (57%) observed.
Conclusions:
- Thrombosed prosthetic grafts near patent bypasses are a significant source of secondary infection.
- Recommendations include the total removal of thrombosed grafts in proximity to patent bypasses, especially when infection risk is high or during amputation.
- Proactive management of thrombosed grafts is essential to prevent catastrophic graft failure and patient morbidity.
Background:
A bland thrombosed graft may be more susceptible to the future risk of infection than a patent graft. Once infected, that graft can threaten other patent grafts. Therefore, the purpose of the following study was to assess the role a thrombosed graft might play in infection of contiguous patent bypasses.
Methods:
From 1990, a retrospective review was performed using the operative and medical records of cases in which a prosthetic graft infection was identified arising in association with an adjacent thrombosed graft.
Results:
A total of 22 cases of prosthetic arterial bypass infection were treated at our institution from January 1990 through September 1995. Of these, 7 (32%) were identified by the operative report as arising in a thrombosed prosthetic graft and spreading to an attached or adjacent patent prosthetic graft. All patients had multiple bypasses prior to infection, mean 5.4 +/- .75 (range 3 to 8). All thrombosed infected grafts were infrainguinal polytetrafluoroethylene (PTFE) for limb salvage: 6 femoralpopliteal and 1 femorotibial. Mean interval time between placement of the primarily infected graft and removal was 14.6 +/- 6.7 months (range 1 to 53). The secondarily infected patent bypasses were inflow procedures to the same limb in 6 cases: 1 aortofemoral, 2 ileofemoral, 2 axillofemoral, and 1 femoral femoral graft. The thrombosed infrainguinal bypass was directly attached to the secondarily infected bypass in 5 cases and near but not attached in 1 case. One secondarily infected prosthetic graft was a femoraldistal bypass placed adjacent to the thrombosed graft. Four patients had above-knee amputations with a clinically bland graft divided at the time of amputation. In these 4 patients and 2 additional cases, wet gangrene or infection was present in the distal extremity prior to the development of prosthetic graft infection. At the point that infection became clinically apparent, the thrombosed graft was removed in all cases and the secondarily infected graft was removed in 4 of 7 cases. Overall mortality was 57%.
Conclusions:
A thrombosed prosthetic graft near a patent prosthetic bypass may become secondarily infected and threaten the patent graft. We recommend total removal of any thrombosed prosthetic graft in proximity to a patent prosthetic bypass when the risk of infection is high or at the time of subsequent amputation for gangrene.