[Infection of a vascular prosthesis--a retrospective analysis of 99 cases]

From January 1, 1980 to December 31, 1992, 7970 vascular prostheses have been implanted at the Department for Vascular Surgery and Kidney Transplantation of the University of Düsseldorf. In the same period of time, 99 patients had to be reoperated for (type Szilagyi III [14]) graft infection (1,2%), out of which 70 patients have had their previous operation in our institution (0,9%). The infection became apparent within 30 days in 14 cases, within one year in 54 cases, and in 31 cases within a maximum of 8 years postoperatively. Localisation of the infection was the groin in 70 patients, abdominal aortic prostheses were involved in 16, crural or extraanatomic prostheses in 13 cases. Treatment consisted in most cases of axillofemoral bypass (n = 23) and obturator-bypass (n = 21). In-situ-implantation of vascular prostheses was performed in 8 cases, 4 of these prostheses were intraoperatively soaked with an antibiotic. 47 patients had various reconstructions, such as cross-over bypasses, atypical reconstructions or local treatment. Postoperatively 27 amputations were necessary. 30-days mortality rate was 12%. At the end of the follow-up (May 1994) we found a 54% total mortality rate (mean follow-up: 4.6 +/- 4.59 years). Main cause of death in the first year was sepsis. In only 67% of patients discharged from hospital, the peripheral arterial conditions were described as "good" by angiography, ankle-brachial index or clinical examination. We conclude, that vascular graft sepsis threatens the patient in the early phase because of limb loss or death, and during the first year after the operation for the sequelae of sepsis or recurrence. Revascularisation with antibiotic-soaked grafts in a limited number of cases showed good results in preserving limbs and lives of our patients. Future experience will show, whether antibiotic-soaked grafts should be used more generously in vascular surgery.