Current options in prosthetic vascular graft infection

Area of Science:

• Vascular Surgery
• Infectious Diseases

Background:

• Prosthetic graft infections pose a significant challenge in vascular surgery.
• Optimal treatment strategies remain debated, impacting patient outcomes.

Purpose of the Study:

• To evaluate the occurrence, treatment, and outcomes of prosthetic graft infections.
• To identify the most effective management strategies for vascular graft infections.

Main Methods:

• Retrospective review of medical records for vascular graft infections (1985-1995).
• Analysis of patient demographics, initial procedures, infection presentation, causative organisms, and treatment modalities.
• Comparison of outcomes (recurrence, mortality, amputation) across different treatments.

Main Results:

• Twenty-four patients with prosthetic graft infections were identified; most were male (67%) with an average age of 62.
• Aortofemoral bypasses were common (63%), with infections often presenting in the groin (87%) after a median of 29 months.
• Extra-anatomic bypass showed no graft reinfection. In situ replacement was effective for late coagulase-negative Staphylococcus infections. Gram-negative infections had universally poor outcomes (P=0.008).

Conclusions:

• Extra-anatomic bypass is the preferred treatment for prosthetic graft infections due to its association with no recurrence.
• Selective use of in situ replacement and graft preservation is recommended, guided by infection timing and specific pathogens.
• Treatment outcomes, including mortality (17%) and amputation (21%) rates, did not significantly differ between modalities, but pathogen type is critical.