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[Management of severe infection complicating aortofemoral grafts]
J Karner-Hanusch1, M Staudacher, M Prager
1Klinische Abteilung für Gefässchirurgie, Universität Wien, Osterreich.
Objective:
Infection of the retroperitoneum after implantation of an abdomino-femoral aortic graft remains one of the main problems in vascular surgery. On basis of a critical review of own experiences we evaluated the management of this difficult clinical situation.
Patients:
From 1970-1996 1500 aortofemoral graft operations (aneurysmal disease: 512, aortoiliacal occlusive disease: 988) were performed. Abdominal infection occurred in 12 patients (0.8%) (12 men, median age 60.5 [48-80] years).
Results:
The median interval between operation and infection was 17.7 (0.5-108) months. The port of infection was in 50% the groin, 25% suffered from abdominal infection, in 3 cases it was not to identify. Clinical manifestation of infection was aortoduodenal fistula in 2 patients, false aneurysms in 2 cases, and a paraprosthetic abscess in another 4 patients. Operative therapy comprised (partial) removal of infected material in 10 patients with consecutive extraanatomical reconstruction in 8 of these. Mortality of graft infection was 50%. Causes of death were untreatable sepsis in 4 patients, another 2 died from hemorrhagic shock. 3 out of 6 surviving patients finally lost their limbs following multiple vascular procedures.
Conclusion:
Adequate surgical therapy of infected aortofemoral grafts remains an unsolved problem. Lack of knowledge of suitable parameters for the best treatment leaves the outcome of prosthetic infection unpredictable. Removal of the infected graft with extraanatomic reconstruction seems to be the standard of surgical treatment, which is recommended in these cases.
Insights
Graft infection after aortofemoral bypass surgery is a serious complication. Surgical removal of infected grafts with extra-anatomical reconstruction is the recommended treatment, but outcomes remain unpredictable.
Area of Science:
- Vascular Surgery
- Infectious Disease Management
Background:
- Infection of retroperitoneal aortic grafts is a significant challenge in vascular surgery.
- This study reviews management strategies for infected aortofemoral grafts based on clinical experience.
Purpose of the Study:
- To evaluate the management and outcomes of patients with infected aortofemoral grafts.
- To assess the effectiveness of surgical interventions for prosthetic graft infections.
Main Methods:
- Review of 1500 aortofemoral graft operations performed between 1970 and 1996.
- Analysis of 12 cases (0.8%) of graft infection, including clinical presentation, treatment, and outcomes.
Main Results:
- Infection occurred a median of 17.7 months post-operation, with common sites including the groin and abdomen.
- Clinical manifestations included aortoduodenal fistula, false aneurysms, and paraprosthetic abscesses.
- Mortality was 50%, with causes including sepsis and hemorrhagic shock; survivors often faced limb loss.
Conclusions:
- Surgical treatment for infected aortofemoral grafts remains problematic with unpredictable outcomes.
- Removal of the infected graft coupled with extra-anatomical reconstruction is the current standard of care.
- Further research is needed to identify parameters for optimizing treatment and improving patient prognosis.