Abstract
To determine optimal management and outcome of infected extra-anatomic bypass grafts (EABG), we reviewed 28 patients (19 men and 9 women; mean age 70 years) treated over a 13-year period. Mean follow-up was 42 months. There were 16 axillofemoral (AF), 10 femorofemoral (FF), and two axillopopliteal (AP) grafts. Risk factors included previous prosthetic graft infection in 13 patients, enterocutaneous fistula in two, and mycotic aortic aneurysm in one. Initial management involved complete graft excision in 12 patients, partial graft excision in 10, and nonresectional therapy in six. Failure of nonresectional therapy and partial excision in three patients each required further operative intervention with graft excision. Reconstruction in patients eventually requiring graft excision (n=25) entailed placement of a new prosthetic AF or AP graft in eight, an autogenous FF graft in five, combined prosthetic AF and autogenous FF bypass in two, autogenous iliofemoral bypass in one, obturator bypass in one, or no reconstruction in eight. Four autogenous FF reconstructions thrombosed immediately postoperatively, and three prosthetic reconstructions became infected. The mortality rate was 18% (FF=20%, AF=19%, AP=0%). The amputation rate was 25% (AP=100%, AF=25%, FF=10%) and was higher without arterial reconstruction (56% vs. 12%,p=0.02). Two patients required hemipelvectomies and one had bilateral hip disarticulation. We conclude that EABG infections can be successfully treated but carry significant morbidity and mortality. Optimal management includes EABG resection and prompt revascularization, bearing in mind the risk of early thrombosis in autogenous grafts and reinfection in prosthetic grafts.
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References
Edwards WH, Martin RS III, Jenkins JM, et al. Primary graft infections. J Vasc Surg 1987;6:235–239.
Bunt TJ. Synthetic vascular graft infections. I. Graft infections. Surgery 1993;93:733–746.
Kalman PG, Hosang M, Cina C, et al. Current indications for axillounifemoral and axillobifemoral bypass grafts. J Vasc Surg 1987;5:828–832.
Szilagyi DE, Smith RF, Elliott JP, et al. Infection in arterial reconstruction with synthetic grafts. Ann Surg 1972;176: 321–333.
Samson RH, Veith FJ, Janko GS, et al. A modified classification and approach to the management of infections involving peripheral arterial prosthetic grafts. J Vasc Surg 1988;8:147–153.
Hepp W, de Jonge K, Pallua N. Late results following extraanatomic bypass procedures for chronic aortic occlusive disease. J Cardiovasc Surg 1988;29:181–185.
Liekweg WG Jr, Greenfield LJ. Vascular prosthetic infections: Collected experience and results of treatment. Surgery 1977;81:335–342.
Gretchen A, Gooding W, Herzog KA, et al. B-mode ultrasonography of prosthetic vascular grafts. Radiology 1978;127: 763–766.
Brunner MC, Mitchell RS, Baldwin JC. Prosthetic graft infection: Limitations of indium white blood cell scanning. J Vasc Surg 1986;3:42–48.
LaMuraglia GM, Fischman AJ, Strauss HW, et al. Utility of the indium 111-labeled human immunoglobulin G scan for the detection of focal vascular graft infection. J Vasc Surg 1989;10:20–28.
Lawrence PF, Dries DJ, Alasraki N, et al. Indium 111-labeled leukocyte scanning for detection of vascular graft infection. J Vasc Surg 1985;2:165–173.
Shah DM, Chang BB, Darling RC, et al. Management of vascular graft infection. Contemp Surg 1993;43:89–96.
Calligaro KD, Veith FJ, Gupta SK, et al. A modified method for management of prosthetic graft infections involving an anastomosis to the common femoral artery. J Vasc Surg 1990;11:485–492.
Cherry KJ, Roland CF, Pairolero PC, et al. Infected femoro-distal bypass: Is graft removal mandatory? J Vasc Surg 1992;15:295–305.
Mixter RC, Turnipseed WD, Smith DJ, et al. Rotational muscle flaps: A new technique for covering infected vascular grafts. J Vasc Surg 1989;9:472–478.
Kwaan JH, Connolly JE. Successful management of prosthetic graft infection with continuous povidone-iodine irrigation. Arch Surg 1981;116:716–720.
Seeger JM, Wheeler JR, Gregory RT, et al. Autogenous graft replacement of infected prosthetic grafts in the femoral position. Surgery 1983;93:39–45.
Ehrenfeld WK, Wilbur BG, Olcott CN, et al. Autogenous tissue reconstruction in the management of infected prosthetic grafts. Surgery 1979;85:82–92.
Reilly LM, Altman H, Lusby RJ, et al. Late results following surgical management of vascular graft infection. J Vasc Surg 1984;1:36–44.
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de Virgilio, C., Cherry, K.J., Gloviczki, P. et al. Infected lower extremity extra-anatomic bypass grafts: Management of a serious complication in high-risk patients. Annals of Vascular Surgery 9, 459–466 (1995). https://doi.org/10.1007/BF02143860
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DOI: https://doi.org/10.1007/BF02143860