Clinical Evaluations of Prosthetic Vascular Graft Infection

Lee, Ky Yeung; Lee, Dong Shik; Kwun, Woo Hyung; Suh, Bo Yang; Kwun, Koing Bo

Abstract

Infection of a prosthetic vascular graft is a perilous complication, difficult to eradicate, and if not recognized or adequately treated eventually caused the prosthesis to malfunction, often with life- threatening hemorrhage. Authors retrospectively evaluated the 17 cases of prosthetic vascular graft infection to determine treatment modalities of graft infection from May 1983 to April 1997 at department of surgery, Yeungnam University Hospital. Aortic and peripheral vascular graft infection were 2 and 15 cases, and mortality rate were 50% and 13.3%, respectively. Amputation rate was 13.3% in peripheral vascular graft infection. Most of the patients had experienced symptoms and signs of infection, such as fever, leukocytosis, pus discharge, wound disruption and/or bleeding due to anastomotic disruption. The Most common pathogen was Staphylococcus aureus(12 cases) and others were Staphylococcus epidermidis(4 cases), Escherichia coli(1 cases). The most common site of infection was inguinal area(7 cases) that associated with repeated operation for thromboembolectomy. The diagnosis was made with Duplex ultrasonography, computed tomography and sinography. In one case of aorto-iliac bypass, graft-cutaneous fistula was found by sinography. Treament modalities were local antibiotic soaking dressing only (4 cases), rotational muscle flap(1 case), graft excision with revascularization(4 cases), and graft excision without revascularization(6 cases) in peripheral graft infection and aortic graft excision with extra-anatomic bypass graft(2 cases) in aortic graft infection with systemic antibiotic administration. In conclusion, prevention of vascular graft infection and early diagnosis of infection are very important. The time to infection after operation, infection sites, bacteological pathogens and general condition of patients are also important to select treatment modalities, such as local care only, muscle flap application, interposition graft, and removal of graft with or without revascularization.