Cor Vasa 2002, 43(1):12-17

Infectious complications of prosthetic vascular grafts: the pathobiology, clinical practice and their management

Jan Táborský^1,*, Karel Novotný¹, Kateřina Nováčková², Ivan Vaněk¹

¹ II. chirurgická klinika kardiovaskulární chirurgie

² II. interní klinika, Všeobecná fakultní nemocnice a 1. lékařská fakulta Univerzity Karlovy, Praha, Česká republika

Aim of study:
The aim of the study is to present experience with the incidence and surgical treatment of infections of prosthetic vascular grafts.

Method:
A retrospective study of infections of prosthetic vascular grafts at the Division of Surgery II, Department of Cardiovascular Surgery, over the 1992-2000 period.

Results:
In a series of 1,100 arterial reconstruction procedures using prosthetic vascular grafts, infectious complications occurred in 14 patients (1.3%). The shortest and longest intervals to the first manifestations were 7 days and 4 years, respectively. Of the 14 patients undergoing surgery, 3 (20%) died, and one female patient required amputation (6.6%). No difference was seen in the incidence of gram-positive (5 patients) and gram-negative (6 patients) infectious agents. Primary culture was negative in three patients. Future clinical development and bacteriological findings made it clear that the infectious process involved the graft. The mainstay of therapy was extraction of the infected graft followed either by extra-anatomical bypass or by allotransplant implantation. Three patients had simple infected graft removal without any sequels. It is not recommended to perform partial vascular graft resection only (based on macroscopically detectable manifestations of infection).

Conclusion:
The incidence of vascular graft infection in our department is roughly consistent with that reported in the relevant literature. Based on our experience, we believe the mainstay of treatment of the infected vascular graft is its complete resection either (a) followed by extra-anatomic reconstruction, or (b) allogenous transplant implantation, or (c) the problems and clinical condition of the limb allowing, to refrain from undertaking another arterial reconstruction.

Keywords: Infection; Prosthetic vascular grafts; Clinical practice; Pathobiology; Operative results

Published: January 1, 2002  Show citation