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The Journal of Cardiovascular Surgery 2002 April;43(2):209-15

Copyright © 2009 EDIZIONI MINERVA MEDICA

language: English

Management of aortic graft infection

Ten Raa S., Van Sambeek M. R. H. M., Hagenaars T., Van Urk H.

From the Department of Vascular Surgery and *Experimental Echocardiography, Erasmus University Medical Center, Rotterdam, The Netherlands


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Background. The opti­mal meth­od of oper­a­tive treat­ment of pros­thet­ic aor­tic ­graft infec­tion (­PAGI) has ­been the sub­ject of ­debate; inci­dence ­rates of ­PAGI are low. Diagnosis of ­PAGI can be dif­fi­cult. The aim of ­this ret­ro­spec­tive ­study is to eval­u­ate our ­results in treat­ing ­PAGI in ­order to try and opti­mize the treat­ment of ­this ­grave prob­lem.
Methods. Thirty-­eight ­patients (­median age 68.5 ­years) ­were treat­ed for ­PAGI ­between 1991 and 2000. Management of ­PAGI was per­formed ­with ­total ­graft exci­sion and simul­ta­ne­ous ­extra-ana­tom­ic ­bypass (n=18), ­total ­graft exci­sion and in ­situ ­repair ­with a Rifampicin-­soaked gel­a­tin-impreg­nat­ed pros­thet­ic aor­tic ­graft (n=8), or a par­tial exci­sion ­with in ­situ ­repair (n=11). In 1 ­patient, ­only ­local irri­ga­tion was per­formed. The ­median fol­low-up was 45 ­months.
Results. Clinical pres­en­ta­tion of ­PAGI (­median inter­val 3 ­years) was: dis­com­fort/­pain (n=14), gas­tro-intes­ti­nal bleed­ing (n=11), per­sist­ing ­fever (n=8), or a non-heal­ing ­wound (n=5). The pri­mary paten­cy ­rate in ­patients ­with ­extra-ana­tom­ic ­bypass was 67% at 6 ­months fol­low-up. In ­patients ­with oth­er sur­gi­cal recon­struc­tions no ­graft occlu­sion was encoun­tered. Overall ampu­ta­tion ­rate was 5%. Recurrent infec­tion of the ­graft was 15%. The over­all ear­ly mor­tal­ity ­rate in ­this ­study was 21%.
Conclusions. The diag­no­sis of ­PAGI is dif­fi­cult and ­should be ­based on a com­bi­na­tion of clin­i­cal symp­toms, labor­a­to­ry find­ings and imag­ing tech­niques. There are sev­er­al treat­ment ­options ­that ­should be tail­ored to the ­extent of infec­tion and the ­patients’ phys­i­cal con­di­tion. In a select­ed ­group of ­patients par­tial exci­sion of the infect­ed ­graft ­only can be jus­ti­fied.

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