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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY
A Journal on Vascular and Endovascular Surgery
Giornale Italiano di Chirurgia Vascolare 2003 December;10(4):347-60
language: English, Italian
Graft infection. Conservative treatment
Ippoliti A. 1, Di Giulio L. 1, Accrocca F. 1, Pampana E. 2, Gandini R. 2, Simonetti G. 2, Pistolese G. R. 1
1 Department and Specialisation School in Vascular Surgery
2 Department and Specialisation School in Radiodiagnostics “Tor Vergata” University of Rome, Rome
Aim. Indications for the conservative treatment of graft infections.
Methods. Nine patients who underwent surgery of the aortoiliac tract and later developed graft infection were treated using a conservative approach: 2 patients underwent surgical drainage and focused antibiotic therapy, whereas CT-guided percutaneous drainage of the perigraft fluid collection was associated with specific antibiotic therapy in 7 patients. Each patient was controlled both clinically and using ultrasonographic and CT scan once every 6 months.
Results. The 2 patients treated surgically remained asymptomatic for 2 and 3 years respectively and died from non graft-related reasons. Among the 7 patients treated percutaneously, 4 recovered (mean follow-up=30.7 months), and in the other 3 cases an aortoduodenal fistula was reported in 2 cases, at the 75th and 77th postoperative month, leading to patient death. In the 3rd case, 4 months after drainage, the patient underwent surgical extra-anatomic revascularisation and died 3 months later from acute myocardial infarction.
Conclusion. In the presence of a prosthetic infection, the treatment of choice should be graft excision coupled with extra-anatomic revascularisation or ìin situî reconstruction. Percutaneous drainage represents a good option for non-complicated cases in which more aggressive treatment would increase the surgical risk. This diagnostic method can provide either useful confirmation of the microbiological diagnosis and, when diagnosis is prompt, as a first-line procedure, giving the chance of a complete recovery or permitting amelioration of the retroperitoneal environment in preparation for a surgical approach.