BACTERIAL AND CLINICAL CRITERIA RELATED TO THE OUTCOME OF PATIENTS OPERATED ON BY IN SITU REPLACEMENT FOR INFECTED ABDOMINAL AORTIC GRAFT

Eur J Vasc Endovasc Surg. 1997 Feb;13(2):127-33. Bacterial and clinical criteria relating to the outcome of patients undergoing in situ replacement of infected abdominal aortic grafts. Speziale F, Rizzo L, Sbarigia E, Giannoni MF, Massucci M, Maraglino C, Santoro E, Fiorani P. Source Department of Vascular Surgery, University of Rome La Sapienza, Italy. Abstract OBJECTIVES: In a retrospective non-randomised study we assessed the outcome after in situ replacement of infected knitted Dacron abdominal aortic grafts in patients without septicaemia or retroperitoneal abscesses. We also assessed whether the specific bacterial infection influenced outcome. MATERIALS AND METHODS: Over the 5 years studied, 18 patients (9 with perigraft infection and 9 with aortoenteric erosion) underwent in situ replacement of aortofemoral grafts. All patients were haemodynamically stable, none required emergency treatment. Preoperative assessment included CT, MRI, leukocyte-labelled scintigraphy, and bacterial cultures whenever possible. Infected grafts were totally excised and replaced in situ with standard PTFE prostheses. Bacterial diagnosis included intraoperative Gram-staining and postoperative graft cultures. None of the patients had retroperitoneal collections or proximal anastomotic dehiscence. All patients had 6 week intravenous antibiotic therapy. RESULTS: One patient died of myocardial infarction, and another of haemorrhagic shock from proximal anastomotic dehiscence, accounting for a graft-related mortality of 6%. Dehiscence resulted from a polymicrobial infection. Mean 37 month surveillance showed no amputations and no graft-related infections. CONCLUSIONS: In clinically and bacteriologically selected patients, total in situ replacement of infected abdominal aortic grafts offers an excellent outcome. PMID: 9091143 [PubMed - indexed for MEDLINE