VASCULAR GRAFT INFECTION - A RETROSPECTIV E STUDY OF 99 CASES

From January 1, 1980 to December 31, 1992, 7970 vascular prostheses ha ve been implanted at the Department for Vascular Surgery and Kidney Tr ansplantation of the University of Dusseldorf. In the same period of t ime, 99 patients had to be reoperated for (type Szilagyi III [14]) gra ft infection (1,2 %), out of which 70 patients have had their previous operation in our institution (0,9 %). The infection became apparent w ithin 30 days in 14 cases, within one year in 54 cases, and in 31 case s within a maximum of 8 years postoperatively. Localisation of the inf ection was the groin in 70 patients, abdominal aortic prostheses were involved in 16, crural or extraanatomic prostheses in 13 cases. Treatm ent consisted in most cases of axillofemoral bypass (n = 23) and obtur ator-bypass (n = 21). In-situ-implantation of vascular prostheses was performed in 8 cases, 4 of these prostheses were intraoperatively soak ed with an antibiotic. 47 patients had various reconstructions, such a s cross-over bypasses, atypical reconstructions or local treatment. Po stoperatively 27 amputations were necessary. 30-days mortality rate wa s 12 %. At the end of the follow-up (May 1994) we found a 54 % total m ortality rate (mean follow-up: 4,6 +/- 4,59 years). Main cause of deat h in the first year was sepsis. In only 67 % of patients discharged fr om hospital, the peripheral arterial conditions were described as ''go od'' by angiography, ankle-brachial index or clinical examination. We conclude, that vascular graft sepsis threatens the patient in the earl y phase because of limb loss or death, and during the first year after the operation for the sequelae of sepsis or recurrence. Revascularisa tion with antibiotic-soaked grafts in a limited number of cases showed good results in preserving limbs and lives of our patients. Future ex perience will show, whether antibiotic-soaked grafts should be used mo re generously in vascular surgery.