EXPOSED FEMOROPOPLITEAL GRAFT - EX-SITU R EPLACEMENT

From December 1990 to July 1995 we performed 171 sub-inguinal revascul arizations including 35 popliteal revascularizations and 146 revascula rizations of an artery in the leg or foot. Five cases of infection wer e observed within a delay of 7 and 25 days after the operation. Them w ere 3 men and women (mean age 78 years), Four femorotibial bypasses we re made For critical ischaemia (2 necroses of the toes, one eschar of the heal, one stage III). There was one femoro-popliteal bypass which was associated with a femoro-femoral for necrosis of the toes. Two byp asses were made with polytetrafluoroethylene, one with Dacron and two with the greater saphenous vein. Signs of sepsis were bleeding in 2 pa tients who had a venous bypass and septicaemia in 2 patients. Local sk in necrosis and/or apparently infected discharge or potent pus were se en in all patients. Staphylococcus aureus was found in 4 patients and Enterobacter cloacae in one. Revascularization was done with an extra- anatomic bypass in 4 patients and with a cryopreserved in situ allogra ft in 1. Mortality was 20 % and amputation rate was 40 %. All exposed bypasses were infected but the severity of the infection varied depend ing on the causal germ, general signs and ischaemia of the limb. Conse rvative treatment has its limits: 1) intact anastomoses, 2) absence of bleeding, 3) patent bypass, 4) absence of generalized sepsis. Results of in situ revascularization depend on the virulence of the causal ge rm. Radical treatment (explantation + extraanatomic revascularization) still has Indications in infected infrainguinal bypass surgery.