SELECTIVE PRESERVATION OF INFECTED PROSTHETIC ARTERIAL GRAFTS - ANALYSIS OF A 20-YEAR EXPERIENCE WITH 120 EXTRACAVITARY-INFECTED GRAFTS

Objective The authors report on their 20-year experience with 120 pati ents with infected extracavitary prosthetic arterial grafts (95 polyte traflouroethylene, 25 Dacron). Throughout this experience, an effort w as made, when appropriate, to salvage all or a portion of these infect ed grafts. Methods When patients had arterial bleeding (20 cases) or s ystemic sepsis (6 cases), immediate graft excision was performed. When the infected graft was occluded (43 cases), subtotal graft excision w as performed, leaving an oversewn 2- to 3-mm graft remnant to maintain patency of the artery. Complete graft preservation was attempted in 5 1 cases in which the graft was patent, the patient was not septic, and the anastomoses were intact. Aggressive operative wound debridement w as repeated, as necessary, to achieve wound healing. The preferred met hod of revascularization, when necessary, included secondary bypasses tunneled through uninfected (often lateral) routes. Follow-up averaged 3 years (range, 1 month-20 years). Results This strategy resulted in a hospital mortality of 12% (14/120) and a hospital amputation rate in survivors of 13% (14/106 threatened limbs). Of the surviving patients treated by complete graft preservation, the hospital amputation rate was only 4% (2/45) and long-term complete graft preservation was succe ssful in 71% (32/45) of cases. Partial graft preservation also proved successful in 85% (35/41) of surviving patients who had occluded graft s. Successful complete graft preservation was as likely when gram-nega tive or gram-positive bacteria were cultured from the wound, with the exception of Pseudomonas (successful graft preservation in only 40% [4 /10] of cases). Conclusion Based on this 20-year experience, the autho rs conclude that selective partial or complete graft preservation repr esents a simpler and better method of managing infected extracavitary prosthetic grafts than routine total graft excision.