BACTERIAL AND CLINICAL-CRITERIA RELATING TO THE OUTCOME OF PATIENTS UNDERGOING IN-SITU REPLACEMENT OF INFECTED ABDOMINAL AORTIC GRAFTS

Objectives: In a retrospective non-randomised study we assessed the ou tcome after in situ replacement of infected knitted Dacron abdominal a ortic grafts in patients without septicaemia or retroperitoneal absces ses. We also assessed whether the specific bacterial infection influen ced outcome. Materials and methods: Over. the 5 years studied, 18 pati ents (9 with perigraft infection and 9 with aortoenteric erosion) unde rwent in situ replacement of aortofemoral grafts. All patients were ha emodynamically stable, none required emergency treatment. Preoperative assessment included CT, MRI, leukocyte-labelled scintigraphy, and bac terial cultures whenever possible. Infected grafts were totally exerci se and replaced in situ with standard PTFE prostheses. Bacterial diagn osis included intraoperative Gram-staining and postoperative graft cul tures. None of the patients had retroperitoneal collections or proxima l anastomotic dehiscence. All patients had 6 week intravenous antibiot ic therapy. Results: One patient died of myocardial infarction, and an other of haemorrhagic shock from proximal anastomotic dehiscence, acco unting for a graft-related mortality of 6%. Dehiscence resulted from a polymicrobial infection. Mean 37 month surveillance showed no amputat ions and no graft-related infections. Conclusions: In clinically and b acteriologically selected patients, total in situ replacement of infec ted abdominal aortic grafts offers an excellent outcome.