MANAGEMENT OF SEVERE INFECTION AS COMPLICATION IN AORTOFEMORAL GRAFTS

Objective: Infection of the retroperitoneum after implantation of an a bdomino-femoral aortic graft remains one of the main problems in Vascu lar surgery. On basis of a critical review of own experiences we evalu ated the management of this difficult clinical situation. Patients: Fr om 1970-1996 1500 aortofemoral graft operations (aneurysmal disease: 5 12, aortoiliacal occlusive disease: 988) were performed. Abdominal inf ection occured in 12 patients (0,8%) (12 men, median age 60,5 [48-80] years). Results: The median interval between operation and infection w as 17,7 (0,5-108) months. The port of infection was in 50% the groin, 25% suffered from abdominal infection, in 3 cases it was not to identi fy. Clinical manifestation of infection was aortoduodenal fistula in 2 patients, false aneurysms in 2 cases, and a paraprosthetic abscess in another 4 patients. Operative therapy comprised (partial) removal of infected material in 10 patients with consecutive extraanatomical reco nstruction in 8 of these. Mortality of graft infection was 50%. Causes of death were untreatable sepsis in 4 patients, another 2 died from h emorrhagic shock. 3 out of 6 surviving patients finally lost their lim bs following multiple vascular procedures. Conclusion: Adequate surgic al therapy of infected aortofemoral grafts remains an unsolved problem . Lack of knowledge of suitable parameters for the best treatment leav es the outcome of prosthetic infection unpredictable. Removal of the i nfected graft with extra anatomic reconstruction seems to be the stand ard of surgical treatment, which is recommended in these cases.