The results of in situ prosthetic replacement for infected aortic grafts

BACKGROUND: Treatment of aortic graft infection with graft excision and axi llofemoral bypass may carry an increased risk of limb loss, aortic stump bl owout, and pelvic ischemia. A review of patients with aortic graft infectio n treated with in situ prosthetic graft replacement was undertaken to deter mine if mortality, limb Toss, and reinfection rates were improved with this technique. METHODS: The clinical data of 25 patients, 19 males and 6 females, with a m ean age of 68 years (range 35 to 83), with aortic graft infection, treated between January 1, 1989, and December 31, 1998, by in situ prosthetic graft replacement were reviewed. Follow-up was complete in the 23 surviving pati ents and averaged 36 months (range 4 to 103). RESULTS: Twenty aortofemoral, 3 aortoiliac, and 2 straight aortic graft inf ections were treated with excision and in situ replacement with standard po lyester grafts in 16 patients (64%), or with rifampin-soaked collagen or ge latin-impregnated polyester grafts in 9 patients (36%). Fifteen patients (6 0%) had aortic graft enteric fistulas, 8 patients (32%) had abscesses or dr aining sinuses, and 2 patients (8%) had bacterial biofilm infections. Thirt y-day mortality was 8% (2 of 25). There were no early graft occlusions or a mputations. There was one late graft occlusion. There were no late amputati ons. The reinfection rate was 22% (5 grafts). All reinfections occurred in patients operated upon for occlusive disease. Only one reinfection occurred in the rifampin-soaked graft group (11% versus 29%, P = NS). Reinfection t ended to be lower in patients with aortoenteric fistulas and without absces s. Autogenous tissue coverage provided statistically significant protection against reinfection. There were no late deaths related to in situ graft in fection. CONCLUSIONS: Patients treated with in situ graft replacement had an 8% mort ality and 100% limb salvage rate. Reinfection rates were similar to those o f extra-anatomic bypass, but a trend of lower reinfection rates with rifamp in-impregnated grafts was apparent. Patients with aortoenteric fistula and without abscess appear to be well treated by the technique of in situ prost hetic grafting and autogenous tissue coverage. Am J Surg. 1999;178:136-140. (C) 1999 by Excerpta Medica, Inc.