MANAGEMENT OF ABDOMINAL AORTIC PROSTHETIC GRAFT INFECTION REQUIRING EMERGENT TREATMENT

The purpose of this study was to investigate mortality and morbidity r ates and long-term outcome of patients who underwent emergency treatme nt of abdominal aortic prosthetic graft infection. Between January 198 4 and December 1993, 18 men aged fifty-nine +/-sixteen years were oper ated on as an emergency for an acute life-threatening complication of aortic prosthetic graft infection. The grafts had been implanted for a bdominal aortic aneurysm in 9 patients and aortoiliac occlusive diseas e in 9, from one to one hundred seventy months previously. Five (28%) patients presented with a hemorrhagic shock due to a fistula between t he vascular reconstruction and the small bowel (4 patients) or the rig ht ureter (1 patient) and 13 (72%) had generalized sepsis. The grafts were always radically explanted. Extraanatomic revascularization proce dures included 6 axillopopliteal and 12 axillofemoral bypass grafts. O perative mortality was 39% (7 patients), and 3 (9%) limbs were amputat ed within thirty days. Two (11%) patients died after seven and twelve months, respectively, of septic complications, and 1 (5%) patient died after six months from an unrelated cause. Eight (73%) patients are st ill alive at a mean follow-up of fifty +/-thirty-four months, but in 3 the extraanatomic bypass was removed for infection and 5 major amputa tions were performed. Two-year survival and limb salvage rates were 44 % and 50%, respectively. Aortic prosthetic graft infections that requi re emergent treatment continue to demonstrate high early and late mort ality and limb loss rates despite aggressive intervention and limb sal vage procedures. Newer methods of managing these complications should continue to be investigated.