Aortic graft infection: Is there a place for partial graft removal?

Abstract

Aortofemoral grafts may become infected intraoperatively by direct graft contamination or postoperatively by bacteriaema or septicaemia, abscess in the vicinity of the graft and aortoenteric fistula. All causes put together, the incidence of aortofemoral graft infection is between I and 3%. 1 Graft infection remains a devastating complication. Mortality rates mainly due to arterial rupture or generalised sepsis with multiorgan failure varies between 8 and 43% and amputation rates between 7 and 250/o. 2 A variety of treatment strategies for aortofemoral graft infection have been proposed including conservative management, total graft excision and partial graft removal. In the two latter options the question remains open as to which type of revascularisation should be employed (in situ vs. extra-anatomical route) and by which conduit (autogenous vein or arteries, fresh or cryo-conserved allograft, PTFE or antibiotic bonded Dacron graft). This paper focuses on our own experience with partial graft removal as well as a literature review to define the place of this treatment in aortofemoral graft infection.