Bacteriology and Treatment of Aortic Graft Infection: A Modern Perspective

Abstract

Aortic graft infection after open repair is infrequent but morbid. In the endovascular era, prevalence of infected aortic grafts may be lower but outcomes no less severe. We reviewed recent infected aortic grafts at our institution to understand contemporary bacteriology and outcomes. All infected aortic grafts from 1996 through 2014 were reviewed. Surgeries, treatments, microbiology, and outcomes were collected. A total of 34 cases were identified. Average age was 64 years, and 53% were men. Twenty-three (64%) had aortobifemoral bypass, seven (22%) had aortic tube graft, three (8%) had aortoiliac bypass, and one had aortopopliteal bypass. Indication for surgery was occlusive disease in 62% and aneurysm in 38%. Sixty-seven percent of patients had total graft removal, while 33% had partial removal. Fifteen patients had excision without reconstruction, 11 had simultaneous extraanatomic bypass, and eight had staged extra-anatomic bypass. Five patients with reconstruction developed infection of the new graft requiring removal. Three of these patients had their reconstruction done simultaneously with aortic graft removal, while two had their reconstruction staged after aortic graft removal. Thirty-one patients had culture results available: 11 had no growth, three grew candida, four grew staphylococcus, three grew streptococcus, five grew enterococcus, and eight grew multiple organisms. Thirty-day mortality after graft removal was 26%. Eight patients eventually came to amputation; three of these patients had a failed extra-anatomic bypass. Explantation and extra-anatomic bypass may still be considered standard treatment for aortic graft infection, but mortality and limb loss remain high. Bacterial species are heterogeneous and many infections are polymicrobial. Tailoring contemporary available treatments including medical management, excision without reconstruction, partial excision, and deep-vein or antibiotic-soaked graft inline reconstruction as cases permit are all reasonable given the morbidity of standard treatment.