Graft preserving methods for managing aortofemoral prosthetic graft infection

Abstract

The traditional approach to aortofemoral graft infection has included total graft excision and extraanatomic bypasses but has been associated with mortality rates of 25-75% and amputation rates of 1025%. 1-5 Recent reports have documented an improved mortality rate using this traditional approach. 6 A more controversial strategy to treat infected aortofemoral prosthetic graft infections includes selective complete and partial graft preservation. When used appropriately, this method may be associated with lower mortality and limb-loss rates. 7-11 Aortofemoral prosthetic graft preservation should only be attempted when strict criteria are fulfilled, and by vascular surgeons who fully understand the essential adjuncts of this management. cannot tolerate such prolonged, stressful operations. Third, abdominal exploration after previous placement of an aortic graft may result in injury to the bowel or ureter when dense adhesions are encountered. Fourth, most patients require revascularisation procedures if part or all of the graft is excised, especially if the original aortic operation was performed for limb salvage or aneurysmal disease. If the original operation was performed for claudication, many patients will maintain lower limb viability after graft excision when the proximal anastomosis was performed in an end-toside fashion to the aorta. Revascularisation procedures often pose challenging problems, especially the route of a secondary bypass to avoid the infected wounds. The revascularisation procedure itself may be timeconsuming and contribute to the morbidity associated with graft excision.