Surgical Treatment of the Infected Aortic Graft

Abstract

The primary goal of treatment in dealing with an infected aortic graft is to save life and limb. This goal is best accomplished by eradicating all infected graft material and maintaining adequate circulation with appropriate vascular reconstruction. This review describes the choice of procedures, including an extra-anatomic bypass, an aortic allograft, an antibiotic-treated prosthetic graft, and an in situ autogenous reconstruction. Once a procedure has been decided on, preoperative evaluation and operative planning must take place. The review describes operative technique from the thigh incision and exposure of the femoral vessels to closure. Postoperative care is described. Outcomes and complications are discussed. Special consideration is given to aortoenteric fistulas. This review contains 8 figures, 2 tables, and 83 references. Key words: antibiotic-impregnated Dacron, aortic graft infection, aortoenteric erosion, aortoenteric fistula, axillobifemoral bypass, cryopreserved allograft, neoaortoiliac surgery