Treatment of major aortic graft infection: Preliminary experience with total graft excision and in situ replacement with a rifampicin bonded prosthesis

Abstract

The most feared complication after aortic reconstruction is infection, principally because the ensuing death and/or amputation rate may exceed 70%. 1 Its relative rarity (1-2%) 1' 2 has contributed towards problems in determining the optimal mode of management because thousands of patients would be required in prospective trials to prove the effectiveness of one treatment regime over another. Accordingly the literature contains genuine claims and counter-claims on the respective merits of antibiotic irrigation, total graft excision, extra-anatomical bypass, autologous reconstruction, in situ prosthetic revascularisation or retroperitoneal in-line prosthetic bypass. 3-7 Until recently, it had been our policy to excise infected aortic prostheses and undertake synchronous extra-anatomic bypass. However we were then faced with a patient with an infected aortic graft, massive retroperitoneal abscess formation and poor peripheral perfusion in whom flexion deformities at the hips precluded extra-anatomical bypass. We therefore undertook to manage this patient by graft excision and in situ replacement with a rifampicin bonded prosthesis as had been recently advocated by Strachan. 8 Impressed with the outcome, we have since dealt with four further patients in a similar manner.