Graft Sepsis Research Articles

A national study of allogeneic stem cell transplantation for adults with acute myeloid leukemia: Do gender and age above 70 years matter?

e19020 Background: Allogeneic stem cell transplantation (alloSCT) is increasingly being offered to older patients with acute myeloid leukemia (AML) due to availability of reduced-intensity conditioning regimens and better supportive care. Though studies have shown improving alloSCT survival outcomes in older age groups, it is still not known if older age confers higher mortality and morbidity during transplant hospitalization. We queried a national inpatient database to evaluate in-hospital mortality and resource utilization during alloSCT for AML in patients >70 years compared to a younger age group. Methods: We conducted a retrospective study of alloSCT for AML patients ≥ 18 years using the 2018 National Inpatient Sample database. Hospitalizations were selected using International Classification of Disease, tenth revision (ICD-10) codes. Demographics, comorbidities, transplant, and outcome variables were compared between a reference age group (18-70 years) and a comparator group (> 70 years). Study outcomes were in-hospital mortality, length of stay (LOS) and transplant complications. Regression models were fit to assess the association between predictors and outcomes. Results: During the study period, 2610 alloSCT met the inclusion criteria. This cohort consisted of 50% males and 77% Caucasians. Only 7% of these alloSCT were performed for patients > 70 years. Patients >70 yrs had a lower proportion of females compared to the reference age group (32% versus 52%, p<0.01). There were no significant differences in racial distribution, Charlson comorbidity index or median income between the 2 age groups. In-hospital mortality rates for the reference age group versus >70 years were 3% and 5% respectively (p=0.35). In a multivariable model, we found no association between age >70 years and in-hospital transplant mortality. Acute graft versus host disease was more frequent among the reference age group (14% versus 2%, p=0.04), but there were no differences in LOS or rates of graft failure, respiratory failure, sepsis, and acute renal failure between the 2 groups. Conclusions: Despite similar in-hospital transplant outcomes as their younger counterparts, patients >70 years comprised only a small proportion of alloSCT performed for AML in our study. Females were more disproportionately affected by this age disparity. More studies are necessary to identify barriers to alloSCT for older AML patients, more so for older females.

Lung Transplantation for Pulmonary Lymphangioleiomyomatosis: Single-Centre Experience

Purpose Lymphangioleiomyomatosis (LAM) is a rare disease in women leading to progressive deterioration of lung function and respiratory failure. Here, we describe the outcome of patients with end stage LAM who underwent lung transplantation at our center. Methods and Materials We conducted a retrospective study of 20 patients who underwent lung transplantation for end-stage LAM between 11/96 and 11/12. Analyses included standard clinical parameters (e.g. age, survival) as well as surgical approach, use of ECC, operation and ICU time etc. Results Out of as total of more than 1200 double/single lung transplantations during the period of analysis, one single and 17 bilateral lung transplants were performed in 18 patients with LAM. All patients were women with a mean age of 50 ± 9 years. The mean cold ischemia time was 376,5 ± 136,5 minutes. Thirty-day survival was 100%. Four late deaths occurred due to chronic graft dysfunction, sepsis, airway stenosis (1) and CMV pneumonitis. The actuarial survival in the LAM group was 92% at 1 year, 69% at 3 years and 69% at 5 years compared to an overall survival of 77%, 69% and 61% after LTx for other indications. Conclusions LTx in patients with end-stage pulmonary LAM yields equivalent or better results to patients with lung transplantation for other indications. While there are no prospective data on survival in LAM patients, lung transplantation improves quality of life and probably also increases survival in patients with end-stage LAM. The results justify transplantation and offer a valuable therapy for patients with end-stage pulmonary LAM.

Lung transplantation for pulmonary lymphangioleiomyomatosis: Single-centre experience

Introduction: Lymphangioleiomyomatosis (LAM) is a rare disease in women leading to progressive deterioration of lung function and respiratory failure. Here, we describe the outcome of patients with end stage LAM who underwent lung transplantation at our centre. Patients and methods: We conducted a retrospective study of 20 patients who underwent lung transplantation for end-stage LAM between 11/96 and 10/12. Analyses included demographic parameters (e.g. age, survival) as well as surgical approach, use of ECC, operation and ICU time etc. Results: Out of as total of more than 1237 double/single lung transplantations during the period of analysis, one single and 19 bilateral lung transplants were performed in 20 patients with LAM. All patients were women with a mean age of 50 years. The mean cold ischemia time was 376.5 ± 136.5 minutes. 30 day survival was 100%. Four late deaths occurred due to chronic graft dysfunction (1), sepsis (1), airway stenosis (1) and CMV pneumonitis (1). The actuarial survival in the LAM group was 92% at 1 year, 69% at 3 years and 69% at 5 years compared to an overall survival of 77%, 69% and 61% after LTx for other indications. Conclusions: LTx in patients with end-stage pulmonary LAM yields equivalent results to patients with lung transplantation for other indications. While there are no prospective data on survival in LAM patients, lung transplantation improves quality of life and very likely increases survival in patients with end-stage LAM.

A comparison of total laparoscopic and open repair of abdominal aortic aneurysms

The feasibility of total laparoscopic abdominal aortic aneurysm (AAA) repair has been well established. In a previous case-control study, we showed that the postoperative courses of total laparoscopic and open AAA repairs were similar. The purpose of this study was to compare the long-term results of these techniques in the same cohort of patients. Thirty patients with AAAs treated by total laparoscopic repair between July 2003 and December 2004 (group I) were matched in a case-control fashion by morphology and American Society of Anesthesiologists class with 30 patients who underwent open AAA repair between April 1997 and May 2004 (group II). Patients who survived the intervention were followed up during 5 years. Follow-up consisted of physical examination and duplex ultrasonography at 1 month and yearly thereafter. Group I patients had an additional control computed tomography scan within the first 3 months postoperatively. Five-year cumulative survival rates were similar (group I: 83% ± 7% vs group II: 79% ± 7%; log-rank test, P = .69). No late aneurysm-related death occurred during the follow-up period. Incisional hernias were more likely to occur in group II patients (group I: 0% vs group II: 15.4%; P = .047). Incidence of postoperative sexual dysfunction was similar in both groups (group I: 22.2% vs group II: 25.0%; P = not significant [NS]). No late reintervention was recorded in group I, whereas 2 patients in group II had incisional hernia repair. At 5 years, no graft sepsis or anastomotic pseudoaneurysm was reported. This study suggests that total laparoscopic AAA repair provides good long-term results, comparable to those of open repair in terms of aneurysm-related mortality and morbidity. It may reduce the incidence of laparotomy-related complications.

Repair of abdominal aortic aneurysms with aorto-uni-iliac stentgraft and femoro-femoral bypass.

Endovascular repair (EVAR) is accepted as effective treatment for abdominal aortic aneurysms (AAAs) and has become the standard of care in many instances. The standard bifurcated stentgraft (BFG) is often not possible in patients with unfavourable aneurysm morphology. The aorto-uni-iliac (AUI) graft configuration with femoro-femoral bypass (FFBP) is a promising alternative which may extend the scope of EVAR for AAAs. The aim of this study was to evaluate the feasibility, efficacy and durability of AUI with FFBP. Design. The results of a single institution and a single surgeon were prospectively collected from January 2002 to August 2010. All patients were followed up at 1, 3, 6 and 12 months and then annually. Results. There were 33 patients (27 males) with a mean age of 71.7 years (range 46 - 84). Open surgery posed an unacceptably high risk to all patients owing to advanced age and/or American Society of Anesthesiologists (ASA) classification 3/4. Ineligibility for BFG was due to unfavourable anatomy or a combination of factors in most cases (31 patients). Two patients had anastomotic aneurysms after previous open surgery. The technical success rate was 100%. One severe intra-operative complication occurred (perforated iliac artery). Two patients (ASA 4) died within 30 days (peri-operative mortality rate 6.1%). Seven patients (21.1%) developed postoperative wound complications. Eight patients died during follow-up of non-aneurysm-related conditions. Twenty-three patients are alive, with mean follow-up of 24.4 months and a survival rate of 69.7%. Two complications occurred during long-term follow-up, namely 1 case of graft sepsis and 1 of FFBP occlusion. Conclusion. AUI with FFBP is a safe, effective and durable alternative in high-risk patients with AAAs where standard open repair is contraindicated and BFG repair is not possible owing to unfavourable aneurysm morphology.

Midterm Results of Axilloaxillary Cardiopulmonary Bypass

Total axilloaxillary cardiopulmonary bypass (CPB) is an alternative peripheral cannulation technique that has the advantages of antegrade flow during CPB, monohemispherical brain perfusion in case of circulatory arrest, and achieving excellent decompression of the heart during sternotomy. The results of this strategy, particularly beyond the immediately postoperative period, are not well known. Eleven patients with huge aortic aneurysms (>80 mm) and/or acute-subacute ascending aorta dissections underwent surgery with totally axilloaxillary CPB. Short- and midterm outcomes, including survival and complications relating to axilloaxillary cannulation, were reported. All attempts at axillary artery cannulation were successful. Ten of the 11 axillary vein cannulation attempts were successful, and the target pump flow was achieved via the axillary vein alone. Postoperatively, clinical examinations revealed no cases of arm ischemia or compartment syndrome. Three patients (27.3%) experienced ipsilateral brachial plexus neuropathy that produced right hand weakness. The neuropathy was transient in 2 patients, and the symptoms resolved completely. Hospital death occurred in 1 (9.1%) of the 11 patients. The mean (±SD) follow-up time was 956 ± 292 days. One of the survivors died on postoperative day 105 from subacute graft infection and sepsis. The right arms of all 9 of the living patients were examined physically and by Doppler ultrasonography. We found a chronic recanalized thrombotic change in the subclavian vein in 1 patient (11.1%), who had no complaints. Axilloaxillary CPB is an alternative technique that can be used under certain conditions. Adding axillary venous cannulation to axillary artery cannulation at least does not increase the risk of a procedure that uses the axillary artery alone, either in the early or mid term.

Management of HIV Vasculopathy – A South African Experience

The aim of the study was to describe the presentation management and short term results of therapy (< 1 month) in patients admitted with HIV vasculopathy. Records were culled from a prospectively maintained data base on the Vascular Unit at Inkosi Albert Luthuli Hospital, Durban, South Africa between January 2005 and June 2009. 226 patients were studied; 111 had aneurysms and 115 occlusive disease. 98% were African and ages ranged from 4–53 years (average 36); 90% were male. The CD4 count ranged from 1–930 cells/mm 3 while serum albumin averaged 30 mMol/L. 202 aneurysm presented in 111 participants; commonest sites were superficial femoral artery (40%) and carotid (25%). 82 patients had standard operative repair and 8 had stent grafts; 29 were not treated due to advanced disease. Within 30 days of operation the mortality was 9% with 5% developing graft sepsis and 11% pulmonary complications. Of 115 with occlusive disease, there were 2 distinct groups. 51 had no previous claudication and had acute thrombosis; no thrombophilia could be demonstrated. 64 had premature atherosclerotic disease. The majority presented with critical ischaemia. In the acute thrombosis group 15 (29%) had primary amputation, limb salvage was achieved in 13 (36%) and 4 died (11%). In the chronic occlusive group 30 (47%) had primary amputation, of 25 submitted to surgery limb salvage was achieved in 17 (68%). Low CD4 count and albumen levels did not correlate with mortality or complications. Conclusion Surgical therapy for aneurysm is worthwhile in the short term. Following occlusive disease there is a 25% overall salvage rate in the short term (< 1/12) but the long term outlook is uncertain.

Aortoduodenal Fistula and Streptococcal Myonecrosis

Pyomyositis is a rare primary bacterial infection of the skeletal muscles. Pyomyonecrosis is the most severe manifestation of this disease and is associated with a potentially devastating outcome. Patients with peripheral vascular disease presenting with pyomyositis may be difficult to distinguish from those with critical ischemia or synthetic graft sepsis. This article reports on a patient with aortobifemoral bypass graft and severe vitamin B(12) deficiency who developed pyomyonecrosis and aortoduodenal fistula. This article highlights the etiologic dilemma, diagnostic difficulties, and management challenges inherent in such cases. Pitfalls in our management of this patient are discussed.

Comparative Study of Graft Nephrectomy in Pre-Cyclosporine and Cyclosporine Era

Objective: To assess the incidence and identify the indications for graft nephrectomy (GN) in the cyclosporine (CSA) era as compared to GN in the pre-CSA era. Materials and Methods: This is a retrospective study of 1,866 renal transplants done from 1971 to 1999. 675 were transplanted in the pre-CSA era (group 1) and 1,191 in the CSA era (group 2). The published series on experience with GN in the pre-CSA era was compared with that in the CSA era. GN done within 6 months of transplant was defined as early GN and those done after 6 months were included under late GN. The incidence, indication and the implications of GN were studied and compared with our experience in the pre-CSA era. Results were analyzed using the χ² test. Results: Of the 675 transplants in group 1, thirty-one had GN compared to 15 of 1,191 in group 2. There was a significant decrease in GN in the CSA era. Of the 31 in group 1, thirty had early GN as compared to 6 of 15 in group 2 (p = 0.003). On the contrary, late GN was significantly higher in group 2 (9/15) as compared to group 1 (1/31). Acute rejections and graft infections were the predominant causes of graft loss in group 1, while late graft loss due to symptomatic chronic rejection was the commonest cause in group 2. Morbidity was equal in both groups while mortality was significantly higher in group 1. Conclusion: CSA has significantly reduced the need for GN. By reducing hyper, acute, and irreversible acute rejection, the need for early GN has also been reduced significantly. Though there is an increased incidence of chronic allograft nephropathy, late GN is indicated only when there is refractory hematuria, intractable proteinuria and graft sepsis. With better immunosuppression, graft loss secondary to infection has decreased and mortality due to GN has been minimized.

Hypertrophic Osteoarthropathy Secondary to Vascular Prosthesis Infection

An infected vascular graft is an uncommon association in hypertrophic osteoarthropathy (HOA) but is important because of potential catastrophic complications. Here we describe 3 new patients with HOA secondary to vascular prosthesis infection and review the other 23 patients described in the English literature with this clinical syndrome. The finding of symptoms and signs of localized HOA in patients with arterial prosthesis may be the presenting manifestation of graft sepsis. In most patients the graft is located at the aorta or aortic bifurcation. The initial symptoms are fever, joint pain mainly involving the knees and ankles, clubbing, and in some cases intestinal bleeding. Recurrent abscesses and bacteremia arising in spite of appropriate antimicrobial therapy are prominent infectious signs. Another characteristic feature is the wide variety of bacteria isolated from a single patient. When a polymicrobial enteric flora is isolated from the blood or other tissue, an intestinal origin of infection can be readily suspected. Gallium or leukocyte scans are useful for detecting an abscess around the vascular prosthesis. In some cases, the detection of gas around the graft demonstrated by computed tomography is highly suggestive of prosthesis infection. Mechanisms involved in the pathogenesis of HOA associated with aortic graft infection are unknown. Treatment consists of intravenous antibiotics and surgical replacement of the infected graft. The prognosis of arterial prosthesis infection depends greatly on early diagnosis and treatment before the onset of life-threatening complications. Knowledge of this rare association may lead to an early diagnosis and appropriate management of this serious and often fatal complication.

Significance of positive bacterial cultures from aortic aneurysm contents.

Aneurysm contents were cultured in 275 patients out of a series of 546 cases undergoing infrarenal aortic aneurysm repair between 1961 and 1981. The incidence of positive cultures was 8 per cent. Cultures were more likely to be positive if taken from ruptured (16.7 per cent) and acute (9.1 per cent) aneurysms than from elective (4.2 per cent) cases (X2 = 6.69, P less than 0.01). Gram-positive organisms predominated with Micrococcus being the commonest isolate. Positive cultures were seen at an annual rate of 1-3 cases up to 1976 since which time all have been negative and we believe this may be due to prophylactic antibiotics being given preoperatively rather than postoperatively. The incidence of subsequent graft sepsis was greater in patients with positive aneurysm contents cultures (7 out of 22) than in those with negative cultures (6 out of 253) (X2 = 32.7, P less than 0.001). We recommend the routine culture of aneurysm contents to identify patients who are at high risk of developing graft sepsis and suggest that those cases with positive cultures receive prolonged organism-specific antibiotic therapy. In addition, there is evidence that pre-operative antibiotics may eliminate organisms from aneurysms, thus reducing the subsequent risk of graft sepsis.

Plantar melanoma in black South Africans.

The outcome of treatment in 40 black patients (27 women, 13 men; mean age 62.9 years) with plantar melanoma over a 13-year period was analysed to evaluate the efficacy of wide local excision with split skin grafting. Substantial delay in seeking medical attention occurred in 35 patients. At presentation, 20 patients had stage I disease, one stage II, 15 stage III and four stage IV. Acral lentiginous melanoma (27 patients) was the most common histological type. The mean Breslow depth was 6.9 mm and 35 patients had lesions of Clark level IV or V. The mean surface area or plantar lesions was 13.3 cm2. Wide local excision with split skin grafting was used in 29 patients; four patients with neglected advanced plantar lesions had below-knee amputation and seven with metastatic disease did not undergo surgery. Graft sepsis occurred in six patients and local recurrence in two. Nine patients were alive at follow-up; the 5-year survival rate was 25 per cent. Delay in presentation and locally advanced disease may explain the poor prognosis of plantar melanoma in black South Africans.

Early Transposition of the Sartorius Muscle for Exposed Patent Infrainguinal Bypass Grafts

The traditional approach for patent and exposed and infected infrainguinal bypass grafts in the groin has included wide operative debridement and secondary or delayed primary closure. However, this has been associated with significant risk of further contamination and length of stay. The authors reviewed their experience using the wide debridement, sartorius muscle flap transposition, and primary wound closure as an alternative. During the past 5 years, they have had 50 patients with major wound necrosis or infection in the groin or thigh with the graft or native artery being exposed after debridement. This group included 28 men; 74% of the patients had hypertension, 58% had diabetes, and 20% had renal failure. The grafts were split evenly between native vein and prosthetic material. After wide debridement, closure was performed by the vascular surgeon using the sartorius muscle flap. Postoperatively, there was an 8% major amputation rate and a 12% mortality rate in the first 30 days. One patient developed a pseudoaneurysm 5 weeks after placement of the flap. This patient underwent removal of the infected polytetrafluoroethylene graft with ligation of the common femoral artery. None of the procedures have resulted in further systemic or graft sepsis. None have resulted in arterial or graft blowout. Follow-up was for an average of 18 months. Closure of groin and thigh wounds with exposed bypass graft or native artery can be safely performed with the sartorius muscle flap with excellent results. The length of stay of these patients compared to historical controls is acceptable. Furthermore, the chance of infection of the native artery or bypass may be reduced. Familiarity with this simple technique can be a valuable tool for the vascular surgeon.

The effectiveness of muscle flaps for the treatment of prosthetic graft sepsis.

The objective of this study was to assess the efficacy and reliability of muscle flaps in the treatment of prosthetic graft sepsis. A retrospective analysis was performed to assess the outcome of all patients with prosthetic graft sepsis who were treated with a muscle flap at Groote Schuur Hospital between January of 1991 and July of 2000. The specific end points studied were flap survival, limb salvage rate, and mortality. A total of 27 muscle flaps were raised to cover 24 sites of graft sepsis in 21 patients. Twenty-five flaps were performed primarily and two secondarily. The mortality rate was zero. Limb salvage was achieved in 15 of 21 patients (71 percent), with no recurrent sepsis after an average follow-up period of 36 months. The groin was the most common site of infection, with an 86 percent incidence. Eighteen sartorius flaps were raised in the groin. Seventeen of the 18 sartorius flaps survived (94 percent), and a 71 percent limb salvage was achieved with no recurrent sepsis after 36 months of follow-up. This series supports the use of muscle flaps for the treatment of prosthetic graft sepsis. The sartorius flap has been shown to be reliable as a flap in the groin, with successful limb salvage in the majority of patients.

The Effectiveness of Muscle Flaps for the Treatment of Prosthetic Graft Sepsis

The Effectiveness of Muscle Flaps for the Treatment of Prosthetic Graft Sepsis

Aneurysm-related mortality during late follow-up after endovascular aneurysm repair of infrarenal aorta

Abstract Background Aneurysm-related mortality (ARM) accounts for around 1·5 per cent of all deaths following open aneurysm repair. The incidence of ARM following endovascular aneurysm repair (EVAR) is unknown. The aim was to examine all causes of death, including ARM, during late follow-up after EVAR. ARM was defined as death resulting directly from rupture of the repaired aneurysm or another complication of the aneurysm, more than 30 days after repair, or death within 30 days of a secondary intervention undertaken solely to rectify a complication of repair. Methods Preoperative and follow-up data on 2194 patients from 88 European centres were collected prospectively on to a database. Survival up to 48 months after EVAR was analysed by means of Kaplan–Meier survival analysis. The causes of death during this period were noted. Results There were 161 deaths between 1 and 48 months after EVAR. The cumulative rate of secondary intervention for this cohort at 4 years was 33 per cent. The causes of death were: cardiac 28·6 per cent, malignancy 18·6 per cent, cerebrovascular 6·8 per cent, respiratory 3·1 per cent, renal 1·8 per cent, other 22·3 per cent and ARM 11·8 per cent. There were 19 deaths from aneurysm-related causes. Nine patients died following proven rupture of the aneurysm, three died from presumed rupture of the aneurysm and a further seven died following late conversion (three patients), graft sepsis (two) and secondary intervention (two). Sudden death of uncertain cause occurred in ten patients in whom rupture of AAA was a possibility. Conclusion Non-aneurysm-related causes of death were comparable to those in published reports of survival after open repair. However, the proportion of aneurysm-related deaths (11·8 per cent) was appreciably higher than that reported after open repair. These results may reflect the learning curve experience of the teams involved in the study, but continued caution is advisable regarding expectations of outcome following EVAR.

Management of Synchronous Infrarenal Aortic Disease and Large Bowel Cancer: a North-east of Scotland Experience

Objectives to review our experience of combined aortic and colonic surgery. Design retrospective review. Methods synchronous aortic and colorectal procedures were identified from prospective computerised audit and archival vascular records. Clinical parameters were used as surrogates for measuring clinical outcome. Results six patients (F:M=2:1), median age 75.6 years (range 70–80 years) were identified with infrarenal aortic pathology (5 aneurysms, median AP diameter 6 cm, 1 occluded aortoiliac segment) and colonic carcinoma. All carcinomas were Dukes stage B and moderately well differentiated. Synchronous aortic and colonic resections were performed in five cases, bypass for aortoiliac occlusion was deferred in preference to colonic resection in one case. Operating time ranged between 3–6.5 hours (median 4 h), transfusion requirements 2–5 units (median 3 units). One anastomotic dehiscence was reported. With follow-up between 6 months to 6 years all patients remain alive; no patient has re-presented with graft sepsis or symptomatic tumour recurrence.Conclusion synchronous resections of aortic and colonic lesion may be a treatment option in selected cases.

Randomized trial of rifampicin-bonded Dacron grafts for extra-anatomic vascular reconstruction: 2-year results

Abstract Background Serious infection complicates a small proportion of prosthetic vascular grafts and usually follows implantation of bacteria at the time of graft insertion. The aim of this study was to determine whether the use of a rifampicin-bonded, gelatin-coated Dacron graft (Gelsoft/Gelseal; Sulzer Vascutek) could reduce the rate of infective complications after extra-anatomic bypass. Methods In a multicentre study involving 14 vascular units, 257 patients underwent extra-anatomic bypass. There were 178 men and 79 women, of median age 69 (range 43–92) years. Some 132 (51 per cent) had no risk factors for wound or graft sepsis, 82 (32 per cent) had one and 43 (17 per cent) had two or more risk factors. Patients were randomized to rifampicin bonding (rifampicin 1 mg ml−1 soak for 15 min before insertion) (n = 123) or control (n = 134). The authors have previously reported small, but not statistically significant, reductions in total perioperative wound complications, antibiotic requirements and delayed hospital discharge in favour of patients with bonded grafts. Results Of 257 patients originally randomized, follow-up to 2 years or death is available for 197 patients; 60 have died. A total of ten patients have had serious wound or graft infections (Szilagyi grade III), four with unbonded and six with bonded grafts (P not significant). All occurred within 6 months of operation. The graft fabric was involved in eight patients. Treatment and outcome are listed in the Table below. Conclusion It has not been possible to show any advantage for the routine use of antibiotic bonding for extra-anatomic reconstruction.

Gentamicin Beads in Vascular Surgery: Long-Term Results of Implantation

The authors conducted a prospective study, with a subsequent review of case-notes and follow-up of patients, to review the results of insertion of gentamicin beads for the prevention and treatment of infection in vascular surgery. In particular, special reference was given to leaving chains of beads permanently implanted in the body. There were thirty-five patients in whom gentamicin beads were used in 62 sites. These were implanted completely in 45, left protruding for removal in 15 and in open wounds in two. Forty-two chains of beads were left permanently implanted, and these patients were followed up for 1–44 months (median 15) later. There was no further infection at 60% of the sites where gentamicin beads were used to treat proven graft sepsis, and 50% of sites in various sinuses. Infection developed at 16% of the sites where gentamicin beads were used prophylactically. Adverse effects were observed in three cases of long-term implantation: one chain of beads caused discomfort that required removal, the skin failed to heal over one chain, and one may possibly have caused a bypass graft to kink and occlude. In conclusion, gentamicin beads are a useful adjunct In the management of vascular graft infection and in prophylaxis for some high risk cases. Chains of beads can be implanted long term with few adverse sequelae.

Gentamicin beads in vascular surgery: long-term results of implantation

The authors conducted a prospective study, with a subsequent review of case-notes and follow-up of patients, to review the results of insertion of gentamicin beads for the prevention and treatment of infection in vascular surgery. In particular, special reference was given to leaving chains of beads permanently implanted in the body. There were thirty-five patients in whom gentamicin beads were used in 62 sites. These were implanted completely in 45, left protruding for removal in 15 and in open wounds in two. Forty-two chains of beads were left permanently implanted, and these patients were followed up for 1–44 months (median 15) later. There was no further infection at 60% of the sites where gentamicin beads were used to treat proven graft sepsis, and 50% of sites in various sinuses. Infection developed at 16% of the sites where gentamicin beads were used prophylactically. Adverse effects were observed in three cases of long-term implantation: one chain of beads caused discomfort that required removal, the skin failed to heal over one chain, and one may possibly have caused a bypass graft to kink and occlude. In conclusion, gentamicin beads are a useful adjunct in the management of vascular graft infection and in prophylaxis for some high risk cases. Chains of beads can be implanted long term with few adverse sequelae.