Prosthetic graft infections involving the femoral artery

Abstract

Background Prosthetic graft infection is a major complication of peripheral vascular surgery. We investigated our institution’s experience over ten years with bypass grafts involving the femoral artery to determine the incidence and risk factors for prosthetic graft infection. Methods A retrospective cohort single institution review of prosthetic bypass grafts involving the femoral artery from 2001–2010 evaluated patient demographics, body mass index, comorbidities, indications, location of bypass, type of prosthetic material, case urgency, previous ipsilateral bypass or percutaneous interventions; and evaluated the incidence of graft infections, amputations, and mortality. Results There were 496 prosthetic grafts identified with a graft infection rate of 3.8% (n=19) at a mean follow-up of 27 months. Multivariable analysis shows that redo bypass (HR 5.8, 95% CI 2.2–15.0), active infection at time of bypass (HR 5.2, 95% CI 1.9–14.2), female gender (HR 4.5, 95% CI 1.6–12.7), and diabetes mellitus (HR 4.6, 95% CI 1.5–14.3) were significant predictors of graft infection. Graft infection was predictive of major lower extremity amputation (HR 9.8, 95% CI 3.5–27.1) as was preoperative tissue loss (HR 4.7, 95% CI 1.8–11.9). Graft infection did not predict long term mortality, however chronic renal insufficiency (HR 2.3, 95% CI 1.6–3.4), tissue loss (HR 1.4, 95% CI 1.0–1.9), and active infection (HR 2.3, 95% CI 1.6–3.4) did. Infected grafts were removed 79% of the time. Staphylococcus epidermidis (37%) and Methicillin-sensitive Staphylococcus aureus (26%) were the most common pathogens isolated. Conclusions Redo-bypass, female gender, diabetes, and active infection at time of bypass are associated with a higher risk for prosthetic graft infection and major extremity amputation, but do not confer an increased risk of mortality. Autologous vein for lower extremity bypass and endovascular interventions should be considered when feasible in high-risk patients.

Pathophysiology and burden of infection in patients with diabetes mellitus and peripheral vascular disease: focus on skin and soft-tissue infections

“…Patients who developed a surgical site infection were at increased risk of graft failure requiring intervention or revision (OR = 2.4; 95% CI 1.9-3.1), sepsis (OR = 6.5; 95% CI 5.1-8.3) and septic shock (OR = 2.4; 95% CI 1.8-3.4). Risk of graft infection is also increased in patients with diabetes mellitus (hazard ratio = 4.6; 95% CI 1.5-14.3 versus patients without diabetes mellitus), with only 71% of patients with a graft infection free of major amputation at 1 year [23].…”

Surgical Site Infection after Multiple Groin Incisions in Peripheral Vascular Surgery

“…This effect of BMI differed significantly between superficial and deep-seated incisional SSIs. In the literature, BMI is associated with SSI development [14,15], but no distinction was made between superficial and deep-incisional SSIs in these studies. A potential explanation is that in the case of a high BMI, prosthetic grafts are better embedded in subcutaneous tissue.…”

“…A groin incision for femoral artery access is a risk factor for these SSIs [5,6]. Additionally, in an aging population wherein risk factors for the development of severe PAD increase, a higher demand for peripheral surgical revascularization and re-intervention is expected [4,7,8].…”

Surgical and Endovascular Complications: Infection and Hemorrhage

“…Although blood cultures are rarely positive (less than 5 %), the presence of bacteremia along with high fever indicates advanced infection and sepsis. Multivariate predictors of infections after bypass surgery include female gender, obesity, chronic obstructive pulmonary disease, hemodialysis, preoperative hyponatremia, and length of operation (greater than 4 h) [ 36 ].…”