Surgical management of infrainguinal arterial prosthetic graft infections: Review of a thirty-five-year experience

Mertens, R; O׳Hara, Patrick J.; Hertzer, Norman; Krajewski, Leonard P.; Beven, Edwin G.

doi:10.1016/s0741-5214(05)80009-6

Cited by 106 publications

(66 citation statements)

References 17 publications

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“…In a large historical series, the reported rates for postoperative amputation and mortality were 40 and 18 %, respectively [ 40 ].…”

Section: Discussionmentioning

confidence: 99%

Surgical and Endovascular Complications: Infection and Hemorrhage

Davies

2014

Essentials of Vascular Surgery for the General Surgeon

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In all cases of hemorrhage, the Advanced Trauma Life Support (ATLS) algorithm should be followed, with prompt recognition, rapid resuscitation, and immediate decision making and action [ 1 ]. Retroperitoneal Hemorrhage EtiologyRetroperitoneal hematoma (RPH) describes bleeding into the potential space between the peritoneum and the musculoskeletal elements of the back. Several conditions can cause RPH including ruptured aortic aneurysm, traumatic vascular injury, retroperitoneal neoplasms, and coagulopathy. RPH occurs most frequently as a complication of percutaneous femoral artery puncture for interventional procedures. The reported incidence of RPH after cardiac catheterization is 0.15 % for diagnostic procedures, 0.8 % for balloon angioplasty, and 3 % for coronary stents. Three dichotomous variables were identifi ed as independent predictors of RPH: female gender (odds ratio [OR] 5.4), body surface area (BSA) less than 1.73 m 2 (OR 7.1), and high femoral artery puncture site (OR 5.3) [ 2 ]. Twenty-fi ve percent of retroperitoneal bleeds were remote from the femoral artery puncture site, with the majority of these being contralateral to the side of the puncture. PresentationThe diagnosis of retroperitoneal hematoma requires clinical acumen, and an awareness of the scenarios in which this complication is likely to occur. Patients with signifi cant groin, fl ank, abdominal, or back pain or hemodynamic instability following an interventional procedure should be evaluated for a retroperitoneal hematoma. The nonspecifi c symptoms associated with RPH often delay the diagnosis. Approximately 23-54 % of retroperitoneal hematoma patients have documented clinical evidence of femoral neuropathy caused by compression of the femoral nerve [ 3 ]. Seventy-fi ve percent of cases presented within the fi rst 3 h after conclusion of the procedure, with a rapid decline in frequency after this time period [ 4 ]. Spontaneous hemorrhage usually occurs in patients receiving anticoagulation. Idiopathic retroperitoneal hematoma may present symptomatically in the form of acute abdominal pain, nausea, and anorexia. Upon physical examination, the patient may have a tender abdomen and hypovolemic shock. ImagingContrast-enhanced computed tomography (CT) scan is the imaging modality of choice to identify and categorize a retroperitoneal hemorrhage (Fig. 23.1 ). TreatmentAlthough a widely accepted consensus on the management of patients with RPH does not exist, a reasonable treatment algorithm is shown in Fig. 23.2 . Conservative TherapyHemodynamically stable patients with RPH can be managed with fl uid resuscitation, correction of coagulopathy, and blood transfusion. Non-interventional therapy mandates close observation for the development of abdominal compartment syndrome (ACS) which can be fatal if it is not promptly recognized and treated. ACS is defi ned as sustained intra-abdominal pressure greater than 20 mmHg with end-organ dysfunction manifested as respiratory insuffi ciency, oliguria, and decreased venous return resulting in severe hy...

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“…In a large historical series, the reported rates for postoperative amputation and mortality were 40 and 18 %, respectively [ 40 ].…”

Section: Discussionmentioning

confidence: 99%

Surgical and Endovascular Complications: Infection and Hemorrhage

Davies

2014

Essentials of Vascular Surgery for the General Surgeon

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“…Patients in this series required arterial reconstruction to preserve limb viability and none had available or suitable GSV to perform a complete lower-limb arterial reconstruction. We embarked on a refrigerated stored homograft replacement program because the homografts harvested from deceased donors may be available as part of an active, local multiorgan transplant retrieval program and we were dissatisfied with the more conventional treatments in terms of mortality, reinfection, and amputation rates [3] . The results demonstrate that cold-stored refrigerated homograft reconstruction is applicable in the management of serious graft infection, even for emergency use, and the results suggest that vein homografts have a good resistance to infection as well.…”

Section: Discussionmentioning

confidence: 99%

“…The goal of therapy is infection eradication and maintenance of adequate perfusion. Radical excision of infected perigraft tissue is recommended and mandatory in cases of sepsis, anastomotic disruption or graft occlusion [1][2][3] .…”

Section: Introductionmentioning

confidence: 99%

“…Today, autologous saphenous veins are considered the best substitute for lower-extremity revascularization in infected fields, but they are often unavailable or unsuitable in these patients [3] . With the increasing age of the population and the growing number of reoperations due to the development of intimal hyperplasia and accelerated atherosclerosis in bypass grafts, over one third of patients will not have these conduits available at the time of revascularization.…”

Section: Introductionmentioning

confidence: 99%

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Successful Human Vascular Reconstructions with Long-Term Refrigerated Venous Homografts

Galambos

Oláh

Banga³

et al. 2009

Eur Surg Res

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Fresh autologous vein grafts are commonly used for infrainguinal vascular reconstructions with good results. Previously we have confirmed the high viability index of homografts even after long-term storage at 4°C in tissue culture medium. In this clinical study, we have evaluated the in vivo efficiency of this storage method in humans with major peripheral graft infections. Between April 2006 and November 2008, data from patients who underwent graft excision and venous allograft reconstruction were collected prospectively (5 men, 2 women, mean age 68 years). Six patients had acute ischemia at the time of allograft reconstruction, while 3 had experienced anastomosis rupture. Allograft reconstruction was performed as an emergency procedure in 3 cases. The observed parameters included patient survival, limb salvage, persistence or recurrence of infection and allograft patency. In the follow-up period reoperation, excision or thrombectomy was necessary in 3 cases. There were no perioperative deaths, early amputations, persistent or recurrent infections. In conclusion, this study demonstrates the efficacy of long-term 4°C storage of venous allografts for revascularization in cases with peripheral bypass graft infection. We suggest that this technique is a useful option for graft preservation and propose a wide-scale introduction.

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“…4,5 In cases involving systemic infection, bypass removal is mandatory, often in association with amputation or bypass using a different pathway and anastomotic sites. 4,6 In cases involving localized infection of the distal anastomosis, the same solutions may be adopted but other options are available, including rerouting the bypass to another patent artery and conservative treatment. 2,5,[7][8][9][10] Conservative treatment is the more likely choice since there is rarely another artery suitable for re-anastomosis and, if there is, hemodynamic results are generally less favorable.…”

Section: Introductionmentioning

confidence: 99%

Infection-Related Exposure of the Lower Anastomosis of Femorodistal Bypass: Salvage through Use of Pedicle Muscle Flaps

Lermusiaux¹,

Laurent²,

Forges³

et al. 2000

Annals of Vascular Surgery

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Surgical management of infrainguinal arterial prosthetic graft infections: Review of a thirty-five-year experience

Abstract: IAPGI is associated with substantial early mortality and amputation rates. Complete excision of infected graft material results in a significant reduction in the incidence of recurrent sepsis.

Cited by 106 publications

References 17 publications

Surgical and Endovascular Complications: Infection and Hemorrhage

Surgical and Endovascular Complications: Infection and Hemorrhage

Successful Human Vascular Reconstructions with Long-Term Refrigerated Venous Homografts

Infection-Related Exposure of the Lower Anastomosis of Femorodistal Bypass: Salvage through Use of Pedicle Muscle Flaps

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