Surgical Site Infections after Lower Extremity Revascularization Procedures Involving Groin Incisions

Kuy, SreyRam; Dua, Anahita; Desai, Sapan S.; Dua, Arshish; Patel, Bhavin; Tondravi, Nader; Seabrook, Gary R.; Brown, Kellie R.; Lewis, Brian D.; Lee, Cheong; Kuy, SreyReath; Subbarayan, Rishi; Rossi, Peter J.

doi:10.1016/j.avsg.2013.08.002

Cited by 72 publications

(56 citation statements)

References 13 publications

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“…Suggested reasons for this association are that collagen deposition and tensile strength in surgical sites are limited by perfusion and tissue oxygen tension [14]. Other investigators have shown a direct correlation between blood transfusion for LE bypass and more wound infections [15][16][17]. In one analysis examining cardiac surgery and the relation between transfusion and the risk of major infection, researchers found that each unit of blood transfused was associated with a 29% increase in the crude risk of major infection [18].…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for 30-Day Hospital Re-Admission with an Infectious Complication after Lower-Extremity Vascular Procedures

Melvin

Smith

Kruse

et al. 2017

Surgical Infections

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Section: Discussionmentioning

confidence: 99%

Risk Factors for 30-Day Hospital Re-Admission with an Infectious Complication after Lower-Extremity Vascular Procedures

Melvin

Smith

Kruse

et al. 2017

Surgical Infections

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“…In addition, postoperative hematomas and perioperative statin administration may contribute to risk of surgical site infection specifically in those with surgery involving a groin incision. 11 The development of postoperative infection results in longer hospital stays, costs, increased risk of conduit failure and limb loss.…”

Section: Discussionmentioning

confidence: 99%

Prospective Randomized Double-blinded Trial Comparing 2 Anti-MRSA Agents With Supplemental Coverage of Cefazolin Before Lower Extremity Revascularization

et al. 2015

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Objective To compare with antibiotics with methicillin-resistant microbial coverage in a prospective fashion. Background Current antibiotic prophylaxis for vascular procedures includes a first generation cephalosporin. No changes in recommendations have occurred despite changes in reports of incidence of MRSA related surgical site infections. Does supplemental anti-MRSA prophylactic coverage provide a significant reduction in Gram-positive or MRSA infections? Methods Single center prospective double blinded randomized study of patients undergoing lower extremity vascular procedures from 2011 to 2014. One hundred seventy-eight (178) patients were evaluated at 90 days for surgical site infection. Infections were categorized as early infections less than 30 days of the index procedure and late after 90 days. Results Early vascular surgical site infection occurred in 7(8.24%) of patients in the Vancomycin arm, and 11 (11.83%) in the Daptomycin arm (P = 0.43). Gram-positive related infections and MRSA infections occurred in 1(1.18%)/0(0%) of Vancomycin patients and 9 (9.68%)/1 (1.08%) of Daptomycin patients, respectively (P < 0.02 and P = 1.00). Readmissions related to surgical site infections occurred in 4(4.71%) in the Vancomycin group and 11 (11.8%) in the Daptomycin group (P = 0.11). Patients undergoing operative exploration occurred in 5 (5.88%) in the Vancomycin group and 10 (10.75%) of the Daptomycin group (P = 0.17). Late infections were reported in 3 patients, 2 of which were in the combined Daptomycin group. Median hospital charges related to readmissions due to a surgical site infection was $50,823 in the combination Vancomycin arm and $110,920 in the combination Daptomycin group; however, no statistical significance was appreciated (P = 0.11). Conclusions Vancomycin supplemental prophylaxis seems to reduce the incidence of Gram-positive infection compared with adding supplemental Daptomycin prophylaxis. The Incidence of MRSA-related surgical site infections is low with the addition of either anti-MRSA agents compared with historical incidence of MRSA-related infection.

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“…The literature demonstrates primary patency rates ranging from 93% at 1 year, 74% to 91% at 5 years, and a 10‐year patency rate as high as 94% following surgical revascularization of the CFA . Despite excellent technical outcomes, there remains a potential for significant secondary complications of surgical revascularization of the lower extremity, such as wound infection rates in as high as 31%, and hematoma and seromas in 22% of cases . A recent review of 1843 CFEs found a combined morbidity/mortality of 15%, with more than 60% of complications occurring after discharge .…”

Section: Traditional Gold Standard Therapy For Cfa Lesions Common Fementioning

confidence: 99%

“…1,7,8 Despite excellent technical outcomes, there remains a potential for significant secondary complications of surgical revascularization of the lower extremity, such as wound infection rates in as high as 31%, and hematoma and seromas in 22% of cases. 9 A recent review of 1843…”

Section: Traditional Gold Standard Therapy For Cfa Lesions Common mentioning

confidence: 99%

Management of common femoral artery occlusive disease: A review of endovascular treatment strategies and outcomes

Wong

Lahsaei

Aoun

et al. 2018

Cathet Cardio Intervent

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Isolated atherosclerotic lesions of the common femoral artery (CFA) are rare but can produce significant claudication and critical limb ischemia. To date, the “gold standard” treatment for this entity has been common femoral endarterectomy (CFE) with or without patch angioplasty. However, surgery does have significant early postoperative complications, with a 15% combined mortality/morbidity. This manuscript sought to perform a comprehensive review of all studies and available data on endovascular treatment of isolated CFA disease and compare its utility to the traditional gold standard treatment. Twenty‐one studies from 1987 to 2018 were included exploring the various CFA endovascular therapies (percutaneous transluminal angioplasty, intravascular stenting, drug‐coated balloons, and directional atherectomy employed to treat CFA disease, in terms of efficacy, safety, and complications). As a conclusion, endovascular interventions provide acceptable short‐term technical outcomes for CFA disease while limiting procedural complications. While only two randomized controlled trials compare short and long‐term outcomes of surgical versus endovascular treatment, further studies are required to clarify the role of endovascular therapy.

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Surgical Site Infections after Lower Extremity Revascularization Procedures Involving Groin Incisions

Cited by 72 publications

References 13 publications

Risk Factors for 30-Day Hospital Re-Admission with an Infectious Complication after Lower-Extremity Vascular Procedures

Risk Factors for 30-Day Hospital Re-Admission with an Infectious Complication after Lower-Extremity Vascular Procedures

Prospective Randomized Double-blinded Trial Comparing 2 Anti-MRSA Agents With Supplemental Coverage of Cefazolin Before Lower Extremity Revascularization

Management of common femoral artery occlusive disease: A review of endovascular treatment strategies and outcomes

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