Survival and limb salvage in patients with infected arterial prostheses

Weyman, Albert K.; Burnard, Ralph J.; Yashar, James J.

doi:10.1016/0002-9610(78)90027-2

Cited by 64 publications

(20 citation statements)

References 12 publications

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“…This procedure, first performed in the 1960s, was accepted as the standard of care against which other procedures were measured. 5,83,[92][93][94][95][96][97][98][99] In selected patients, it is still considered to be the treatment of choice. However, the major disadvantages of extra-anatomic bypass followed by graft excision are lower short-and long-term patency rates of the bypass graft; a 2-stage, lengthy surgical procedure; relatively high rate of amputation of the lower extremity; risk of rupture of the stump at the aortic suture line, with potentially life-threatening hemorrhage; and difficulty establishing an extra-anatomic revascularization route in the inguinal region.…”

Section: Intra-abdominalmentioning

confidence: 99%

“…4,[92][93][94][95][96][97][98][99]111 The primary reason for this recommendation is because of the risk of recurrent infection that can occur with in situ reconstruction. 4,[92][93][94][95][96][97][98][99]111 The major disadvantages of extra-anatomic bypass grafting and graft excision are as follows: (1) a 2-stage procedure is required; (2) conduit failure with amputation of lower extremities has been observed in 20% to 30% of patients; (3) blood supply is decreased with ischemia to the inferior mesenteric and internal iliac arteries; and (4) residual infection of the aortic stump with blowout occurs in 10% to 20% of patients. 4 Theoretically, the risk of recurrent infection should be lower with this procedure, because the VGI is resected with no in situ reconstruction in an infected tissue bed; however, in the meta-analysis published by O'Connor et al, 4 the infection rate was highest with this procedure, followed by rifampin-bonded, then arterial allograft, and lowest with venous autograft.…”

Section: Extensive Intra-abdominal Abscess or Gross Purulence Around mentioning

confidence: 99%

“…8,11,27 In the past, the "gold standard" management of these patients was extra-anatomic bypass surgery followed by graft excision. 5,83,[92][93][94][95][96][97][98][99]111 In selected patients, that might still be the procedure of choice; however, because of the high rates of mortality and potential complications, including limb loss, numerous studies have suggested that alternative surgical options might be preferable to extra-anatomic bypass and graft excision. For patients with aortoenteric fistula caused by methicillin-sensitive S aureus or less virulent microorganisms, such as coagulase-negative staphylococci, streptococci, susceptible enterococci, or susceptible enteric gram-negative bacilli, graft excision and in situ reconstruction with either cryopreserved or fresh arterial allograft, venous autograft, or rifampin-bonded synthetic graft are reasonable.…”

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confidence: 99%

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Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: A Scientific Statement From the American Heart Association

Wilson¹,

Bower²,

Creager³

et al. 2016

Circulation

355

307

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The use of synthetic material for reconstructive vascular surgery was first reported during the early 1950s. Infection involving vascular graft prostheses is an infrequent but devastating complication of reconstructive vascular graft surgery and is associated with a high morbidity and, in some situations, mortality. Improvements in surgical techniques and graft design, including the use of native venous or arterial tissue, have reduced the frequency of infection and severity of complications from vascular graft infection (VGI). However, these advances have also led to more frequent vascular graft procedures occurring in a patient population with multiple underlying comorbidities that would have previously disqualified them as candidates for vascular reconstructive surgery. Underlying comorbidities, such as diabetes mellitus or immune compromise, increase the risk of infection and serious infection-related complications. The major complications of VGI include sepsis, amputation, disruption of infected anastomotic suture line with rupture or pseudoaneurysm formation, embolization of infected thrombi, reinfection of reconstructed vascular grafts, enteric fistulae to the small or large bowel, bacteremic spread of infection to other sites, and death. VGIs can be categorized broadly into those that occur in an extracavitary location, primarily in the groin or lower extremities, or in an intracavitary location, primarily within the abdomen or less commonly within the thorax. frequencyThe frequency of VGI depends on the anatomic location of the graft. The infection rate is 1.5% to 2% for most extracavitary grafts and as high as 6% with vascular grafts in the groin. [1][2][3][4][5][6][7][8][9] For intracavitary grafts, the infection rate is ≈1% to 5%. 1-6 Graft infection is most common after emergency procedures and after reoperation. [1][2][3][4]10 Aortic graft erosion or fistulous communication into the duodenum or other areas of the bowel reportedly occurs in 1% to 2% of patients after aortic reconstruction. 11,12 MicrobiologyThe microbiological cause of VGI has evolved over the years. 1 In early published studies, Staphylococcus aureus was the predominant microorganism recovered. 1,13 Improvements in surgical technique, administration of prophylactic antistaphylococcal antimicrobial therapy, and other factors have resulted in a changing microbiological epidemiology. Vascular graft surgery performed on patients with multiple underlying comorbidities and the increased frequency of emergency procedures have contributed to the changing spectrum of infection. Other factors such as changes in hospital flora, surgery in patients with complicated vascular anatomy, and multiple revisions of previous vascular surgery have resulted in a more diverse microbio- clInIcal stateMents anD GuIDelInes logical spectrum of infection, which includes multidrugresistant strains, polymicrobial infection, and Candida species. Gram-positive cocci accounts for at least two thirds of VGIs. 1,13 Infections caused by coagulase-negative staphylococ...

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Section: Intra-abdominalmentioning

confidence: 99%

Section: Extensive Intra-abdominal Abscess or Gross Purulence Around mentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: A Scientific Statement From the American Heart Association

Wilson¹,

Bower²,

Creager³

et al. 2016

Circulation

355

307

View full text Add to dashboard Cite

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“…Der Grund hierfür liegt in der direkten Nähe dieses Gebietes zur stark kontaminierten Anogenitalregion. Weiterhin tragen die an dieser Stelle nur dünne Weichteildecke und die direkt unter der Haut verlaufenden Blutund Lymphgefäße, die potenziell infektiöse Partikel enthalten, dazu bei [32,63,69,73,74]. Vertikale Schnittführungen entgegen der Spaltlinien der Haut kön-nen durch mögliche Wundrupturen zu- …”

Section: Wundinfektionenunclassified

“…Weitere, häufig auftretende Keime sind S. epidermidis und andere koagulasenegative Staphylokokken, Proteus-Spezies und gramnegative Enterokokken wie E. coli und Pseudomonas. In bis zu über 70% der Fälle kann mehr als eine Erregerspezies nachgewiesen werden, es handelt sich demnach um Mischinfektionen [35,37,69,75]. Auf der anderen Seite gibt es manifeste Protheseninfekte, in denen kein Keimnachweis gelingt.…”

Section: Protheseninfektionenunclassified

Postoperative complications in vascular surgery

Diener

Larena-Avellaneda

Debus

2009

Chirurg

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The increase in numbers of vascular operations is due to a worldwide increase in vascular disease and diabetes. As a result of demographic changes, most of the vascular patients are comorbid and are therefore associated with multiple risk factors. Complications of vascular surgery can be divided into systemic, local non-vascular and vascular complications. Systemic complications are primarily caused by the patients' comorbidity. The prevalence of additional coronary heart disease and cerebral sclerosis accounts for approximately 40-60%, concomitant relevant stenoses of the renal arteries are documented in the literature in 23-42% of the cases. Special attention is paid to diabetes and its end-stage complications. Failure of wound healing, infection of the wound and lymphatic fistulas are the most common non-vascular complications. Inguinal incisions often give rise to a failure of wound healing caused by subcutaneous lymphatic vessels and because of the proximity to the anogenital region. Asepsis, atraumatic operative techniques and perioperative antimicrobial prophylaxis lead to a reduction of surgical site infections and healing delay. Failing grafts or infection of the bypass are the most common vascular complications. Early graft failures are often caused by inappropriate handling or operation techniques and long-term failure is often related to the bypass material. However, in peripheral vascular surgery, autologous veins are superior to synthetic grafts and provide advantages in cases of infection. Removal of an infected synthetic graft is discussed as well as in-situ or extra-anatomical reconstructions. This article reviews the postoperative complications of vascular surgery and their management.

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