Elsevier

Cardiovascular Surgery

Volume 5, Issue 5, October 1997, Pages 486-489
Cardiovascular Surgery

Mechanism of late prosthetic vascular graft infection

https://doi.org/10.1016/S0967-2109(97)00056-2Get rights and content

Abstract

This study was a retrospective analysis of 41 patients with late prosthetic graft infections (>30 days after operation) from six hospitals in the south-west of England. The 41 patients had a median age of 66 years and generally accepted risk factors for infection were documented in 19 patients preoperatively. Thirteen patients had postoperative wound complications and three had early reoperation at the site of subsequent infection. The median time between index operation and symptoms of infection was 10 (range 1–224) months. Abscess (46%) was the most common presentation followed by false aneurysm (20%) and graft thrombosis (20%). All patients had reoperations (median two per patient, range one to seven). Seven (17%) patients died and 10 (24%) required a major amputation. Bacteria were isolated from retrieved grafts in 23/41 patients (high virulence 14, low virulence nine) and the most frequent organism was coagulase-negative Staphylococcus epidermidis (nine patients). In the majority of cases the aetiology of the late infections in this series was consistent with bacterial implantation at the index operation, but in four cases bacteraemia or intraperitoneal spread was more likely. Dental-type antibiotic prophylaxis would not have prevented any of the infections in this study. Aggressive treatment of recognized sources of infection in patients with vascular grafts is imperative.

Section snippets

Patients and methods

Using local computer vascular registries from six hospitals in the south-west of England, 41 patients were identified who had presented with a prosthetic graft infection >30 days after vascular surgery. There were 30 men and 11 women with a median age of 66 (range 44–85) years. All developed late graft infection between June 1978 and October 1994. The medical notes were reviewed and a standard proforma completed for each patient.

Results

The median months delay before presentation of graft infection was 10 months (range 1–224). The mode of presentation is listed in Table 2. All patients required surgery with a median of two operations per patient (range one to seven). There were 27 complete graft excisions and seven partial graft excisions; 27 also had local procedures such as débridement or sartorius myoplasty. Seven patients (17%) died and 10 (21%) ultimately required a major amputation.

In six cases there was no available

Discussion

Serious late prosthetic graft infection rare; only 41 cases were identified despite careful search of vascular registries from six hospitals including approximately 4500 vascular reconstructions. The aetiology of vascular graft infection is complex, but largely determined by factors evident at the time of initial reconstruction such as the severity of the arterial disease (presence or absence of gangrene), patient factors such as obesity, malnutrition and diabetes, and operative factors such as

Acknowledgements

We would like to thank the vascular surgeons of Bristol Royal Infirmary, Derriford Hospital, Plymouth, Royal Devon and Exeter Hospital, Royal Bournemouth Hospital, Royal United Hospital, Bath, and Gloucestershire Royal Hospital, Gloucester. Thanks also to Mrs Chryzelda Cosgrove and Dr Biddy Ridler for their considerable help with data collection.

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    Copyright © 1997 The International Society for Cardiovascular Surgery. Published by Elsevier Inc. All rights reserved.