Prosthetic vascular graft infections

Background Prosthetic vascular graft infection (PVGI) remains a severe and challenging complication in vascular surgery with high morbidity and mortality rates. Incidence of vascular graft infection following an elective reconstruction has been reported between 1% and 6%. The aim of this study was to retrospectively evaluate the epidemiology of PVGI, the different treatment modalities used, and the post-treatment evolution of the infections. Methods A retrospective consecutive study was conducted of all patients treated in our department for PVGI between January 2000 and December 2015. We analysed all data relative to primary operation, duration interval between initial surgery and infections signs, infection site, type of microorganism involved, and surgical treatment modality, as well as evaluation of short- and long-term results. Results 62 patients were admitted for PVGI. Primary revascularization procedures consisted of a peripheral bypass in 42 (68%) patients and an aortic bypass in the remaining 20 (32%) patients. Median interval between primary procedure and reintervention was 3 months in the peripheral group and 48 months in the aortic group. Complete excision of the prosthetic graft was carried out in 85% of the cases. Thirty-day mortality was 0% and 9.5% in the aortic and peripheral group, respectively, while the global 30-day mortality rate amounted to 6,4%. The overall survival rate was 62.3% at 2-years, 46.4% in the aortic group, and 69.7% in the peripheral group. 2 patients (3,2%), despite optimal surgical treatment followed by the proper antimicrobial therapy, died due to recurrent infections (40% of the mortality). Conclusions Prosthetic vascular graft infection needs a multidisciplinary management with appropriate antibiotherapy, radical removal of the infected graft, and in situ reconstruction if possible. This strategy gives satisfactory results in terms of mortality, morbidity, patency rates, and infection control. The mortality and morbidity post-surgical intervention of our series compares favourably to the values reported in medical reviews, notably at 0% in aortic group and 9,5 % in peripheral group. Furthermore, a 2-year survival rate of 62,3% is encouraging, since, without surgical intervention, PVGI would inevitably lead to the fatal haemorrhagic complications. The exact causes of death are however still unknown due to the unavailability of post-death analysis such as systematic autopsy. On the other hand, the mid-term mortality rate needs to be interpreted according to the multiple risk factors presented by our studied population.