Infra-inguinal synthetic graft infection: a clinical and microbiological outcome

Abstract EN

Background: Synthetic graft infection is a major complication after infra-inguinal bypass.

We investigated the records for patients who had lower extremity prosthetic graft infection in our vascular surgery unit over a 5 year period, with a potential effort to identify potential risk factors related.

Methods: The medical records of patients with vascular graft infections over a five-year period from January 2014 to March 2019 were retrospectively reviewed.

All patients with a graft infection involving the femoral artery were included.

Patient demographics including comorbidities, indications for intervention, location of bypass, date of graft insertion, date of graft related infection, type of prosthetic material, and bacteriology and the treatment and outcome were collected.

Result: 468 prosthetic graft bypass procedures were performed in 412 patients.

Out of these 352 (75%) were males.

Infectious complications of the prosthetic graft (PG) were found in 28/468 grafts (6%) .The mean age±SD of the patients was 62±19 years.

The number of infected grafts in female patients was 16 (57%).

The median follow up duration was 18 months .We found that graft preservation yielded good outcome in selected patients, 7 (25%) PGI were successfully salvaged using a conservative approach .

There were 468 patients enrolled in this study; 440 patients were controls and 28 patients had PGI.

Bivariate analysis of categorical variables identified that the presence of diabetes mellitus (P value=0.01), end-stage-renal disease (ESRD)(P value= 0.01), female gender (P value =0.004) and major or minor tissue loss (P value =0.01) are risk factors for PGI.

Considering continuous variables, high white blood cells (WBCs) was more frequently associated with PGI with a statistically significant P value .The use of an omniflow biosynthetic graft resulted in an 80% (8 of 10 patients) success rate of limb salvage in our patients.

There was no late reinfection during the follow-up period.

The replaced grafts were successful in 88% of cases.

Staphylococcus aureus was the most common isolated bacteria present in 32% of cultures, followed by Coliforms/gram-negative organisms 25%.

The amputation rate was 7% and the mortality among the PGI group during the study period was in 3 patients (11%).

Conclusion: That graft preservation yielded good outcome in selected patients, and the biosynthetic prosthesis appears to be a promising alternative in the absence of an appropriate autologous conduit.

There were statistically differences in female, diabetes ,elevated WBC, End-stage renal disease and tissue loss in both groups.