Peripheral Prosthetic Vascular Graft Infection. A 5-Years Retrospective Study

INTRODUCTION: Peripheral prosthetic vascular graft infection represents a very serious complication after lower limb revascularization, with amputation and mortality rates up to 70% and 30%, respectively. The study was designed to determine the incidence of prosthetic graft infection, amputation and mortality rate in our Institution, analyzing different types of treatment. MATERIALS AND METHODS: A retrospective cohort single institution review of peripheral prosthetic bypass grafts evaluated patient demographics, comorbidities, indications, location of bypass, type of prosthetic material, case urgency and evaluated the incidence of graft infections, amputations, and mortality. RESULTS: Between January 2016 and December 2021, a total of 516 bypass were recorded: 320 bypass in venous material and 196 prosthetic bypass using Dacron or PTFE.Among patients with a prosthetic bypass, 16 (8.2%) presented a graft infection at a mean follow-up of 39 months. Other 13 patients submitted to prosthetic peripheral bypass in other centres occurred to our Institution with a graft infection, so a total of 29 infected grafts were treated. Infected grafts were removed in 20 patients (68.9%), while a conservative treatment was helpful in 9 cases (31.1%). The germs involved were gram-negative in 27.6% and gram-positive in 41.4%. During follow-up we recorded 5 deaths (17.2%) and 6 amputations (20.7%) directly after bypass excision; another 2 amputations (6.9%) occurred after failure of the new bypass replacing the prosthesis removed. CONCLUSIONS: Redo-bypass, active infection at the time of bypass and advanced gangrene were associated with a higher risk for prosthetic graft infection and major extremity amputation. Complete graft removal and replacement by venous material or Omniflow II represents the typical treatment. However, aggressive local treatment including drainage, debridement, vacuum assisted closure therapy application and muscle transposition seems to be a better solution in selected patients without the need for graft removal and with rates of limb salvage superior to those obtained with excisional therapy.