Late results following surgical management of vascular graft infection.

Ninety-two patients underwent surgical treatment for 59 prosthetic graft infections and 33 secondary aortoenteric fistulas. Definitive treatment was accomplished with a low perioperative mortality rate (14%). Long-term follow-up confirmed that most patients were cured of their infection or fistula, and 88% of the patients who survived the perioperative period (67 of 76) had no further evidence of infection when followed up from 10 months to 12 1/2 years postoperatively. The 12% late mortality rate (9 of 76) was secondary to persistent infection and aortic stump disruption. When perioperative and late deaths in both groups are combined, 67 of 92 patients (73%) were cured of their prosthetic graft infection. Factors associated with a favorable prognosis for survival and cure of infection were autogenous reconstruction and possibly staged operative repair. Poor prognosis for survival and cure of infection resulted from aortic stump disruption, persistent infection, and retained graft material. Significant morbidity (amputation and multiple operative procedures) was related to the severity of underlying vascular disease, the inadequacy of extra-anatomic reconstruction, and in some cases progression of vascular disease. The major challenges in the treatment of graft infection at present are the preoperative identification of limited graft infection and the successful management of the interrupted aorta. Complex and innovative reconstructive procedures continue to be necessary to ensure limb salvage and remain a considerable technical challenge. Nonetheless, the prospects for cure as reported in this series justify an aggressive operative approach. A successful outcome following definitive treatment of these devastating complications is possible for the majority of affected patients.