Why remove an infected aortofemoral graft?

The radical treatment of infected vascular grafts is a major procedure with a high mortality and loss of limb. The authors review their experience with 13 consecutive cases of infected aortofemoral grafts treated conservatively during an 11-year period. The treatment consisted of wide incision and drainage of the infected area followed by assiduous irrigation with an antiseptic or antibiotic solution. In 10 patients the inguinal wound healed and the prosthesis was reincorporated; 8 of the 10 had a patent prosthesis and the treatment was considered successful, while 2 needed further surgery. Three patients died of hemorrhage or sepsis. Follow-up ranged from 8 to 144 months (mean 77 months). Two patients had a false aneurysm 3 and 7 years after wound healing. The results compare favourably with those of radical treatment. The authors believe a conservative approach must always be tried as the first step in the management of infected vascular prostheses. The gratifying results observed in their series, in both the short and long term, support this conservative approach, which is a satisfying alternative to radical operations with their high mortality and morbidity.