Management of infected aortic grafts.

Aortic graft infection will continue to occur in a small proportion of patients who undergo reconstructive aortic surgery. For most patients, the standard approach should use extra-anatomic bypass, followed by complete excision of the graft, as the treatment of choice. However, in selected patients who have localized infection, are high risk surgical candidates, or have grafts located in positions that preclude removal, less aggressive alternatives such as topical antibiotic irrigation, graft resection with debridement and replacement, and in situ replacement with a biologic graft take an increasing role. When prosthetic grafts are developed that are less susceptible to reinfection, owing to incorporation of antibiotics into the graft, in situ replacement may become the treatment of choice. In spite of many advances in the management of aortic graft infection, this complication continues to carry a high mortality and amputation rate, and consequently should be managed by surgeons who have a particular interest and experience in managing this particular problem. With a thorough understanding of the circumstances of the original operation, bacteria infecting the graft, extent of graft infection, and management alternatives, most patients can survive prosthetic aortic graft infections with a combined morbidity and mortality of less than 50%.