Infections in lower extremity vascular grafts.

No set of rigid guidelines can replace a clinically rational and methodic approach to the patient with an infrainguinal graft infection. Some fundamental principles are common to infrainguinal graft infections that form the basis for selective management: 1. Graft preservation can be attempted when the graft is patent, the anastomosis is intact, and the patient is not septic. 2. Graft excision is mandatory when the patient presents with a thrombosed infected graft, anastomotic or graft hemorrhage, or significant systemic sepsis. 3. Graft preservation can be attempted in both vein and PTFE grafts but is not advised for Dacron grafts. This approach should be tempered by the extent and virulence of the underlying infection, especially when Pseudomonas aeruginosa is the pathologic organism. 4. Delayed hemorrhage and continued systemic sepsis represent early failures of graft preservation and mandate graft excision. 5. Revascularization may be accomplished through the infected bed, but it is generally prudent to proceed with extra-anatomic reconstruction utilizing alternative approaches to inflow and outflow vessels.