Abdominal aortic prosthetic infection

Aim. The purpose of this paper was to compare our personal experience in the treatment of abdominal aortic prosthetic infection by conventional surgery, with the latest techniques characterized by in situ peripheral revascularization. Alloplastic vascular infection is the worst complication of aorto-iliac reconstructive surgery. Conventional surgery consists in the excision of infected prosthesis and lower limbs revascularization with axillo-femoral bilateral bypass. Other surgical solutions, characterized by in situ peripheral revascularization, have been proposed: allograft, autogenous superficial vein, rifampicin-bonded grafts. Materials and methods. A total of 15 patients have been treated, with conventional surgical approach between January 1986 and December 2001, at the Operative Unit of Vascular Surgery of the University of Parma; in 6 cases there was also a prosthetic-duodenal fistula. Results. The 4-month operative mortality has been of 40% (6/15): higher in cases of prosthetic-duodenal fistula 66,6% (4/6), than in those without prosthetic-duodenal fistula 22,2% (2/9). Despite 3 prosthesis reinfections and one case of extra-anatomic bypass thrombosis, the 4-month limb-salvage rate has been of 100%. Conclusions. The conventional surgical approach, used by the authors, is probably the best one in more compromised patients (shock, emergency surgery). In the other cases (low-grade infections, stable patients) new in situ approaches are possible, such as autogenous superficial vein.