Prosthetic vascular graft infections , analysis of 22 cases

Abdullah ERDOĞAN, İrfan ESER, Necdet ÖZ, Alpay SARPER, Levent DERTSİZ, Abid DEMİRCAN

Abstract

Aim: To analyze graft infections (GI), a serious complication of vascular surgery, regarding the type of the graft, site of the graft and the causal agent. Method: The graft infections of the patients with prosthetic vascular grafts, who were hospitalized at the Department of Thoracic and Cardiovascular Surgery, Medical Faculty of Akdeniz University between the years of 1990-1999, were analyzed retrospectively. Results: Prosthetic vascular grafting was performed in a total of 285 cases. Dacron graft was used in 134(47%) cases and PTFE graft in 151(53%) cases. Of these cases, in 22(7,7%) graft infection was determined. Mean age of the patients was 62,3 years (range 25-74). Of the patients, only one was female and the rest were male. Half of the infected grafts were Dacron, and the other half were PTFE. Five(22%) of those patients had diabetes mellitus. Grafting was performed because of aneurysm(3 patients), trauma(1 patient), Takayasu arteritis(1 patient) and atherosclerosis (18 patients). The localization of the infected grafts was as follows: aortobifemoral (12 grafts) (54,5%), aortofemoral (1 graft) (4%), iliofemoral (3 grafts) (13%), femoropopliteal (5 grafts)(22%) and aortocarotid (1 graft)(4%) regions. In all patients the infection was seen at late postoperative period (1 month-6 years). The site of the infection was inguinal region in 17(77%) patients, femoropopliteal region in 2(9%) patients, cervical region in one(4%) patient and retroperitoneal region in 2(8%) patients. The most frequent causal agent for the graft infection was staphylococcus aureus. Medical treatment was commenced in one patient. The infected graft was removed surgically in 21 patients, and an extraanatomic bypass was performed in4(18%) patients in the same operation. A second grafting was performed in 14(63,6%) patients at a later operation; an extremity amputation was carried out in 4(%18) patients and 3(13,6%) patients died from graft infection. Conclusion: In our series the most common site of graft infection was inguinal region and the most frequent causal agent was staphylococcus aureus. Infections were commonly seen at the late postoperative period. This suggests that hygienic measures are important to prevent the graft infections in these patients.

Özet

Amaç: Vasküler cerrahinin ciddi komplikasyonlarından biri olan greft enfeksiyonunun (GE) greft cinsi,uygulama yeri, etken ve sosyokültürel yapı ile olan ilişkisini araştırmak Metod:Akdeniz Üniversitesi Tıp Fakültesi Göğüs Kalp Damar Cerrahisi Kliniği`nde 1990-1999 yılları arasında değişik patolojiler nedeniyle prostetik vasküler greft uygulanan hastalarda greft enfeksiyonları retrospektif olarak araştırıldı. Sonuç: Toplam 285 hastaya prostetik vasküler greft uygulandı. 134(%47) hastaya Dacron, 151(%53) hastaya PTFE greft uygulandı. Bunlardan 22` sinde(%7,7) greft enfeksiyonu tesbit edildi.Yaş ortalaması 62.3 (25-74 yaş) idi.Greft enfeksiyonu olgularının bir tanesi bayan diğerlerinin tümü erkek olup enfekte greftlerden 11'i(%50) Dacron, 11'i (%50) PTFE idi.Beş hasta (%22) Tip 2 diabetliydi. GE olan hastaların 3'üne anevrizma, birine travma diğer 18`ine ise ateroskleroz nedeniyle prostetik greft konmuştu. Enfekte greftlerden 12'si (%54,5) aortobifemoral, biri (%4) aortofemoral, 3`ü (%13) iliofemoral, 5`i (%22) femoropopliteal ve biride aorta-sol karotis pozisyondaydı. Hastaların tamamında enfeksiyon postoperatif geç dönemde tesbit edildi (1ay - 6yıl). Enfeksiyon 17 olguda (%77) inguinal bölgede 2 (%9) olguda ise uyluk iç yüzünde, bir (%4,5) hastada servikal bölge ve 2 (%9) hastada retroperitonda idi. GE'nun en sık etkeni 14 (%63,6) olgu ile staphilococcus Aureus`tu. Hastaların birine medikal tedavi uygulandı, 21'inde enfekte greft çıkarıldı. Dört (%18) hastaya aynı seansta extra anatomik bypass, 14 (%63,6) hastaya ikinci seansta greft kondu.4 (%18) hastaya extremite ampütasyonu uygulandı. Üç (%13,6) hasta GE nedeniyle kaybedildi. İrdeleme: Tesbitlerimiz GE`nu, en sık inguinal bölgede ve en sık etkeninde staph. Aureus olduğunu göstermektedir. Enfeksiyon sıklıkla postoperatif geç dönemde ortaya çıkmış olup burada hijyen ve sosyo-kültürel yapının önemli bir faktör olduğu kanaatindeyiz.