Vascular graft infection in aortoiliac and aortofemoral bypass surgery: clinical presentation, diagnostic strategies and results of surgical treatment

Abstract

Objectives: Evaluation of the prevalence, diagnostic procedures and clinical outcome of infections of aortoiliac and aortofemoral vascular grafts presented in our centre.

Design: Retrospective study.

Materials: All patients who underwent a surgical aortoiliac or aortofemoral revascularisation between 1991 and 2001.

Methods: Evaluation of several hospital databases.

Results: 32 cases of aortoiliac and aortofemoral vascular graft infection with varied clinical presentation were found. Enteral bleeding was the first clinical manifestation in 31% of the cases, inguinal swelling, wound, or fistula in 59% and fever or sepsis in 6.3%. In 3% the cause was unknown. The vast majority (84.5%) of the infections presented three or more months after surgery (late infections). In cases of enteral bleeding, endoscopy procedures only revealed the diagnosis in 55%. Diagnostic algorithms including an abdominal CT scan appeared to have a sensitivity of 94% for establishing an accurate diagnosis. Remarkably, no specific risk factors for graft infection could be demonstrated. Furthermore, a 30-day survival of 20% or less was observed in early graft infections, whereas late infections managed with extra-anatomical bypasses appeared to have a better survival rate of up to 70%.

Conclusion: Endoscopy in cases of enteral bleeding and CT scanning overall were shown to be very useful for establishing the diagnosis. Clinical outcome and survival after treatment remain poor.