Year 2017 Vol. 25 No 6

CASE REPORTS

V. SIHOTSKÝ 1,2, P. BEREK 1,2, I. KOPOLOVETS 1,4, M. KUBÍKOVÁ 1,2, M. TOMEČKO 1, M. STANČÁKOVÁ 2,3, I. DRAHOVSKÁ 2,3, M. FRANKOVIČOVÁ 1,2

AORTOBIFEMORAL GRAFT INFECTION: POSSIBILITIES OF TREATMENT

Clinic of Vascular Surgery VÚSCH a.s. 1,
Faculty of Medicine PJ Šafárik 2,
University Hospital of L. Pasteur 3, Košice,
Slovakia
DSME Uzhgorod National University 4, Uzhgorod,
Ukraine

Authors describe two case reports of patients with infected aortobifemoral graft. Both were treated by total graft excision. In the first case they decided for extra anatomical revascularization of lower extremities after total graft excision, because of virulent infection (Staphylococcus aureus and G+ bacteries) and graft enteral fistula. They performed axilobifemoral bypass grafting. In the second case, where infection was not so virulent (Staphylococcus epidermidis) they decided for in situ reconstruction with desobliterated native aorta, iliac arteries and femoral vein. Both patients are now without signs of infection and they can walk without claudication pain. Graft infection is one of the most serious complications of aortobifemoral bypass surgery therefore the prevention of infection is very important. It is important to keep all rules of asepsis and antisepsis during surgery. Treatment of graft infection is based on intravenously administered antibiotics and excision of infected graft. Limb revascularization after graft removal can be provided by extra anatomical bypass or in situ arterial reconstruction.

Keywords: infection, aortobifemoralgraft, revascularization, extra anatomical bypass
p. 655-661 of the original issue
References
  1. Back Martin R. Chapter 42: Local Complications: Graft Infection. In: Cronenwett JL, Johnston KW. Rutherfords Vascular Surgery. 8-th ed. Philadelphia, PA: Saunders/Elsevier; 2014. . 654-72.e2.
  2. OHara PJ, Hertzer NR, Beven EG, Krajewski LP. Surgical management of infected abdominal aortic grafts: review of a 25-year experience. J Vasc Surg. 1986 May;3(5):725-31.
  3. Campbell WB, Tambeur LJ, Geens VR. Local complications after arterial bypass grafting. Ann R Coll Surg Engl. 1994 Mar;76(2):127-31.
  4. Campbell WB, Tambeur LJ, Geens VR. Local complications after arterial bypass grafting. Ann R Coll Surg Engl. 1994 Mar;76(2):127-31.
  5. Maltezou HC, Giamarellou H. Community-acquired methicillin-resistant Staphylococcus aureus infections. Int J Antimicrob Agents. 2006 Feb;27(2):87-96.
  6. Bergamini TM, Bandyk DF, Govostis D, Vetsch R, Towne JB. Identification of Staphylococcus epidermidis vascular graft infections: a comparison of culture techniques. J Vasc Surg. 1989 May;9(5):665-70.
  7. Bandyk DF, Novotney ML, Back MR, Johnson BL, Schmacht DC. Expanded application of in situ replacement for prosthetic graft infection. J Vasc Surg. 2001 Sep;34(3):411-19; discussion 419-20.
  8. Clagett GP, Bowers BL, Lopez-Viego MA, Rossi MB, Valentine RJ, Myers SI, et al. Creation of a neo-aortoiliac system from lower extremity deep and superficial veins. Ann Surg. 1993 Sep;218(3):239-48; discussion 248-49.
  9. Kieffer E, Gomes D, Chiche L, Fléron MH, Koskas F, Bahnini A. Allograft replacement for infrarenal aortic graft infection: early and late results in 179 patients. J Vasc Surg. 2004 May;39(5):1009-17.
  10. Bisdas T, Bredt M, Pichlmaier M, Aper T, Wilhelmi M, Bisdas S, et al. Eight-year experience with cryopreserved arterial homografts for the in situ reconstruction of abdominal aortic infections. J Vasc Surg. 2010 Aug;52(2):323-30. doi: 10.1016/j.jvs.2010.02.277.
  11. Oderich GS, Bower TC, Hofer J, Kalra M, Duncan AA, Wilson JW, et al. In situ rifampin-soaked grafts with omental coverage and antibiotic suppression are durable with low reinfection rates in patients with aortic graft enteric erosion or fistula. J Vasc Surg. 2011 Jan;53(1):99-106, 107.e1-7; discussion 106-7. doi: 10.1016/j.jvs.2010.08.018.
Address for correspondence:
88000, Ukraine, Uzhgorod,
Universitetskaya st., 10,
Uzhgorod National University
Tel.: +380 50 558 82 11
E-mail: i.kopolovets@gmail.com
Ivan I. Kopolovets
Information about the authors:
Sihotský V., PhD, Vascular Surgeon, Clinic of Vascular Surgery, East Slovakian Cardiovascular Institute and P.J. Šafýrik´s University, Košice, Slovakia. Deputy of the Head of the Department for Pedagogics.
Berek P., PhD, Vascular Surgeon, Deputy of the Head of the Department for Treatment Clinic of Vascular Surgery, East Slovakian Cardiovascular Institute and P.J. Šafýrik´s University, Košice, Slovakia.
Kopolovets I., PhD, Researcher of DSME "Uzhgorod National University", Uzhgorod, Ukraine. Vascular surgeon, Clinic of Vascular Surgery, East Slovakian Cardiovascular Institute, Košice, Slovakia.
Kubikový M., PhD, Vascular Surgeon, Clinic of Vascular Surgery, East Slovakian Cardiovascular Institute and P.J. Šafýrik´s University, Košice, Slovakia.
Tomečko M., PhD, Vascular Surgeon, Clinic of Vascular Surgery, East Slovakian Cardiovascular Institute and P.J. Šafýrik´s University, Košice, Slovakia.
Stančýkový M., General Surgeon, I. Surgical Clinic, University Hospital of J. Pasteur and P.J. Šafýrik´s University, Košice, Slovakia.
Drahovský I., PhD, Head of the Department, I. Clinic of Radiodiagnosics and Imagine Techniques, University Hospital of J. Pasteur and P.J. Šafýrik´s University, Košice, Slovakia
Frankovičový ., PhD, Professor, Head of the Department, Clinic of Vascular Surgery, East Slovakian Cardiovascular Institute and P.J. Šafýrik´s University, Košice, Slovakia.
Contacts | ©Vitebsk State Medical University, 2007-2023