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Shimbo K, Kawamoto H, Koshima I. Use of Muscle Flaps for Salvage of Groin Wound Infection Following Vascular Surgery: A Systematic Review and Meta-Analysis. Vasc Endovascular Surg 2022; 56:401-407. [PMID: 35050812 DOI: 10.1177/15385744211068342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Groin wound infections in vascular surgery are still a common complication and challenging problem. This systematic review aimed to establish a complete view of patient characteristics and clinical outcomes for infected groin wounds following vascular surgery reconstruction using muscle flaps and to evaluate the differences in outcomes between the sartorius muscle flap (SMF), rectus femoris muscle flap (RFF), and gracilis muscle flap (GMF). METHODS PubMed, Scopus, and Web of Science were systematically searched from inception to April 2021. Random-effects meta-analysis for comorbidities and outcomes and subgroup analyses for outcomes were performed. RESULTS Thirty studies were included in qualitative and quantitative syntheses. Overall pooled data showed the following outcome rates: 4.5% muscle flap necrosis (95% confidence interval [CI], -3.4-12.3%; I2 = 0%), 21.8% overall complications (95% CI, 15.8-27.7%; I2 = 0%), 8.0% limb loss (95% CI, 1.9-14.1%; I2 = 0%), 15.4% graft loss (95% CI, 5.0-25.3%; I2 = 37.9%), and 7.4% 30-day mortality (95% CI, -.9-15.6%; I2 = 0%). The rates of overall complications were 20.3% (95% CI, 12.1-28.2%; I2 = 0%), 23.2% (95% CI, 11.2-34.5%; I2 = 10.2%), and 18.0% (95% CI, -3.537.8%; I2 = 0%) for the SMF, RFF, and GMF, respectively. The rate of limb loss was highest for the GMF (17.2%; 95% CI, -4.237.2%; I2 = 0%). The rate of graft loss for the RFF was the highest (20.7%; 95% CI, .6-39.1%; I2 = 53.9%). The rate of 30-day mortality was the lowest for the SMF (5.3%; 95% CI, -6.1-16.6%; I2 = 0%). CONCLUSIONS The effectiveness and safety of muscle flap reconstruction for infected groin wounds following vascular surgery are clearly positive. This review indicated a tendency for lower complication rates with the SMF than with other muscle flaps.
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Affiliation(s)
- Keisuke Shimbo
- Department of Plastic and Reconstructive Surgery, 37102Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Haruka Kawamoto
- Department of Plastic and Reconstructive Surgery, 37102Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Isao Koshima
- Department of Plastic and Reconstructive Surgery, 37102Hiroshima Prefectural Hospital, Hiroshima, Japan.,International Center for Lymphedema, 68272Hiroshima University Hospital, Hiroshima, Japan
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Post ICJH, Vos CG. Systematic Review and Meta-Analysis on the Management of Open Abdominal Aortic Graft Infections. Eur J Vasc Endovasc Surg 2019; 58:258-281. [PMID: 31178356 DOI: 10.1016/j.ejvs.2019.03.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 03/01/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Aortic graft infection (AGI) is a disastrous complication with an incidence of 0.2-6% in operated patients. With little or no high quality evidence, the best treatment option remains unclear. Therefore, the literature on the management of open abdominal AGI was systematically reviewed to determine optimal treatment. METHODS In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic review and meta-analysis was conducted for AGI. MEDLINE, Embase, and the Cochrane Database of Systematic Reviews were searched. Methodological quality was assessed using the Methodological Index for Non-randomised Studies (MINORS) score. Primary outcomes were 30 day mortality and one year survival. Secondary outcomes were survival, infection recurrence, limb salvage, and graft patency. RESULTS Of 1574 studies identified, 32 papers were included in the study. The overall quality of the studies was moderate, with an average MINORS score of 11.9. Pooled overall 30 day mortality and one year survival were 13.5% (95% CI 10.5-16.4) and 73.6% (95% CI 68.8-78.4), respectively. The lowest 30 day mortality and highest one year survival were found for in situ repair compared with extra-anatomic repair and for prosthetic grafts compared with venous grafts or arterial allografts. The infection recurrence rate was highest for prosthetic grafts. CONCLUSIONS There is a lack of well designed, qualitative comparative studies making conclusive recommendations impossible. The current best available data suggests that partial graft removal should be avoided and the lowest 30 day mortality and best one year survival are achieved with in situ repair using prosthetic grafts. Initiatives such as the MAGIC database to collaboratively collect prospective data are an important step forward in obtaining more solid answers on this topic.
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Affiliation(s)
- Ivo C J H Post
- Department of Surgery, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | - Cornelis G Vos
- Department of Surgery, Martini Hospital, Groningen, the Netherlands.
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Wissanji T, Fouard O, Herman D, Hermans P, Vindevogel C. Management and Prevention of Percutaneous Iliac Stent Infection: A Case Report. Ann Vasc Surg 2016; 32:131.e1-5. [DOI: 10.1016/j.avsg.2015.10.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 10/25/2015] [Accepted: 10/29/2015] [Indexed: 10/22/2022]
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Cost-Utility Analysis: Sartorius Flap versus Negative Pressure Therapy for Infected Vascular Groin Graft Managment. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2016; 3:e566. [PMID: 26893991 PMCID: PMC4727718 DOI: 10.1097/gox.0000000000000551] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Accepted: 10/06/2015] [Indexed: 11/26/2022]
Abstract
Background: Sartorius flap coverage and adjunctive negative pressure wound therapy (NPWT) have been described in managing infected vascular groin grafts with varying cost and clinical success. We performed a cost–utility analysis comparing sartorius flap with NPWT in managing an infected vascular groin graft. Methods: A literature review compiling outcomes for sartorius flap and NPWT interventions was conducted from peer-reviewed journals in MEDLINE (PubMed) and EMBASE. Utility scores were derived from expert opinion and used to estimate quality-adjusted life years (QALYs). Medicare current procedure terminology and diagnosis-related groups codes were used to assess the costs for successful graft salvage with the associated complications. Incremental cost-effectiveness was assessed at $50,000/QALY, and both univariate and probabilistic sensitivity analyses were conducted to assess robustness of the conclusions. Results: Thirty-two studies were used pooling 384 patients (234 sartorius flaps and 150 NPWT). NPWT had better clinical outcomes (86.7% success rate, 0.9% minor complication rate, and 13.3% major complication rate) than sartorius flap (81.6% success rate, 8.0% minor complication rate, and 18.4% major complication rate). NPWT was less costly ($12,366 versus $23,516) and slightly more effective (12.06 QALY versus 12.05 QALY) compared with sartorius flap. Sensitivity analyses confirmed the robustness of the base case findings; NPWT was either cost-effective at $50,000/QALY or dominated sartorius flap in 81.6% of all probabilistic sensitivity analyses. Conclusion: In our cost–utility analysis, use of adjunctive NPWT, along with debridement and antibiotic treatment, for managing infected vascular groin graft wounds was found to be a more cost-effective option when compared with sartorius flaps.
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Metzger PB, Barbato HA, Angelieri FMR, Almeida BLD, Filho FADCL, Jordão EDS, Kambara AM, Rossi FH, Izukawa NM. Enxerto aorto bi-ilíaco com veia femoral superficial: uma opção nas infecções de próteses e endopróteses aórticas - relato de caso. J Vasc Bras 2011. [DOI: 10.1590/s1677-54492011000200011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Uma das complicações mais temidas na cirurgia vascular é a infecção do enxerto sintético. Afeta 2% dos procedimentos cirúrgicos convencionais e 0,3 a 6% dos procedimentos endovasculares. Relatamos o caso de paciente tratada de aneurisma de aorta abdominal por ambos os métodos e que, após seis anos, foi submetida a retirada das próteses devido à infecção. A veia femoral superficial bilateral foi usada como substituto, com sucesso.
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Parmar CD, Kumar S, Torella F. Autologous basilic vein for in situ replacement of infected prosthetic vascular grafts: initial experience. Vascular 2009; 17:158-60. [PMID: 19476748 DOI: 10.2310/6670.2008.00070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Successful treatment of prosthetic vascular infection usually requires graft removal with or without replacement. A variety of materials have been used for in situ replacement, with femoral vein being the preferred autologous conduit in the literature for the aortoiliac segment. We present three cases of prosthetic infection treated successfully by in situ replacement with autologous basilic vein harvested from the upper arm. This vessel, which closely matches the iliofemoral arteries in diameter, may be a suitable alternative to femoral vein for in situ replacement of infected iliac and femoral grafts.
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Affiliation(s)
- Chetan D Parmar
- Department of Vascular Surgery, University Hospital Aintree, Liverpool, UK
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Dunn DL. Diagnosis and Treatment of Infection. Surgery 2008. [DOI: 10.1007/978-0-387-68113-9_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Antonios VS, Noel AA, Steckelberg JM, Wilson WR, Mandrekar JN, Harmsen WS, Baddour LM. Prosthetic vascular graft infection: A risk factor analysis using a case–control study. J Infect 2006; 53:49-55. [PMID: 16310254 DOI: 10.1016/j.jinf.2005.10.004] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2005] [Revised: 08/31/2005] [Accepted: 10/03/2005] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Several factors have been anecdotally reported to increase the risk of prosthetic vascular graft infection (PVGI), a serious complication with high mortality and limb amputation rates. The goal of this study is to confirm purported risk factors using a well-designed statistical model. METHODS Patients undergoing vascular graft placement at Mayo Clinic Rochester between January 1, 1982 and December 31, 2002 were retrospectively evaluated, excluding redo cases. PVGI cases had to meet one of the following criteria: perigraft air or fluid >8 weeks postoperatively, positive Gram stain or cultures of graft or perigraft material, intraoperative gross purulence, failure of graft incorporation, or exposed graft. Each case had two controls matched for age, gender and date of surgery. Duration of follow-up for a given control had to be at least equal to the time to infection of the corresponding case. Demographic and other clinical data were collected for each patient. RESULTS Fifty-one cases and 102 controls met the inclusion criteria. Median age was 68 years. Staphylococcal species were identified in 45% of the total number of cases, and 60% of cases with a recovered organism. Univariate analysis identified groin incision, wound complication and wound infection as significant risk factors for PVGI (p<0.005 for all three factors). After adjusting for age and surgery date, multivariate analysis confirmed the statistical significance of groin incision and wound infection as risk factors for PVGI. CONCLUSIONS This is the first published risk factor analysis that includes statistical evaluation in a case-control study of PVGI. Groin incision, wound complication, and wound infection are significantly associated with developing PVGI. These findings will assist in identifying patients at increased risk of developing subsequent infection. SUMMARY In order to confirm purported risk factors of prosthetic vascular graft infections (PVGI), a well designed case-control study was conducted at Mayo Clinic, Rochester, MN. Univariate and multivariate analyses of 51 cases and 102 controls identified three statistically significant risk factors for the development of PVGI: groin incision, wound complication, and wound infection.
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Affiliation(s)
- Vera S Antonios
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
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Seify H, Moyer HR, Jones GE, Busquets A, Brown K, Salam A, Losken A, Culbertson J, Hester TR. The role of muscle flaps in wound salvage after vascular graft infections: the Emory experience. Plast Reconstr Surg 2006; 117:1325-33. [PMID: 16582808 DOI: 10.1097/01.prs.0000204961.32022.ab] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND The incidence of prosthetic graft infection is 1 to 6 percent, and the mortality rate of infected aortoiliac or aortofemoral bypass is 25 to 75 percent. The goal of this study was to report the use of muscle flaps in the management of patients presenting with infected vascular grafts. METHODS A total of 22 patients required 26 muscle flaps to cover 24 infected vascular grafts. Muscle flaps were used for local wound control in all patients regardless of the fate of the graft. The vascular surgeons elected for graft salvage in eight of the 24 grafts. All of the muscle flaps survived. RESULTS The average time interval between the bypass and infection was 371 days. One-month follow-up revealed an 88 percent salvage rate, but this decreased to 50 percent during the mean follow-up of 23 months. None of the patients originally managed with a salvaged graft lost a limb, and overall, 14 of 22 limbs in this series remained viable (64.0 percent). The mortality rate during the index hospitalization was 9 percent. In this series, suprainguinal grafts had a higher mortality rate. In addition, infection occurring more than 1 month postoperatively, culture-positive Pseudomonas and methicillin-resistant species, and exposure of the arterial-graft anastomosis were poor prognostic indicators of graft preservation. CONCLUSIONS Management of infected vascular grafts remains a challenging problem. Muscle flap coverage should have a high priority, as the chance of a good outcome is highly favorable in early infections.
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Affiliation(s)
- Hisham Seify
- Division of Plastic and Vascular Surgery, Joseph B. Whitehead Department of Surgery, Emory University, Atlanta, GA 30327, USA.
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Reid JDS, MacDonald PS. Removing the Infected Aortofemoral Graft Using a Two-Stage Procedure with a Delay Between the Stages. Ann Vasc Surg 2005; 19:862-7. [PMID: 16200471 DOI: 10.1007/s10016-005-7759-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This study describes the results of a procedure for removing the infected aortofemoral graft using a two-stage procedure with a delay between the stages. The objective was to lessen the morbidity and mortality associated with removing an infected graft through a single operation. Eight consecutive patients were treated in this manner over a 6-year span. The indications for surgery were infected groin false aneurysms in three, chronic draining sinuses involving the prosthetic graft in four, and an open groin infection involving graft in one. There were five males and three females, with ages ranging 47-83 years (mean = 63). The mean operative time of the first-stage operation was 5.1 hr (range 3.0-7.7), and the mean blood transfusion requirement was 1.7 units. The mean operative time of the second stage operation was 3.5 hr (range 3.5-7.6), and the mean blood transfusion requirement was 2.5 units. In six patients, the hospital course was uncomplicated, with a mean hospital stay of 8.4 days for the initial stage and 9.2 days for the second stage. Two patients had complicated postoperative courses with hospital stays of >30 days. There was no operative or graft-related late mortality. No patients were lost to follow-up. One patient died of unrelated causes with a patent graft at 22 months postsurgery. All other patients remain well with patent grafts, without requiring revisions at a mean follow-up of 33 months (range 6-73). A two-stage approach with a delay between the stages may reduce the morbidity and mortality associated with the removal of an infected aortobifemoral graft.
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Affiliation(s)
- John D S Reid
- Division of Vascular Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
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Turgut H, Sacar S, Kaleli I, Sacar M, Goksin I, Toprak S, Asan A, Cevahir N, Tekin K, Baltalarli A. Systemic and local antibiotic prophylaxis in the prevention of Staphylococcus epidermidis graft infection. BMC Infect Dis 2005; 5:91. [PMID: 16242027 PMCID: PMC1274316 DOI: 10.1186/1471-2334-5-91] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2005] [Accepted: 10/21/2005] [Indexed: 11/10/2022] Open
Abstract
Background The aim of the study was to investigate the in vivo efficacy of local and systemic antibiotic prophylaxis in the prevention of Staphylococcus (S.) epidermidis graft infection in a rat model and to evaluate the bacterial adherence to frequently used prosthetic graft materials. Methods Graft infections were established in the subcutaneous tissue of 120 male Wistar rats by implantation of Dacron/ePTFE grafts followed by topical inoculation with 2 × 107 CFUs of clinical isolate of methicillin-resistant S. epidermidis. Each of the graft series included a control group, one contaminated group that did not receive any antibiotic prophylaxis, two contaminated groups that received systemic prophylaxis with teicoplanin or levofloxacin and two contaminated groups that received teicoplanin-soaked or levofloxacin-soaked grafts. The grafts were removed 7 days after implantation and evaluated by quantitative culture. Results There was significant bacterial growth inhibition in the groups given systemic or local prophylaxis (P < 0.05). Methicillin-resistant S. epidermidis had greater affinity to Dacron graft when compared with ePTFE graft in the untreated contaminated groups (P < 0.05). Conclusion The study demonstrated that the usage of systemic or local prophylaxis and preference of ePTFE graft can be useful in reducing the risk of vascular graft infections caused by staphylococcal strains with high levels of resistance.
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Affiliation(s)
- Huseyin Turgut
- Department of Infectious Diseases and Clinical Microbiology, Pamukkale University, Faculty of Medicine, Denizli, Turkey
| | - Suzan Sacar
- Department of Infectious Diseases and Clinical Microbiology, Pamukkale University, Faculty of Medicine, Denizli, Turkey
| | - Ilknur Kaleli
- Department of Microbiology and Clinical Microbiology, Pamukkale University, Faculty of Medicine, Denizli, Turkey
| | - Mustafa Sacar
- Department of Cardiovascular Surgery, Pamukkale University, Faculty of Medicine, Denizli, Turkey
| | - Ibrahim Goksin
- Department of Cardiovascular Surgery, Pamukkale University, Faculty of Medicine, Denizli, Turkey
| | - Semra Toprak
- Department of Infectious Diseases and Clinical Microbiology, Pamukkale University, Faculty of Medicine, Denizli, Turkey
| | - Ali Asan
- Department of Infectious Diseases and Clinical Microbiology, Pamukkale University, Faculty of Medicine, Denizli, Turkey
| | - Nural Cevahir
- Department of Microbiology and Clinical Microbiology, Pamukkale University, Faculty of Medicine, Denizli, Turkey
| | - Koray Tekin
- Department of General Surgery, Pamukkale University, Faculty of Medicine, Denizli, Turkey
| | - Ahmet Baltalarli
- Department of Cardiovascular Surgery, Pamukkale University, Faculty of Medicine, Denizli, Turkey
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Ali AT, Bell C, Modrall JG, Valentine RJ, Clagett GP. Graft-associated hemorrhage from femoropopliteal vein grafts. J Vasc Surg 2005; 42:667-72. [PMID: 16242552 DOI: 10.1016/j.jvs.2005.06.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2005] [Accepted: 06/03/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The femoropopliteal vein (FPV) graft has been used extensively for large-caliber vascular reconstructions. To date, there have been no reports of anastomotic dehiscence or rupture leading to graft-associated hemorrhage (GAH). In the present report, we review our experience with GAH from FPV grafts to determine the incidence of this problem, to better understand the etiology, and to determine potential methods to prevent this complication. METHODS All patients undergoing arterial reconstructions with FPV grafts were entered into a registry that included demographics, operative details, complications, and follow-up information. Episodes of GAH that occurred during the period from 1990 to 2004 were studied to determine etiologic factors and outcomes. RESULTS During the study period, 574 FPV grafts were used for arterial reconstructions in 364 patients. GAH occurred in 11 patients (3%). Onset of GAH ranged from 1 hour to 180 days after operation. The mean blood transfusion requirement for GAH was 10 +/- 4 units. In three patients, the etiology of GAH was purely technical, resulting in a slipped or "popped" tie from a large side branch. In eight patients, the etiology was due to graft disruption secondary to uncontrolled infection and failure of anastomotic healing. Most of these patients were being treated for aortic graft infection. Special risk factors for this complication included malnutrition, ongoing polymicrobial and fungal infections, immunocompromised state, active cancer, steroid treatment, and ongoing graft contamination from gastrointestinal or pharyngeal leaks. Outcomes included four deaths and one stroke. CONCLUSIONS GAH is a serious complication with high morbidity, mortality, and transfusion requirements. Although technical problems are preventable, FPV grafts, like all biologic grafts, can develop disruption with GAH from ongoing infection, especially in severely immunocompromised patients who are malnourished and have poor healing ability. Strategies for prevention and alternative treatment modalities are appropriate in patients at high risk for GAH.
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Affiliation(s)
- Ahsan T Ali
- University of Arkansas Medical Center Division of Vascular and Endovascular Surgery, USA
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Abstract
As an increasing number and variety of prosthetic devices are used in cardiovascular medicine, novel infectious complications have been described. Infection of intra-arterial devices, including arterial closure devices, prosthetic carotid patches, coronary artery stents and endovascular stents, and stent-grafts, is now being reported. Prosthetic vascular graft infection is an older, more common, and better-characterized entity, but recent developments in the surgical management of these infections have prompted a re-examination of the syndrome. Staphylococcal species account for most intra-arterial device infections, and often, morbidity and mortality rates are high. An update on intra-arterial device infections is warranted.
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Morasch MD, Sam AD, Kibbe MR, Hijjawi J, Dumanian GA. Early results with use of gracilis muscle flap coverage of infected groin wounds after vascular surgery. J Vasc Surg 2004; 39:1277-83. [PMID: 15192569 DOI: 10.1016/j.jvs.2004.02.011] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Management of a nonhealing femoral wound after vascular surgery can pose a challenging problem, particularly when there is prosthetic material involved. We prefer to use pedicled gracilis muscle flaps (PGMFs) to cover problematic groin wounds when more conventional management is not possible. METHODS We describe the technique for using PGMFs to provide groin coverage, report a summary of our short-term and long-term results, and describe why we prefer this reconstructive technique. RESULTS Twenty PGMFs were placed in 18 patients to treat nonhealing and infected groin wounds. Exposed prosthetic vascular reconstructions were covered with the PGMF in 14 wounds, and in situ autogenous vascular reconstructions were covered in four. Seven wound infections were polymicrobial, 10 had a single gram-positive organism, and one had a single gram-negative organism. Pseudomonas cultured out in four wounds, and Candida in one wound. Two patients had a virulent combination of methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococcus. Complete healing was initially achieved in all wounds, and no patient died within 30 days of surgery. Two PGMFs failed, at 2 weeks and 2 months, respectively, one from tension on the flap pedicle and one from acute inflow occlusion. Underlying prosthetic reconstruction was salvaged in 12 of 14 wounds; the remaining wounds with autogenous reconstructions or exposed femoral vessels all closed successfully. At a mean follow-up of 40 +/- 10 months there were no recurrent groin infections. Seven patients died, at 2.5, 3, 8, 12, 14, 22, and 28 months, respectively. CONCLUSION PGMF transposition is an effective option to cover infected or exposed femoral vessels or salvage prosthetic graft material in the groin. In appropriately selected patients, when complete graft removal and extra-anatomic bypass is not an acceptable option, gracilis muscle flap coverage is a viable alternative. The technique is relatively simple, and morbidity from PGMF harvest is minimal.
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Affiliation(s)
- Mark D Morasch
- Division of Vascular Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Northwestern Memorial Hospital, Suite 10-105, 201 E. Huron Street, Chicago, IL 60611, USA.
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Daenens K, Fourneau I, Nevelsteen A. Ten-year experience in autogenous reconstruction with the femoral vein in the treatment of aortofemoral prosthetic infection. Eur J Vasc Endovasc Surg 2003; 25:240-5. [PMID: 12623336 DOI: 10.1053/ejvs.2002.1835] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE to study the short and long term effectiveness of in situ replacement of infected aortic grafts with the lower extremity deep veins. METHODS forty-nine patients operated on for infrarenal aortic graft infection since 1990 were studied. Diagnosis of infection was based on clinical signs, bacteriological tests and typical findings on CT scan and leukocyte scan. The surgical treatment consisted in harvesting the femoral vein, total graft excision, thorough debridement and in situ reconstruction with the femoral veins. After discharge, the patients were followed at 6 monthly intervals with clinical examination, duplex and/or CT scan. RESULTS there were four in-hospital deaths (8%). One patient required above-knee amputation (2%) and there were two graft limb occlusions (4%). With a mean follow-up 41 months, another 13 patients died, unrelated to the operation (29%). There were no late amputations and only two late graft limb stenoses (4%). We have a 5 year survival rate of 60%, a 5 year limb salvage rate of 98%, and a 5 year primary patency rate of 91%. There were no cases of aneurysmal dilatation of vein grafts and no incidence of reinfection. CONCLUSION in situ reconstruction with the lower extremity deep veins is in the long term a safe and attractive alternative in the treatment of infrarenal aortic graft infection.
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Affiliation(s)
- K Daenens
- Center for Vascular Diseases, University Hospital Gasthuisberg, Leuven, Belgium
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Pinocy J, Albes JM, Wicke C, Ruck P, Ziemer G. Treatment of periprosthetic soft tissue infection of the groin following vascular surgical procedures by means of a polyvinyl alcohol-vacuum sponge system. Wound Repair Regen 2003; 11:104-9. [PMID: 12631297 DOI: 10.1046/j.1524-475x.2003.11205.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Deep groin infections after prosthetic vascular surgical procedures represent a serious complication of surgical practice. Septicemia and/or erosive hemorrhage can both be consequences. In this situation, removal of the graft appears to be the only option. However, if the infection is detected early (type Szilagyi III), local treatment to eradicate the infection could serve as an alternative. Twenty-four patients with confirmed infection of the soft tissue adjacent to the prosthetic material in the groin were treated locally by implantation of a vacuum sponge system. Duration of this treatment was 2 weeks. All patients showed excellent tissue granulation of the wound area and the microbial stains were negative at the end of therapy. In 21 patients the wound could be primarily closed after explantation of the sponge. Three patients underwent open treatment because of a skin defect. After 12 months, the wounds had healed well in all patients. Histologic evaluation revealed a physiological healing process. Deep soft tissue infections of the groin adjacent to prosthetic vascular material (type Szilagyi III) can be treated effectively and safely with the vacuum sponge system. The treatment is inexpensive, easy to perform, and the initial vascular reconstruction can be preserved.
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Affiliation(s)
- Jürgen Pinocy
- Department of Surgery, Division of General Surgery, University of Tübingen, Tübingen, Germany.
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Meneghetti AT, MacDonald PS, Reid JDS, Sladen JG, Turnbull RG. Patency of superficial femoral vein employed as a crossover femoral artery bypass conduit. Ann Vasc Surg 2002; 16:746-50. [PMID: 12404044 DOI: 10.1007/s10016-001-0245-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
This study assesses the patency of superficial femoral vein used as a crossover femoral artery bypass conduit in patients presenting either with localized groin sepsis, generalized sepsis or in patients with occluded or heavily diseased superficial femoral artery outflow. Twenty patients were followed prospectively with femoral crossover grafts constructed of superficial femoral vein. Twelve patients presented with sepsis and 8 with chronic ischemia from iliac artery occlusion and severely diseased superficial femoral artery outflow. Graft patency was assessed with regular duplex ultrasound examination. There was one perioperative death. Six patients died during the follow-up period. Mean follow-up time was 24.3 months. No graft occluded or required revision. There was no limb loss, graft infection, or graft hemorrhage. Superficial femoral vein offers an effective femoral crossover bypass graft in patients with either localized/generalized sepsis or disadvantaged outflow tracts.
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Affiliation(s)
- Adam T Meneghetti
- Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
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Graham RG, Omotoso PO, Hudson DA. The effectiveness of muscle flaps for the treatment of prosthetic graft sepsis. Plast Reconstr Surg 2002; 109:108-13; discussion 114-5. [PMID: 11786800 DOI: 10.1097/00006534-200201000-00018] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The objective of this study was to assess the efficacy and reliability of muscle flaps in the treatment of prosthetic graft sepsis. A retrospective analysis was performed to assess the outcome of all patients with prosthetic graft sepsis who were treated with a muscle flap at Groote Schuur Hospital between January of 1991 and July of 2000. The specific end points studied were flap survival, limb salvage rate, and mortality. A total of 27 muscle flaps were raised to cover 24 sites of graft sepsis in 21 patients. Twenty-five flaps were performed primarily and two secondarily. The mortality rate was zero. Limb salvage was achieved in 15 of 21 patients (71 percent), with no recurrent sepsis after an average follow-up period of 36 months. The groin was the most common site of infection, with an 86 percent incidence. Eighteen sartorius flaps were raised in the groin. Seventeen of the 18 sartorius flaps survived (94 percent), and a 71 percent limb salvage was achieved with no recurrent sepsis after 36 months of follow-up. This series supports the use of muscle flaps for the treatment of prosthetic graft sepsis. The sartorius flap has been shown to be reliable as a flap in the groin, with successful limb salvage in the majority of patients.
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Affiliation(s)
- Roger G Graham
- Departments of Plastic and Reconstructive Surgery and General Surgery, University of Cape Town, Groote Schuur Hospital, Cape Town, Africa.
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Piela A, Kruczek A. Radical hysterectomy for IB cervical cancer in a patient with aorto-femoral transposition. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2000; 26:193-4. [PMID: 10744944 DOI: 10.1053/ejso.1999.0770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We present a cervical cancer case in stage IB, according to FIGO classification, treated with radical hysterectomy and pelvic lymphadenectomy. The 48-year-old patient had 4 years previously undergone a Y aorto-bifemoral Dallon transposition as a result of Leriche's syndrome. During the routine investigation invasive cervical cancer was diagnosed. She had radical hysterectomy of Piver III type and partial pelvic lymphadectomy. Radical hysterectomy caused no technical trouble. Pelvic lymphadenectomy was only partially possible because of hard connective tissue around the artificial vessels. This scarred region made safe preparation of the total pelvic lymphatic system impossible.
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Affiliation(s)
- A Piela
- Department of Obstetrics and Gynecology, District Hospital in Rzeszow, Poland
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