Peripheral Prosthetic Vascular Graft Infection: A 5-Year Retrospective Study
<b>Background/Objectives:</b> Peripheral prosthetic vascular graft infection represents a very serious complication after lower limb revascularization, with amputation and mortality rates up to 70% and 30%, respectively. This study was designed to determine the incidence of prosthetic gr...
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MDPI AG
2025-06-01
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| author | Giovanni De Caridi Mafalda Massara Chiara Barilla Filippo Benedetto |
| author_facet | Giovanni De Caridi Mafalda Massara Chiara Barilla Filippo Benedetto |
| author_sort | Giovanni De Caridi |
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| description | <b>Background/Objectives:</b> Peripheral prosthetic vascular graft infection represents a very serious complication after lower limb revascularization, with amputation and mortality rates up to 70% and 30%, respectively. This study was designed to determine the incidence of prosthetic graft infection, amputation, and mortality rate in our institution, analyzing different types of treatment. <b>Methods:</b> A retrospective cohort single institution review of peripheral prosthetic bypass grafts evaluated patient demographics, comorbidities, indications, location of bypass, type of prosthetic material, and case urgency and evaluated the incidence of graft infections, amputations, and mortality. <b>Results:</b> Between January 2016 and December 2021, a total of 516 bypasses were recorded (318 male, 198 female, mean age 74.2): 320 bypasses in venous material and 196 prosthetic bypasses using Dacron or PTFE. Among patients with a prosthetic bypass, 16 (8.2%) presented a graft infection at a mean follow-up of 39 months. Thirteen other patients who submitted to prosthetic peripheral bypass in other centers presented to our institution with a graft infection, so a total of 29 infected grafts were treated. Infected grafts were removed in 20 patients (68.9%), while a conservative treatment was helpful in nine cases (31.1%). The germs involved were Gram-negative in 27.6% and Gram-positive in 41.4%. During follow-up, we recorded five deaths (17.2%) and six amputations (20.7%) directly after bypass excision; another two amputations (6.9%) occurred after failure of the new bypass replacing the prosthesis removed. <b>Conclusions:</b> Redo-bypass, active infection at the time of bypass, and advanced gangrene were associated with a higher risk for prosthetic graft infection and major extremity amputation. Complete graft removal and replacement by venous material or Omniflow II represents the typical treatment. However, aggressive local treatment including drainage, debridement, vacuum-assisted closure therapy application, and muscle transposition seem to be a better solution in selected patients without the need for graft removal and with rates of limb salvage superior to those obtained with excisional therapy. |
| format | Article |
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| institution | Kabale University |
| issn | 2076-3271 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | MDPI AG |
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| series | Medical Sciences |
| spelling | doaj-art-d81609851bb4482d99ae8052b7c19b752025-08-20T03:27:22ZengMDPI AGMedical Sciences2076-32712025-06-011327110.3390/medsci13020071Peripheral Prosthetic Vascular Graft Infection: A 5-Year Retrospective StudyGiovanni De Caridi0Mafalda Massara1Chiara Barilla2Filippo Benedetto3Dipartimento di Scienze Biomediche, Odontoiatriche e delle Immagini Morfologiche e Funzionali, Università di Messina, 98122 Messina, ItalyDivisione di Chirurgia Vascolare ed Endovascolare, GOM di Reggio Calabria, 89124 Reggio Calabria, ItalyDipartimento di Scienze Biomediche, Odontoiatriche e delle Immagini Morfologiche e Funzionali, Università di Messina, 98122 Messina, ItalyDipartimento di Scienze Biomediche, Odontoiatriche e delle Immagini Morfologiche e Funzionali, Università di Messina, 98122 Messina, Italy<b>Background/Objectives:</b> Peripheral prosthetic vascular graft infection represents a very serious complication after lower limb revascularization, with amputation and mortality rates up to 70% and 30%, respectively. This study was designed to determine the incidence of prosthetic graft infection, amputation, and mortality rate in our institution, analyzing different types of treatment. <b>Methods:</b> A retrospective cohort single institution review of peripheral prosthetic bypass grafts evaluated patient demographics, comorbidities, indications, location of bypass, type of prosthetic material, and case urgency and evaluated the incidence of graft infections, amputations, and mortality. <b>Results:</b> Between January 2016 and December 2021, a total of 516 bypasses were recorded (318 male, 198 female, mean age 74.2): 320 bypasses in venous material and 196 prosthetic bypasses using Dacron or PTFE. Among patients with a prosthetic bypass, 16 (8.2%) presented a graft infection at a mean follow-up of 39 months. Thirteen other patients who submitted to prosthetic peripheral bypass in other centers presented to our institution with a graft infection, so a total of 29 infected grafts were treated. Infected grafts were removed in 20 patients (68.9%), while a conservative treatment was helpful in nine cases (31.1%). The germs involved were Gram-negative in 27.6% and Gram-positive in 41.4%. During follow-up, we recorded five deaths (17.2%) and six amputations (20.7%) directly after bypass excision; another two amputations (6.9%) occurred after failure of the new bypass replacing the prosthesis removed. <b>Conclusions:</b> Redo-bypass, active infection at the time of bypass, and advanced gangrene were associated with a higher risk for prosthetic graft infection and major extremity amputation. Complete graft removal and replacement by venous material or Omniflow II represents the typical treatment. However, aggressive local treatment including drainage, debridement, vacuum-assisted closure therapy application, and muscle transposition seem to be a better solution in selected patients without the need for graft removal and with rates of limb salvage superior to those obtained with excisional therapy.https://www.mdpi.com/2076-3271/13/2/71critical lower limb ischemiabypassnegative-pressure wound therapy-peripheral vascular disease-infection |
| spellingShingle | Giovanni De Caridi Mafalda Massara Chiara Barilla Filippo Benedetto Peripheral Prosthetic Vascular Graft Infection: A 5-Year Retrospective Study Medical Sciences critical lower limb ischemia bypass negative-pressure wound therapy-peripheral vascular disease-infection |
| title | Peripheral Prosthetic Vascular Graft Infection: A 5-Year Retrospective Study |
| title_full | Peripheral Prosthetic Vascular Graft Infection: A 5-Year Retrospective Study |
| title_fullStr | Peripheral Prosthetic Vascular Graft Infection: A 5-Year Retrospective Study |
| title_full_unstemmed | Peripheral Prosthetic Vascular Graft Infection: A 5-Year Retrospective Study |
| title_short | Peripheral Prosthetic Vascular Graft Infection: A 5-Year Retrospective Study |
| title_sort | peripheral prosthetic vascular graft infection a 5 year retrospective study |
| topic | critical lower limb ischemia bypass negative-pressure wound therapy-peripheral vascular disease-infection |
| url | https://www.mdpi.com/2076-3271/13/2/71 |
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