Int J Angiol 2019; 28(01): 039-043
DOI: 10.1055/s-0038-1676798
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Results of Graft Removal and Negative Pressure Wound Therapy in Management of Graft Infection

Keisuke Miyake
1  Department of Cardiothoracic and Vascular Surgery, Kinan Hospital, Sinjyocho, Tanabe, Japan
,
Nobuo Sakagoshi
1  Department of Cardiothoracic and Vascular Surgery, Kinan Hospital, Sinjyocho, Tanabe, Japan
,
Katsukiyo Kitabayashi
1  Department of Cardiothoracic and Vascular Surgery, Kinan Hospital, Sinjyocho, Tanabe, Japan
› Author Affiliations
Further Information

Publication History

Publication Date:
02 January 2019 (eFirst)

Abstract

Graft infections are a challenging complication in lower extremity bypass surgery with poor outcome, even when treated with graft removal (Gr-R) as a gold standard therapy. The efficacy of negative pressure wound therapy (NPWT) for graft infections has been reported recently, but it is still controversial. The purpose of this study was to assess the efficacy of NPWT and Gr-R for treating graft infections. Twelve consecutive patients with graft infections from 2008 to 2014, treated with Gr-R or NPWT, were enrolled. Those procedures were assessed in complete wound healing, reinfection, amputation, and mortality rate. Five grafts were treated with Gr-R, and seven grafts with NPWT. The initial indications for bypass surgery were claudication, in five grafts treated with Gr-R and three grafts treated with NPWT, and critical limb ischemia in four grafts treated with NPWT. The median time until healing in Gr-R and NPWT was 12 and 59 days, with complete healing seen in 100 and 85.7%, respectively. The major amputation rate was 20 and 14.3%, and reinfection rate was 20 and 14.3%, respectively. There was no perioperative mortality. Gr-R did not show devastating outcome when applied for grafts without limb-threatening ischemia. NPWT showed a low level of invasiveness with excellent results, except for anastomosis site infections. To achieve optimal results, a tailored treatment strategy should be considered.

Authors' Contributions

Study conception: K.M.


Writing: K.M.


Critical review and revision: All authors.


Final approval of the article: All authors.


Accountability for all aspects of the work: All authors.