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.
Keywords
negative pressure wound therapy - graft infection - vascular surgery - graft removal
- artificial graft - complication - infrainguinal bypass
