Graft Infection After Aortic Surgery: Strategy and Outcome

Graft infection is the most serious complication associated with aortic surgery. It is difficult to treat, and as a consequence mortality and morbidity are high. The conventional treatment when dealing with this complication is resection of the infected graft and creation of an extraanatomical bypass. We have introduced a new treatment strategy that aims to preserve the original graft by a disinfection procedure of the wound. This procedure consists of two stages. The first stage is an extended disinfection maneuver that includes reexploration, debridement of infected tissue, irrigation, and soaking with iodine solution. The second stage is vital tissue transposition around the graft and to the wound, with primary closure. Nine patients with graft infection (five at the ascending + aortic arch segment, two at the descending segment, and one each at the thoracoabdominal and infrarenal segments) were treated with this procedure. Infection could not controlled in two patients, who died of sepsis; it was controlled in seven patients, although one died in hospital from an unrelated cause. Six patients were discharged without signs of infection recurrence. A 78% infection control rate was achieved using this new treatment strategy.