Kysela P and Silhart Z
Though the frequency of vascular graft infections is very low, its consequences are too serious. The paper aims at the vascular graft infection causes analysis in a single centre. Results achievable by means of several approaches have been discussed and a possible way of lowering the vascular graft infection rate has been tested.
Material and methods: A population of 2812 patients having implanted an artificial vascular graft in 2000-2010 were prospectively followed up. Upon the analysis of risk factors, the control group of 653 patients operated on during 2011-2013 were followed up.
Results: Number of vascular graft infections was 28 (1,0%). Amputation rate was 19% (5 patients) and the overall mortality 14% (4 patients). Leading signs of the infection were local findings in 88%. All patients with the infection had two or more co-existing independent risk factors picked out by chi-square statistics. It was obesity, repeated interventions and emergency surgery (p<0,001). Gender (men), co-existing infection, diabetes and too long bypass were also significant (p<0,01). There was not MRSA infection at all. After adoption of risk factors reducing approach, there was not proven decreased infection occurrence in patients with implanted artificial grafts. However, during the control period, a higher share of autologous grafts and endovascular methods were used. Thus the overall infection rate was reduced from 0,43 to 0,31%.
Conclusion: The graft infection is not a matter of resistant bacteria, but the infection in general. An accumulation of more than two independent risk factors according to local situation should be avoided. As the infection treatment is very demanding with uncertain results, patient’s wish should be taken into account as well. In all primaries, the use of the artificials ought to be minimized and endovascular procedures should be preferred, where appropriate. Emergency surgery should be avoided by in time indication to revascularization.