Arterial prosthetic graft infections
(Portuguese PDF version)

Eduardo Toledo de Aguiar*

* Associate professor, Medicine School, Universidade de São Paulo (USP). Scientific Director of the Brazilian Society of Angiology and Vascular Surgery (SBACV) - São Paulo Unit.

J Vasc Br 2004;3(3):290

The review made by França & Stalke¹ about infections that compromise arterial reconstruction comes at a very opportune time, once this topic has not been addressed in the last medical publications. With the goal of complementing their review, I would like to remind you of an experience we had at Hospital de Clínicas of the Medical School from Universidade de São Paulo, published from 1985 to 1996.

In 269 reconstructions, the incidence of infections in arterial prosthetic grafts was 5.57%. In operations of aorto-iliac, femoro-popliteal and extra-anatomic areas, the incidence of infections was 3.9%, and in reoperations it increased to 10.7%. We concluded that preventive measures during reoperations should be twice as much as during operations.² Different etiology for infections was found, with the most common being Staphylococcus sp. and gram-negative germs; in 10% of cases, etiology was multiple (including one case associating staphylococcal and anaerobic etiology); time for the infection clinical manifestation also varied: almost half of the patients presented with infection during the first postoperative year, in more than one third of cases the infection arose in the period of 4 postoperative years, and in almost 10% of cases the infection arose after longer postoperative periods (up to 12 years).^3,4

Follow-up of patients with longer use of arterial prosthesis revealed that the risk of infection increases with time, that is, the arterial reconstruction with arterial prosthetic graft is always at risk of being infected.⁵ With relation to treatment, we concluded that the total withdrawal of the prosthesis would be the ideal procedure for eradication of the infection, but this is not always possible. Thus, research on substitutes that resist to infections, like the one described by França & Stalke, is fundamental, as well as the emphasis on endarterectomy techniques, which can produce the same results as reconstructions with synthetic arterial prosthetic grafts but without the complications resultant from these substitutes.⁶

My compliments to the authors.

REFERENCES

1. França LHG, Stahlke Jr H. Estratégias atuais para tratamento de infecção em restaurações infra-inguinais. J Vasc Bras 2004;3:137-44.

2. Aguiar ET, Albers MTV, Langer B, Puech-Leão LE. Incidência de infecções comprometendo próteses arteriais. Rev Paul Méd 1985;103:239-42.

3. Aguiar ET, Albers MTV, Langer B, Fratezi AC, Furlan JC. Tratamento cirúrgico de infecções comprometendo próteses arteriais em posição aorto-femoral. Rev Hosp Clin Fac Med S Paulo 1993;48:76-81.

4. Aguiar ET, Langer B, Albers MTV, Fratezi AC, Basseto FL. Infecção comprometendo próteses arteriais. Rev Hosp Clin Fac Med S Paulo 1993;48:8-12.

5. Aguiar ET, Langer B, Albers MTV, Lobato AC. Le risque de survenue de faux anévrysme et d'infection prothétique après pontage prothétique aorto-fémoral. Étude retrospective. A propos de 211 cas. J Mal Vasc 1996;11:86-91.

6. Aguiar ET, Lederman A, Sitrângulo Jr CJ, Puech-Leão P. Aortofemoral thromboendarterectomy. Rev Hosp Clin Fac Med S Paulo ,,2002;57:147-60.