Management of infected vascular prostheses.

Management of an infected vascular prosthesis must be aggressive. Aerobic and anaerobic cultures should be obtained immediately and broad spectrum antibiotics started at once and modified as culture and sensitivities direct. A period of intensive local wound care should be carried out for several days if possible, before removal of the infected prosthesis. Prolonged local therapy is usually ill-advised since healing is rarely permanent until the graft is removed and the patient is constantly in danger of suture line disruption. Hemorrhage requires immediate removal of the infected portion of the prosthesis. Revascularization should be considered at the time of graft excision only if limb viability is questionable; otherwise it is best to wait until the infection has cleared and the wound has healed. Immediate or late revascularization will usually require an extra-anatomic bypass through uninfected tissue. The best form of treatment is, of course, prevention, which includes meticulous surgical technique, elimination of sources of contamination prior to surgery, and the use of prophylactic, systemic and local antibiotics.