Operative strategies in aortic graft infections: is complete graft excision always necessary?

The classic approach to aortic graft infections involves complete excision of the graft material with remote reconstruction of the distal circulation. Certain patients may not be well suited for this approach for physiologic or anatomic reasons. This study was undertaken to determine the outcome of partial graft excision in selected patients with aortic graft infection who were not felt to be candidates for complete graft excision. Retrospective analysis of 30 consecutive patients treated with infected grafts arising from the aorta over the past 10 years was performed. Mean interval between graft placement and infection was 5.5 years. Complete graft excision with bypass via clean tissue planes was achieved in 15 patients (group A), and partial or complete graft salvage or in situ graft replacement was performed at the discretion of the surgeon in 15 patients (group B). Perioperative mortality occurred in eight subjects (27%), including six in group A (40%) and two in group B (13%; p = NS). Six patients (20%) developed recurrent infection following graft excision, two (13%) in group A and four (27%) in group B (p = NS). Microorganisms were recovered from 24 of 30 (80%) graft cultures: 13 (43%) were gram positive, 4 (13%) were gram negative, and both gram-positive and gram-negative organisms were recovered from 7 (23%). Identification of culture isolates did not influence either perioperative mortality or the development of recurrent infection. Long-term survival was no different between the groups. We conclude that in certain high-risk patients who may not tolerate complete graft excision, local resection of infected graft segments may be preferable and leads to similar short- and long-term outcome.