CASE REPORT
Aortobifemoral prothesis infection
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Department of Vascular Surgery, Provincial Specialist Hospital in Olsztyn, Poland
Publication date: 2020-04-10
Corresponding author
Antoni Dutkiewicz
Provincial Specialist Hospital in Olsztyn, Department of Vascular Surgery, Żołnierska 16, 10-561 Olsztyn, Poland. Tel.: +48 89 538 65 23, +48 89 538 65 45; fax: +48 89 538 65 50.
Pol. Ann. Med. 2012;19(2):129-133
KEYWORDS
ABSTRACT
Introduction:
Vascular prosthesis infection constitutes one of the most serious complications in vascular surgery and is associated with a high risk of extremity amputation or death. Possibilities of conservative treatment are limited. The only radical procedure effecting the regression of inflammation is the removal of the infected prosthesis. This usually necessitates vascular reconstruction in the involved extremities. An ideal way to reconstruct blood flow in the lower extremities does not exist.
Aim:
This work aimed at presenting possibilities for managing complications in a patient with an aortobifemoral prosthesis.
Case study:
The described patient developed symptoms of intermittent claudication at the age of 38 years. When he was 39 years old he had a myocardial infarction, and afterwards problems concerning his lower extremities exacerbated. This necessitated the implantation of aortobifemoral prosthesis. After 5 years, the patient was operated on due to an anastomotic pseudoaneurysm in the left groin area, and then due to hemorrhage from the anastomotic pseudoaneurysm in the right groin area with symptoms of prosthesis infection. In January 2000, the infected prosthesis was removed surgically and a bypass polytetrafluoroethylene (PTFE) graft to both femoral arteries was implanted with a good result. In 2005, the patient was operated on due to a cerebral aneurysm.
Results and discussion:
The bypass graft has been functional in the described patient for 11 years, despite progressive atherosclerosis, smoking, three surgeries due to a graft thrombosis and an anastomotic pseudoaneurysm.
Conclusions:
Despite the enumerated complications and progressive atherosclerosis, the patient did not manage to give up his addiction (smoking). His case illustrates various difficulties in the course of treating an infected prosthesis, even when bacteria are very sensitive to antibiotics.
CONFLICT OF INTEREST
None declared.
REFERENCES (14)
1.
Dutkiewicz A. Zastosowanie kul gentamycynowych w zakażeniu protezy naczyniowej [The use of gentamicin balls in vascular prosthesis infection]. Pol Przeg Chir. 1990;62:603–605 [in Polish].
2.
Gabriel M, Oszkinis G, Stanisić M, Pawlaczyk K, Krasiński Z, Dzieciuchowicz Ł, et al. Prosthetic graft infection treated by local surgery – comparative analysis of 64 consecutive cases. Acta Angiol. 2006;12(4):167–179.
3.
Kielar M, Noszczyk W. Zakażenia w chirurgii tętnic [Infections after arterial surgeries]. Pol Przeg Chir. 1999;71:1274–1284 [in Polish].
4.
Landry GJ, Carlson JR, Liem TK, Mitchell EL, Edwards JM, Moneta GL. The sartorius muscle flap: an important adjunct for complicated femoral wounds involving vascular grafts. Am J Surg. 2009;197(5):655–659.
5.
Mirzaie M, Schmitto JD, Tirilomis T, Fatehpur S, Liakopulos OJ, Teucher N, et al. Surgical management of vascular graft infection in severely ill patients by partial resection of the infected prosthesis. Eur J Vasc Endovasc Surg. 2007;33:610–613.
6.
Niedźwiadek J, Mazur E, Terlecki P, Ziemba B, Ligięza J, Wroński J, et al. Czynniki etiologiczne zakażeń przeszczepów naczyniowych i ocena ich lekooporności [Etiological factors of vascular grafts infections and their resistance to antibiotics]. Pol Merk Lek. 2006;21(125):423–428 [in Polish].
7.
Pukacki F, Gabriel M, Chęciński P, Oszkinis G, Dzieciuchowicz Ł, Zapalski S. Sześcioletnie doświadczenia w zastosowaniu mrożonych tętniczych przeszczepów alogenicznych w leczeniu chorych z zakażeniem dużych protez naczyniowych [Six-year experience in frozen arterial allografts used in the treatment of infected aortic prosthetic grafts]. Pol Przeg Chir. 2003;75:579–595 [in Polish].
8.
Pukacki F, Zieliński M. Współczesne metody leczenia zakażeń protez naczyniowych [Modern methods of treating vascular prosthesis infections]. In: Pukacki F, Chęciński P, eds. Zakażenia protez naczyniowych [Vascular Prosthesis Infections]. Warszawa: Fundacja Polski Przegląd Chirurgiczny; 2005: 23–38 [in Polish].
9.
Pupka A, Barć P, Kałuża G, Dawiskiba T, Szyber P. Ocena wgajania dakronowej protezy naczyniowej impregnowanej solami srebra i uszczelnianej kolagenem w leczeniu zakażeń w chirurgii naczyniowej [Evaluation of the healing process of vascular dacron silver/collagen coated prosthesis in the treatment of infection in vascular surgery]. Inż Biom. 2003;26:18–20 [in Polish].
10.
Pupka A, Skóra J, Janczak D, Patrzałek D, Pawłowski S, Dawiskiba T, et al. Leczenie zakażeń protez naczyniowych w odcinku aortalno-biodrowo-udowym z zastosowaniem przeszczepu tętniczego [Management of prosthetic graft infections of the aorto-ilio-femoral segment using arterial homografts]. Pol Przeg Chir. 2004;76(2):198–209 [in Polish].
11.
Pupka A, Skóra J, Janczak D, Plonek T, Marczak J, Szydełko T. In situ revascularisation with silver-coated polyester prostheses and arterial homografts in patients with aortic graft infection – a prospective, comparative, single-centre study. Eur J Endovasc Surg. 2011;41(1):61–67.
12.
Wolska O, Zaborowska-Sapeta K, Kiebzak W, Kowalski IM, Torres MAT. Seniors rehabilitation – clinical implications and therapy planning. Pol Ann Med. 2009;16(1):148–159.
13.
Ziaja K, Urbanek T, Kostyra J, Kucharzewski M, Glanowski M, Kuczmik W, et al. Leczenie zakażeń protez naczyniowych w odcinku aortalno-biodrowym [Management of infected vascular prostheses in the aorto-iliac segment]. Chir Pol. 2006;8(1):1–10 [in Polish].
14.
Zieliński M, Pukacki F. Epidemiologia i ekonomia zakażeń chirurgii naczyniowej [Epidemiology and economy of infections in vascular surgery]. In: Pukacki F, Chęciński P, eds. Zakażenia protez naczyniowych [Infections of Vascular Prostheses]. Warszawa: Fundacja Polski Przegląd Chirurgiczny; 2005: 9–10 [in Polish].