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Prosthetic Graft Infections Involving the Femoral Artery - Ten Year Experience
Jeffrey J. Siracuse, M.D., Marc L. Schermerhorn, M.D., Prathima Nandivada, M.D., Kristina A. Giles, M.D., Allen D. Hamdan, M.D., Mark C. Wyers, M.D., Elliot L. Chaikof, M.D., Ph.D., Frank B. Pomposelli, M.D..
Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.


Objectives:
Prosthetic graft infection is a major and feared complication of peripheral vascular surgery. We set forth to investigate our institution’s experience for bypasses involving the femoral artery.
Methods: A retrospective cohort single institution review of prosthetic bypass grafts involving the femoral artery from 2001-2010 looked at patient demographics, BMI, comorbidities, indications, location of bypass, type of prosthetic material, case urgency, previous ipsilateral bypasses or percutaneous interventions, and evaluated mortality, amputations, and graft infections.
Results: There were 421 prosthetic grafts identified. The graft infection rate was 4.3% with a median post-operative time to presentation of 90 days. Multivariate analysis shows that redo bypass (OR 5.6, 95% CI 2.2-14.6), active infection at time of bypass (OR 4.8, 95% CI 1.7-13.1), female gender (OR 4.2, 95% CI 1.5-12.0), and diabetes (OR 3.9, 95% CI 1.3-12.1) were significant predictors of graft infection. Redo bypasses made up 55% of graft infections. Graft infection was predictive of major lower extremity amputation (OR 10.6, 95% CI 3.7-30.2), as were concurrent bypass (OR 4.2, 95% CI 1.2-15.1) and preoperative tissue loss (OR 3.8, 95% CI 1.5-9.7). Graft infection did not predict mortality, however chronic renal insufficiency (OR 2.2, 95% CI 1.5-3.1), tissue loss (OR 1.4, 95% CI 1.0-1.9), and age (OR 1.2, 95% CI 1.1-1.4) were predictive. Infected grafts were removed 77% of the time. S. epidermidis (39%) and Methicillin-sensitive S. aureus (28%) were the most common pathogens isolated.
Conclusion: Redo, female, diabetic, and patients with an active infection are at a higher risk for graft infection and therefore higher rates of major extremity amputation, but are not at increased risk of mortality. Alternate sources of vein and endovascular interventions should be used when available in high risk patients.


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