Use of ultrasound debridement as an adjunctive tool for treating infected prosthetic vascular grafts in the lower extremities

Michele Carmo, Daniela Mazzaccaro, Iacopo Barbetta, Alberto M. Settembrini, Sergio Roveri, Miriam Fumagalli, Luca Tassinari, Piergiorgio G. Settembrini

Research output: Contribution to journalArticle

Abstract

Background To evaluate the role of an ultrasound (US) debridement system to treat conservatively patients with poor medical conditions who presented with infection of a prosthetic vascular graft in the lower extremities. Methods Data of all patients who underwent debridement of the grafts and/or surrounding tissue using an ultrasonic generator (Genera, Italia Medica, Milan, Italy) were recorded and retrospectively reviewed. Based on cultures, patients received specific antibiotic therapy. Partial graft removal, sartorius muscle flap rotation, or negative pressure wound treatment (NPWT) was selectively used. Early and late morbidity and mortality and recurrence were analyzed. Results Thirteen patients (median age, 72 years; range, 57-92 years; 8 men) were treated (12 Szilagyi grade III and 1 grade II infections) with US debridement without removing the graft (8 cases) or with partial excision and "in situ" reconstruction with a silver prosthetic graft (5 cases). Sartorius flap rotation was associated in 6 and NPWT in 1 case. One patient died perioperatively because of pulmonary edema because of sepsis secondary to treatment failure. Estimated freedom from reinfection was 90.9 ± 9% at 6 months and 77.9 ± 14% at 1 and 2 years. Estimated limb survival was 78.7 ± 13% at 6 months, 65.6 ± 16% at 1 year, and 52.5 ± 18% at 2 years. Conclusions US debridement proved to be a valuable aid in the treatment of patients with infected grafts and poor medical conditions. Used in conjunction with antibiotics, it allowed us to be more conservative without compromising the chance of success.

Original languageEnglish
Pages (from-to)607-615
Number of pages9
JournalAnnals of Vascular Surgery
Volume29
Issue number3
DOIs
Publication statusPublished - Apr 1 2015

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

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