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Abstract

Purpose

To report an initial experience and midterm results of a novel hybrid technique (EndoVAC) combining stent-grafts, surgical revision, and vacuum-assisted wound closure (VAC).

Methods

All 10 patients (5 men; mean age 62 years) treated with the EndoVAC technique for infected vascular reconstructions (5 carotid, 4 femoral) or access sites (1 femoral and 1 brachial artery) between November 2007 and June 2010 were retrospectively reviewed. Follow-up included laboratory investigations, duplex ultrasonography, and imaging.

Results

VAC therapy was applied for a median 15 days (range 9–54). Three complications occurred: a watershed infarction (dysphasia), a transient hypoglossal nerve palsy, and a late stent-graft thrombosis. Two patients died during treatment but with local infection under control. Over a median follow-up of 11 months (range 1–33), no recurrent infection was noted after healing of the skin in any of the 8 survivors.

Conclusion

The EndoVAC technique seems to be a promising option for treatment of infected vascular reconstructions in selected cases.

Keywords

infected grafts access site infection hybrid technique stent-graft vacuum-assisted wound closure

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References

Szilagyi

Smith

Elliott

. Infection in arterial reconstruction with synthetic grafts. Ann Surg. 1972;176:321–333.

Liekweg

Greenfield

. Vascular prosthetic infections: collected experience and results of treatment. Surgery. 1977;81:335–342.

Yeager

McConnell

Sasaki

. Aortic and peripheral prosthetic graft infection: differential management and causes of mortality. Am J Surg. 1985;150:36–43.

Kikta

Goodson

Bishara

. Mortality and limb loss with infected infrainguinal bypass grafts. J Vasc Surg. 1987;5:566–571.

Zacharoulis

Gupta

Seymour

. Use of muscle flap to cover infections of the carotid artery after carotid endarterectomy. J Vasc Surg. 1997;25:769–773.

Colwell

Donaldson

Belkin

. Management of early groin vascular bypass graft infections with sartorius and rectus femoris flaps. Ann Plast Surg. 2004;52:49–53.

Morasch

Sam

Kibbe

. Early results with use of gracilis muscle flap coverage of infected groin wounds after vascular surgery. J Vasc Surg. 2004;39:1277–1283.

Shermak

Yee

Wong

. Surgical management of groin lymphatic complications after arterial bypass surgery. Plast Reconstr Surg. 2005;115:1954–1962.

Herrera

Kohanzadeh

Nasseri

. Management of vascular graft infections with soft tissue flap coverage: improving limb salvage rates–a veterans affairs experience. Am Surg. 2009;75:877–881.

10.

Nordmyr

Svensson

Bjorck

. Vacuum assisted wound closure in patients with lower extremity arterial disease. The experience from two tertiary referral centres. Int Angiol. 2009;28:26–31.

11.

Dosluoglu

Loghmanee

Lall

. Management of early (<30 day) vascular groin infections using vacuum-assisted closure alone without muscle flap coverage in a consecutive patient series. J Vasc Surg. 2010;51:1160–1166.

12.

El-Sabrout

Reul

Cooley

. Infected postcarotid endarterectomy pseudoaneurysms: retrospective review of a series. Ann Vasc Surg. 2000;14:239–247.

13.

Rizzo

Hertzer

O'Hara

. Dacron carotid patch infection: a report of eight cases. J Vasc Surg. 2000;32:602–606.

14.

Naylor

Payne

London

. Prosthetic patch infection after carotid endarterectomy. Eur J Vasc Endovasc Surg. 2002;23:11–16.

15.

Rockman

Domenig

. Postoperative infection associated with polyester patch angioplasty after carotid endarterectomy. J Vasc Surg. 2003;38:251–256.

16.

Asciutto

Geier

Marpe

. Dacron patch infection after carotid angioplasty. A report of 6 cases. Eur J Vasc Endovasc Surg. 2007;33:55–57.

17.

Krishnan

Clowes

. Dacron patch infection after carotid endarterectomy: case report and review of the literature. Ann Vasc Surg. 2006;20:672–677.

18.

Knight

Tait

. Dacron patch infection following carotid endarterectomy: a systematic review of the literature. Eur J Vasc Endovasc Surg. 2009;37:140–148.

19.

Calligaro

Veith

Schwartz

. Selective preservation of infected prosthetic arterial grafts. Analysis of a 20-year experience with 120 extracavitary-infected grafts. Ann Surg. 1994;220:461–471.

20.

Perler

Kolk

Manson

. Rotational muscle flaps to treat localized prosthetic graft infection: long-term follow-up. J Vasc Surg. 1993;18:358–365.

21.

Graham

Omotoso

Hudson

. The effectiveness of muscle flaps for the treatment of prosthetic graft sepsis. Plast Reconstr Surg. 2002;109:108–115.

22.

Seify

Moyer

Jones

. The role of muscle flaps in wound salvage after vascular graft infections: the Emory experience. Plast Reconstr Surg. 2006;117:1325–1333.

23.

Svensson

Monsen

Kolbel

. Predictors for outcome after vacuum assisted closure therapy of peri-vascular surgical site infections in the groin. Eur J Vasc Endovasc Surg. 2008;36:84–89.

24.

Domingos Hadamitzky

Schulte

Horsch

. Vacuum assisted wound closure in postoperative periprosthetic groin infections: a new gold standard? J Cardiovasc Surg (Torino). 2007;48:477–483.

25.

Sorelius

Mani