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Ann Vasc Surg. 2015 Apr;29(3):607-15. doi: 10.1016/j.avsg.2014.11.001. Epub 2014 Nov 26.

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

Author information

1
Division of Vascular Surgery, S. Carlo Borromeo Hospital, Milan, Italy.
2
Division of Vascular Surgery, S. Carlo Borromeo Hospital, Milan, Italy. Electronic address: amsettembrini@gmail.com.
3
Division of Vascular Surgery, S. Carlo Borromeo Hospital, Milan, Italy; Chair of Vascular Surgery, Università di Milano, Milan, Italy.

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.

PMID:
25433279
DOI:
10.1016/j.avsg.2014.11.001
[Indexed for MEDLINE]

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