Tratamento híbrido para revascularização de membro inferior em paciente com infecção de prótese vascular: relato de caso / Hybrid treatment for lower limb revascularization in a patient with vascular graft infection: a case report

Resumo Pacientes portadores de doença arterial obstrutiva periférica com isquemia crítica do membro associada a infecção de prótese vascular apresentam elevadas taxas morbimortalidade e alto risco de perda do membro. Apresentamos o caso de um paciente masculino de 76 anos com isquemia crítica do membro inferior esquerdo associada a infecção de prótese vascular femoropoplítea. Utilizamos abordagem híbrida para o tratamento com acesso cirúrgico das regiões inguinais e poplíteas, sendo a prótese vascular utilizada como acesso endovascular para recanalização direta da artéria femoral superficial devido a obstrução longa e extensa calcificação, que impediram as tentativas iniciais de tratamento endovascular. Após a recanalização endovascular, a prótese infectada foi retirada. O avanço das técnicas e materiais endovasculares em associação com a cirurgia aberta permitem novas soluções para pacientes quando os procedimentos habituais falham.

Abstract Patients with severe arterial obstructive disease and critical limb ischemia associated with vascular graft infection have elevated morbidity and mortality rates and are at high risk of limb loss. We present the case of a 76-year-old male patient with left lower limb critical ischemia and a femoropopliteal vascular graft infection. We used a hybrid treatment approach with an open surgical approach to the inguinal and popliteal regions and used the vascular prosthesis as endovascular access for direct recanalization of the superficial femoral artery, because the long occlusion and extensive calcification had frustrated initial attempts at endovascular treatment. After endovascular recanalization, the infected graft was removed. Used in conjunction with open surgery, advances in endovascular techniques and materials offer new solutions for patients when usual procedures fail.

Endovascular treatment of coarctation of the aorta with a self-expanding endoprosthesis: how i do it using the braile dominus ® coarctation aorta device

Abstract The coarctation of the aorta is a relatively highly prevalent congenital heart disease and may be diagnosed as an underline cause of hypertension in adolescents and adults. The gold standard treatment for coarctation of the aorta in these patients is being replaced - from open surgery to endovascular therapy. Some prostheses have been developed to treat the coarctation with less acute and chronic complications. The Dominus® Coarctation Aorta (Braile Biomédica) is the first self-expandable prosthesis created specifically to treat coarctation of the aorta, reducing possible acute complications, like aortic rupture or aortic dissection. Here, we discuss the step-by-step method for using this prosthesis.

Hemorragia digestiva masiva por fístulas secundarias de grandes vasos al tracto digestivo / Massive digestive hemorrhage from secondary fistulas of great vessels to the digestive tract

RESUMEN La formación de una fístula entre arterias de gran calibre y el tubo digestivo es una complicación infrecuente de la cirugía reconstructiva de los grandes vasos sanguíneos secundario al uso de prótesis vasculares, los cuales se manifiestan con hemorragias masivas con elevada mortalidad. Presentamos dos casos de fístula aorto-entérico y de fístula carotideo-esofágico que comparten características comunes como la manifestación clínica de hemorragia digestiva masiva y mortal en pacientes con antecedentes de colocación de prótesis vasculares.

ABSTRACT The formation of a fistula between large caliber arteries and the digestive tract is an uncommon complication of reconstructive surgery of the large vessels secondary to the use of vascular prostheses, which manifest themselves with massive hemorrhages with high mortality. We report two cases of aorto-enteric fistula and carotid-esophageal fistula that share common characteristics such as the clinical manifestation of massive and fatal gastrointestinal bleeding in patients with a history of vascular prosthesis placement.

Dilatation of common iliac arteries after endovascular infrarenal abdominal aortic repair with bell-bottom extension

Abstract Objective: Endovascular techniques to treat abdominal aortic aneurysms results in lower morbidity and mortality rates. However, dilation of the common iliac arteries prevents adequate distal sealing, which compromises the procedure success. The aim of this study is report the long-term outcomes of patients with abdominal aortic aneurysms associated with aneurysm of the common iliac artery following endovascular repair using a bifurcated bell-bottom stent graft. Methods: This is a retrospective study that evaluated patients treated with bifurcated bell-bottom extension stent grafts to repair an infrarenal abdominal aortic aneurysm and who had at least one common iliac artery with dilatation > 1.5 cm for at least 12 months after the endovascular intervention. Results: Thirty-eight patients with a mean age of 70.4±8.2 years were included. Stent graft placement was followed by dilation of the common iliac artery aneurysms in 35.3% of cases; endoleak and reoperation rates were 17.6% and 15.7%, respectively. Younger patients showed a higher rate of artery diameter increase following the procedure. The average arterial dilation was 16% in the first year, 29% in the second year, 57% in the third year and 95% from the fourth year until the end of follow-up. Conclusion: Repair of infrarenal abdominal aortic aneurysms with bifurcated bell-bottom type stents when there is common iliac artery dilation is a good therapeutic option to preserve hypogastric flow. The rate of endoleak was 17.6%, and 15.7% of cases required reoperation. Younger patients are more likely to experience dilation of the common iliac artery after the procedure.

Lyophilized allografts without pre-treatment with glutaraldehyde are more suitable than cryopreserved allografts for pulmonary artery reconstruction

Various methods are available for preservation of vascular grafts for pulmonary artery (PA) replacement. Lyophilization and cryopreservation reduce antigenicity and prevent thrombosis and calcification in vascular grafts, so both methods can be used to obtain vascular bioprostheses. We evaluated the hemodynamic, gasometric, imaging, and macroscopic and microscopic findings produced by PA reconstruction with lyophilized (LyoPA) grafts and cryopreserved (CryoPA) grafts in dogs. Eighteen healthy crossbred adult dogs of both sexes weighing between 18 and 20 kg were used and divided into three groups of six: group I, PA section and reanastomosis; group II, PA resection and reconstruction with LyoPA allograft; group III, PA resection and reconstruction with CryoPA allograft. Dogs were evaluated 4 weeks after surgery, and the status of the graft and vascular anastomosis were examined macroscopically and microscopically. No clinical, radiologic, or blood-gas abnormalities were observed during the study. The mean pulmonary artery pressure (MPAP) in group III increased significantly at the end of the study compared with baseline (P=0.02) and final [P=0.007, two-way repeat-measures analysis of variance (RM ANOVA)] values. Pulmonary vascular resistance of groups II and III increased immediately after reperfusion and also at the end of the study compared to baseline. The increase shown by group III vs group I was significant only if compared with after surgery and study end (P=0.016 and P=0.005, respectively, two-way RM ANOVA). Microscopically, permeability was reduced by ≤75% in group III. In conclusion, substitution of PAs with LyoPA grafts is technically feasible and clinically promising.

Infecção em endoprótese / Stent graft infection

A infecção envolvendo endopróteses é uma complicação pouco frequente, associada a elevadas taxas de mortalidade. A apresentação clínica é geralmente tardia, podendo variar de sintomas inespecíficos até complicações graves como pseudoaneurisma e fístula aortoentérica. O diagnóstico envolve alto índice de suspeição e investigação com exames de imagem e laboratoriais. O tratamento segue os preceitos da infecção de prótese em cirurgia convencional, indicando-se, para a maioria dos pacientes, a excisão cirúrgica acompanhada da revascularização in situ ou extra-anatômica. O tratamento conservador fica reservado para casos selecionados.

Infection involving stent grafts is an infrequent complication associated with high mortality rates. The clinical presentation is usually delayed and it may vary from nonspecific symptoms to severe complications such as pseudoaneurysm and aorto-enteric fistula. The diagnosis involves a high index of suspicion and investigation with imaging and laboratory exams. The treatment follows the precepts of graft infection in conventional surgery, and surgical excision is recommended for most patients, followed by in situ or extra-anatomic revascularization. Conservative treatment is reserved for selected cases.

In situ reconstruction with bovine pericardial tubular graft for aortic graft infection / Reconstrução in situ de enxerto de pericárdio devido à infecção de enxerto aórtico

Prosthetic graft infection is a serious complication of abdominal aorta surgery. Its removal is always indicated because it prevents potential significant complications, but reconstruction is a technical challenge. The authors present a case of an in situ reconstruction with corrugated bovine pericardial tubular graft.

A infecção de um enxerto é uma complicação séria em cirurgia de aorta abdominal. A remoção deste enxerto é uma indicação obrigatória devido às potenciais e graves complicações. Entretanto, sua reconstrução é uma técnica complexa e, ao mesmo tempo, desafiadora. Os autores apresentam um caso de reconstrução in situ utilizando um enxerto tubular de pericárdio bovino corrugado.

Urological complication following aortoiliac graft: case report and review of the literature / Complicação urológica após enxerto aorto-ilíaco: relato de caso e revisão de literatura

CONTEXT: Ureteral stenosis and ureterohydronephrosis may be serious complications of aortoiliac or aortofemoral reconstructive surgery. CASE REPORT: A 62-year-old female patient presented with a six-month history of left lumbar pain. She was a smoker, and had mild chronic arterial hypertension and Takayasu arteritis. She had previously undergone three vascular interventions. In two procedures, Dacron prostheses were necessary. Excretory urography showed moderate left ureterohydronephrosis and revealed a filling defect in the ureter close to where the iliac vessels cross. This finding was compatible with ureteral stenosis, and the aortoiliac graft may have been the reason for this inflammatory process. The patient underwent laparotomy, which showed that there was a relationship between the ureteral stenosis and the vascular prosthesis. Segmental ureterectomy and end-to-end ureteroplasty with the ureter crossing over the prosthesis anteriorly were performed. There were no complications. The early and late postoperative periods were uneventful. The patient evolved well and the results from a new excretory urogram were normal. We concluded that symptomatic ureterohydronephrosis following aortoiliac graft is a real complication and needs to be quickly diagnosed and treated by urologists.

INTRODUÇÃO: Estenose ureteral e ureterohidronefrose podem ser sérias complicações da cirurgia reconstrutiva aorto-femoral ou aorto-ilíaca. RELATO DE CASO: Uma paciente de 62 anos apresentou-se referindo história de dor lombar a esquerda há seis meses. Ela era fumante, portadora de hipertensão arterial crônica leve e arterite de Takayasu. Havia sido submetida a três intervenções vasculares. Em dois procedimentos o uso de prótese de Dacron foi necessário. Uma urografia excretora revelou moderada ureterohidronefrose à esquerda e falha de enchimento no ureter próximo ao cruzamento dos vasos ilíacos. Esse achado era compatível com uma estenose ureteral e o enxerto aorto-ilíaco poderia ser a causa do processo inflamatório. A paciente foi submetida a laparotomia, que evidenciou a relação entre estenose ureteral e a prótese vascular. Ureterectomia segmentar e uretroplastia término-terminal com o ureter passando anteriormente à prótese foram realizadas. Não ocorreram complicações. Os períodos de pós-operatório precoce e tardio transcorreram sem intercorrências. A paciente evoluiu bem e uma nova urografia excretora apresenta-se normal. Concluímos que ureterohidronefrose sintomática após enxerto aorto-ilíaco é uma complicação real e precisa ser rapidamente diagnosticada e tratada pelo urologista.

O stent descoberto não promove reações em artérias renais e parênquima renal em suínos / Uncovered stent does not provoke reactions in renal arteries and renal parenchyma in swines

OBJETIVO: Avaliar as alterações histológicas da aorta, artéria renal e parênquima renal, em suínos, induzidos pelo stent metálico descoberto implantado em localização transrenal na aorta abdominal. MÉTODOS: Foram utilizados 10 suínos com peso médio de 86,6 quilos e idade média de 6 meses, submetidos a implante de stent metálico posicionado na aorta, no nível das artérias renais, após 100 dias do implante. Os stents foram liberados por auto-expansão com laparotomia. Foram realizadas análises anatômicas e histológicas da aorta abdominal, artérias renais e parênquima renal. Os cortes histológicos foram realizados nos seguintes locais: 1) transição entre a aorta normal e aorta contendo stent; 2) porção contendo os óstios das artérias renais, 3) parênquima renal. As lâminas foram coradas pela técnica da hematoxilina e eosina e analisadas conforme protocolo de análise histológica aplicada na prática clínica dos laboratórios de patologia. RESULTADOS: Os achados macroscópicos revelaram espessamento da parede aórtica; artérias renais pérvias; estrutura anatômica renal normal. Análises microscópicas, próximas aos stents, evidenciaram espessamento da parede vascular, artérias renais sem alterações e parênquima renal preservado. CONCLUSÃO: O stent de aço inoxidável descoberto produziu importante reação inflamatória com espessamento da parede da aorta. No entanto, as artérias renais permaneceram pérvias e o parênquima renal sem alterações isquêmicas ou embólicas.

OBJECTIVE: To assess the histological changes of the aorta, the renal arteries and the renal parenchyma in swine, induced by a metalic uncovered stent implanted in transrenal position in the abdominal aorta. METHODS: Ten pigs with a mean weight of 86.6 kg and mean age of 6 months underwent implantation of metal stent graft placed in the aorta at the level of the renal arteries after 100 days of implantation. The self-expanding stents were released by laparotomy. Anatomic and histological analyses of the abdominal aorta, the renal arteries and the renal parenchyma were performed. Histological slices were performed in the following sites: 1) transitional zone between the aorta with and without stent graft; 2) portion of the renal arteries ostia; 3) renal parenchyma. The slices were stained through the hematoxylin and eosin stain technique and analyzed according the protocol of histological analyses applied in the clinical practice of pathology labs. RESULTS: The macroscopic findings showed thickening of the aortic wall; patent renal arteries; and normal anatomic renal structures. Microscopic analyses, close to the stents, showed thickening of the vascular wall, renal arteries without changes, and preserved renal parenchyma. CONCLUSION: The uncovered stainless steel stent caused a significant inflammatory reaction with thickening of the aortic wall. However, the renal arteries remained patent and the renal parenchyma did not present embolic or ischemic changes.

Stent thrombosis.

Technology of drug-eluting stent (DES) implantation is relatively young. DES have remarkably reduced the incidence of stent-restenosis (SRS) and the need for target vessel revascularization (TVR). Yet it has added a small but significant risk of late and very late stent thrombosis (ST). The incidence of ST varies between 0.3-2.8% with a mean of 1.3%. ST occurs both with bare-metal stents (BMS) and drug-eluting stents (DES) but the time course differs with an excess of ST in the first six months of implantation with BMS while the number of ST is more with DES after 6 months of implantation. Despite this difference, there are no overall differences between BMS and DES regarding the end points of death or myocardial infarction (MI) on long term (3-5 years) follow-up. Endothelial dysfunction and incomplete neointimal coverage of stent strut remain the basic underlying mechanisms responsible for ST in DES. Stent thrombosis, though infrequent, is a dreadful condition. Over 30% may die suddenly. 60% develop massive MI with cardiogenic shock, poor LVEF and serious arrhythmias. The beneficial effects of primary percutaneous intervention (PCI) for ST are not spectacular, and TIMI flow grade III, is achieved in less than 80% cases, while distal embolization and residual dissection of coronary artery are frequently encountered. Proper selection and optimization of stent with prolonged dual antiplatelet therapy may prevent the undesirable stent thrombosis after DES implantation.

Niveles séricos de Apo-AI y Apo-B como indicadores de estenosis de injerto sintético después de bypass arterial en enfermedad arterial periférica / Serum levels of Apo-AI and B as markers of synthetic graft stenosis after bypass for peripheral artery disease

BACKGROUND: Hyperlipidemias are the main risk factors for atherosclerosis and cardiovascular disease. Nevertheless, the protein fractions of these lipids such as apolipoprotein B (Apo-B) can lead to arterial obstruction. In this study we investigated levels of apolipoproteins AI and B in patients with chronic occlusive peripheral arterial disease (PAD) of the lower extremities and their association with either patency or stenosis of synthetic grafts. METHODS: This cohort study included 24 patients with chronic occlusive PAD who underwent infrainguinal revascularization with polytetrafluoroethylene (PTFE) synthetic graft. Patients were divided into two groups according to whether or not they were exposed to Apo-B, thus integrating two cohorts: the unexposed group (group 1, normal levels of Apo-B) and the exposed group (group 2, high levels of Apo-B). Variables investigated at 3, 6 and 12 months included arm/ankle index (AAI) and its association with levels of Apo-AI and Apo-B, and levels of cholesterol, triglycerides, and fibrinogen. RESULTS: The study was comprised of 67% men and 33% women. Average age was 65.2 +/- 8.4 years. There was a correlation between AAI and high levels of Apo-B (p <0.001). Apo-AI levels were not significantly different between groups. Fibrinogen remained elevated in both groups with no statistical difference. Triglycerides demonstrated a significant difference between groups in basal measurements (p <0.05). Cholesterol remained normal in both groups without statistical difference. CONCLUSIONS: This study demonstrates that patients exposed to high levels of Apo-B had synthetic graft failure (obstruction), as demonstrated by AAI <1.

Derivação arterial extra-anatômica no segmento aorto-ilíaco: experiência de 15 anos / Extra-anatomical arterial bypass of the aortoiliac segment: 15-year experience / Extra-anatomical arterial bypass of the aortoiliac segment: 15-year experience

RESUMO CONTEXTO: As derivações extra-anatômicas, sendo procedimentos cirúrgicos alternativos à cirurgia clássica, têm como principal objetivo simplificar um procedimento de grande porte como a restauração aorto-femoral. OBJETIVOS: Analisar os resultados a longo prazo das derivações extra-anatômicas no segmento aorto-ilíaco. MÉTODOS: Estudo longitudinal retrospectivo envolvendo 79 derivações extra-anatômicas no segmento aorto-ilíaco, realizadas em 75 pacientes, no período de dezembro de 1991 a dezembro de 2006. RESULTADOS: Média de idade foi 64,2 anos, com predominância pelo gênero masculino (64 por cento). A isquemia crítica foi a responsável pela maioria das indicações cirúrgicas (86,1 por cento) e a derivação ilíaco-femoral cruzada representou 41,8 por cento dos casos. Em cinco anos, as taxas de mortalidade geral, perviedade e salvamento do membro foram, respectivamente, de 28 por cento; 70,3 por cento e 67,6 por cento em cinco anos. CONCLUSÕES: As derivações extra-anatômicas devem permanecer como cirurgias alternativas, pois apresentam taxas de perviedade inferiores aos procedimentos que seguem as vias anatômicas naturais além de morbimortalidade considerável. Entretanto, são procedimentos importantes nos casos em que a limitação de ordem clínica ou de natureza local torna difícil ou impede a revascularização por via anatômica. As derivações cruzadas apresentaram perviedade superior às derivações axilo-femorais e as ilíaco-femorais cruzadas revelaram a maior perviedade entre todas (77,3 por cento em cinco anos).

BACKGROUND: Extra-anatomical bypass, which is an alternative procedure to classical surgery, aims at simplifying a complex procedure such as aortoiliac reconstruction. OBJECTIVES: To analyze long-term outcomes of extra-anatomical bypass of the aortoiliac segment. METHODS: Longitudinal retrospective study including 79 extra-anatomical bypasses of the aortoiliac segment, performed in 75 patients between December 1991 and December 2006. RESULTS: Mean age was 64.2 years, and male gender was predominant (64 percent). Critical ischemia accounted for most indications for surgery (86.1 percent); crossover iliofemoral bypass represented 41.8 percent of all procedures. Mortality, patency and limb salvage rates were 28, 70.3 and 67.6 percent, respectively, at five years. CONCLUSIONS: Extra-anatomical bypasses should remain as alternative procedures because of their lower patency rates in comparison to anatomic procedures and considerable morbidity and mortality rates. However, they are important procedures when anatomic revascularization cannot be accomplished due to clinical and local limitations. Crossover bypasses demonstrated better patency rates than axillofemoral bypasses, and crossover iliofemoral bypasses showed the best patency rates of all (77.3 percent at five years).

Infecção de prótese vascular em cirurgia da aorta torácica: revisão da experiência e relato de caso tratado por técnica não convencional / Vascular prosthesis infection in thoracic aorta surgery: review of the experience and a case report illustrating treatment with an unconventional technique

Relatamos o caso de uma paciente de 37 anos de idade, que há cinco anos havia sido submetida à operação de Bental-de Bono em nosso serviço e retornou com dor de forte intensidade no toráx, sendo diagnosticada dissecção aguda de aorta do tipo III e tratada clinicamente. Um ano após esse episódio houve expansão dessa dissecção e a paciente foi submetida à cirurgia com interposição de prótese de dacron em aorta descendente. No pós-operatório imediato houve broncopneumonia esquerda e a paciente recebeu alta em boas condições e afebril. Após um mês da alta, retornou com febre e toxemia. Com diagnóstico de empiema pleural, foi submetida à toracotomia exploradora que não confirmou esse diagnóstico, havendo apenas intenso espessamento pleural. Quatro meses após a toracotomia exploradora, foram isolados Klebsiella pneumoniae e Enterobacter sp na hemocultura. A ressonância magnética revelou imagens compatíveis com infecção peri-prótese. Com esse quadro clínico e laboratorial foi indicada a remoção do enxerto e derivação axilo-bifemoral. A operação foi realizada com sucesso, a paciente recebeu alta em boas condições e continua fazendo controle ambulatorial e, atualmente, encontra-se com 57 meses de evolução sem complicações. São discutidos os métodos empregados para o diagnóstico e tratamento da infecçào de prótese na cirurgia da aorta torácica.

Uma mudança no tratamento dos aneurismas da aorta abdominal / A change in the treatment of abdominal aortic aneurysms

OBJECTIVE: One of the most exciting potential applications of percutaneous therapy is the treatment of abdominal aneurysms. METHODS: Of 230 patients treated with a self-expanding polyester-lined stent-graft for different aortic pathologies at our institution, we selected 80 abdominal aneurysm cases undergoing treatment (from May 1997 to December 2002). The stent was introduced through the femoral artery, in the hemodynamic laboratory, with the patient under general anesthesia, with systemic heparinization, and induced hypotension. RESULTS: The procedure was successful in 70 (92.9 percent) cases; 10 patients with exclusion of abdominal aortic aneurysms were documented immediately within the hemodynamic room and 5 patients persisted with a residual leak. Two surgical conversions were necessary. Additional stent-grafts had to be inserted in 3 (3.7 percent) cases. In the follow-up, 91.4 percent of patients were alive at a mean follow-up of 15.8 months. CONCLUSION: We believe that stent-grafts are an important tool in improving the treatment of abdominal aneurysms, and this new policy may change the conventional medical management of these patients

Avaliação ecocardiográfica prospectiva de pacientes submetidos ao fechamento percutâneo de canal arterial / Prospective echocardiographic evaluation of patients after percutaneous closure of patent arterial duct

Foram estudados evolutivamente pelo ecocardiograma com Doppler 84 pacientes submetidos ao fechamento percutâneo do canal arterial com molas, visando à avaliação da efetividade do procedimento e possíveis complicações. Houve forte correlação entre as medidas do canal obtidas pela angiografia e pelo ecocardiograma. Ocorreu redução progressiva dos diâmetros das cavidades esquerdas e do fluxo residual. Observou-se alta prevalência de protrusão da mola para a luz da artéria pulmonar esquerda, porém só houve associação com perfusão pulmonar esquerda alterada à cintilografia quando o índice da diferença das velocidades obtidas entre as artérias pulmonares e o tronco pulmonar ao Doppler foi > 50 por cento.Eight-four patients submitted to percutaneous closure of the arterial duct with coils were studied prospectively by Doppler ecocardiography, to evaluate the results of the procedure and potential complications. There was a strong correlation between ductal dimensions obtained by echo and by angiography. A progressive reduction of the left cardiac cavities' diameters and of the rate of residual shunt was demonstrated. A high prevalence of coil protrusion inside the left pulmonary artery was observed. However, an association with decreased left lung perfusion by scintigraphy was only detected when the index of the difference of velocities obtained at the pulmonary arteries and trunk was > 50 per cent...

Salvamento de membros na infecçäo de prótese vascular / Axillo-popliteal bypass: member salvation in prsthetic vascular graft infection

A infecção de próteses vasculares é um dos maiores desafios terapêuticos dentro da cirurgia vascular periférica, causando inúmeras dificuldades técnicas e altos índices de morbi-moralidade. Relata-se caso de paciente portador de enxerto aorto-bifemoral com infecção da prótese e oclusão das artérias femorais bilateralmente, que foi submetido a bypass axilo-poplíteo suprapatelar, com abordagem lateral da artéria poplítea

Factores de riesgo en la infección protésica vascular / Risk factors in vascular prothetic infections

Se realizó un estudio para identificar los factores de riesgo de las prótesis vasculares infectadas. Se llevó a cabo un análisis bioestadístico con la utilización del proceso de regresión logística, la prueba de chi-cuadrado y los cálculos para el riesgo relativo. Se logró identificar como factores de riesgo la trombectomía femoral posoperatoria por oclusión inmediata, la diabetes mellitus, la arteriografía por el método de Seldinger y la anastomosis femoral en la región inguinal. Estas variables se consideraron como independientes para la infección de las prótesis vasculares. En el análisis multivariado los 4 factores de riesgo detectados mostraron un riesgo relativo mayor que 1 con valores significativos (p < 0,05). En el análisis univariado se mantuvo la misma estructura de los factores de riesgo detectados y se comprobaron los mismos resultados estadísticos. Los resultados del estudio fueron los siguientes: prótesis infectadas 12/318 (3,8 porciento), anastomosis femorales 281/318 (88 porciento), diabéticos 12/318 (4 porciento), arteriografía femoral 39/318 (12 porciento), trombectomía femoral 23/318 (7 porciento), fístulas aorto-entéricas 2/318 (0,6 porciento), amputados por sepsis 1/318 (0,3 porciento) y mortalidad precoz por sepsis protésica 4/318 (1 porciento). Se coincidió con la literatura médica mundial consultada en cuanto al uso profiláctico de la antibioticoterapia. Se dan a conocer las principales medidas a tener en cuenta como profilaxis de la infección de una prótesis vascular