[Vascular graft-associated infection: successful management without graft removal]. / Infección asociada a prótesis vascular: manejo exitoso sin retirada de prótesis.

INTRODUCTION: Removal of graft with intravenous antibiotics is traditionally considered the most effective treatment of vascular graft-associated infections. However, an increasing number of reports suggests that this complication can be effectively treated without graft removal. METHODS: A prospective study to evaluate the outcome of conservative management of vascular graft-associated infection seen in our center was performed. The diagnosis of graft-associated infection was based on microbiological tests, and imaging studies. In our study, patients were hemodynamically stable with functioning vascular graft as per clinical and imaging evaluations. Conservative management included antibiotic treatment and local debridement without removal of vascular graft. RESULTS: Fourteen patients with vascular graft-associated infection were enrolled in our study. Eleven out of 14 patients (78.6%) responded successfully to conservative management. Treatment failure was reported in 3 patients, 2 of whom required graft removal. After a two-year follow-up, these 14 patients were clinically stable without recurrence of infection. CONCLUSIONS: Our study has revealed that conservative management of vascular graft-associated infection seems to be effective and should be considered in hemodynamically stable patients with functioning vascular graft.

Infección asociada a prótesis vascular: manejo exitoso sin retirada de prótesis / Vascular graft-associated infection: successful management without graft removal

Introducción. La retirada de prótesis con administración de antibióticos endovenosos es tradicionalmente considerada la forma más efectiva para tratar las infecciones asociadas a prótesis vasculares, sin embargo, un incrementado número de trabajos sugieren que esta complicación puede ser efectivamente tratada sin retirar la prótesis. Métodos. Se realiza un estudio prospectivo para evaluar la evolución de manejo conservador de infecciones asociadas a prótesis vasculares vistas en nuestro centro. El diagnóstico de infección asociada a prótesis fue basada en pruebas microbiológicas y en estudios de imagen. En nuestro estudio, los pacientes estuvieron hemodinámicamente estables con buen funcionamiento del injerto demostrado por evaluaciones clínicas y pruebas de imagen. El manejo conservador incluyó tratamiento antibiótico y desbridamiento local sin retirada de la prótesis vascular. Resultados. Incluimos a 14 pacientes con infección asociada a injerto vascular en nuestro estudio. Once de los 14 pacientes (78,6%) respondieron exitosamente al manejo conservador. Observamos fallo en el tratamiento en tres pacientes, dos de los cuales requirieron retirada del injerto. Después de un seguimiento de dos años, todos estos pacientes permanecen estables clínicamente y sin recidiva de la infección. Conclusiones. Como conclusión, nuestro estudio revela que el manejo conservador de prótesis vasculares infectadas parece ser eficaz y debería ser considerado en los pacientes estables hemodinámicamente con buen funcionamiento de la prótesis (AU)

Introduction. Removal of graft with intravenous antibiotics is traditionally considered the most effective treatment of vascular graft-associated infections. However, an increasing number of reports suggests that this complication can be effectively treated without graft removal. Methods. A prospective study to evaluate the outcome of conservative management of vascular graft-associated infection seen in our center was performed. The diagnosis of graft-associated infection was based on microbiological tests, and imaging studies. In our study, patients were hemodynamically stable with functioning vascular graft as per clinical and imaging evaluations. Conservative management included antibiotic treatment and local debridement without removal of vascular graft. Results. Fourteen patients with vascular graft-associated infection were enrolled in our study. Eleven out of 14 patients (78.6%) responded successfully to conservative management. Treatment failure was reported in 3 patients, 2 of whom required graft removal. After a two-year follow-up, these 14 patients were clinically stable without recurrence of infection. Conclusions. Our study has revealed that conservative management of vascular graft-associated infection seems to be effective and should be considered in hemodynamically stable patients with functioning vascular graft (AU)