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Vascular Graft Infections: a Decade’s Clinical Experience in Indian Population

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Abstract

Vascular graft infection with its morbidity and mortality has tormented the world of vascular reconstruction overlong. India despite carrying a sizable burden of patients requiring vascular reconstruction has minimal research on the subject. We attempted to chronicle clinical profiles, symptom variability, risk factors, prophylactic measures, and various therapeutic options extended to patients with vascular graft infection, in this medical record-based case series analysis, of a decade (years 2010–2020), of patients presenting with vascular graft infections. Statistical comparison was done with chi-square and Fisher’s exact probability test. A total of 70 patients presented with vascular graft infection, 92.9% men and 7.1% women (mean age of 58 SD 11.8 years). Diabetes and coronary artery disease were the commonest comorbid conditions (24.7% each). The most common site of infection was the groin, and femoropopliteal bypass graft was the most infected segment (48.5%). The average time interval from index surgery to presentation with infection was 308 days. Early graft infection was seen in 60% patients, with extra-cavitary graft infections manifesting earlier than others. Local symptoms with discharging sinuses and cellulitis were common clinical presentations. Staphylococcus aureus was the commonest organism isolated (31.4%). A total of 58.5% patients underwent graft explantation and 40% were managed conservatively. Incidence of infection in patients who underwent immediate post-operative re-intervention was statistically significant when compared with Bunt’s classification (P value < 0.05). The distribution of incidence of post-operative infection differed significantly across various sites and the type of graft material used (P value < 0.05). Prosthetic vascular grafts provide unparalleled benefit to a patient in maintenance of life and limb. Our Indian experience of a decade when summed up reflects that extra-cavitary graft infections express early and anatomical predisposition of the groin makes femoropopliteal segment the worst affected in VGI. Remote infections and re-interventions are hidden caveats of VGI. Apt to say that “Aegrescit medendo”—“the cure is worse than the disease”—holds good for vascular graft infections.

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References

  1. Chakfé N, Diener H, Lejay A, Assadian O, Berard X, Caillon J, Fourneau I, Glaudemans AWJM, Koncar I, Lindholt J, Melissano G, Saleem BR, Senneville E, Slart RHJA, Szeberin Z, Venermo M, Vermassen F, Wyss TR, ESVS Guidelines Committee, de Borst GJ, Bastos Gonçalves F, Kakkos SK, Kolh P, Tulamo R, Vega de Ceniga M, Document Reviewers, von Allmen RS, van den Berg JC, Debus ES, Koelemay MJW, Linares-Palomino JP, Moneta GL, Ricco JB, Wanhainen A (2020) Editor’s Choice - European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the management of vascular graft and endograft infections. Eur J Vasc Endovasc Surg 59(3):339–384

    Article  Google Scholar 

  2. Gharamti A, Kanafani ZA (2018) Vascular graft infections: an update. Infect Dis Clin N Am 32(4):789–809

    Article  Google Scholar 

  3. DeBakey ME, Cooley DA, Crawford ES, Morris GC Jr (1958) Clinical application of a new flexible knitted Dacron arterial substitute. Am Surg 24:862–869

    CAS  Google Scholar 

  4. Kunlin J (1951) Le traitement de l'ischemic arteritique par la greffe veineuse longue. Rev Chir 70:206–236

    CAS  PubMed  Google Scholar 

  5. Bustos CA, García-Herrera CM, Celentano DJ (2016) Modelling and simulation of the mechanical response of a Dacron graft in the pressurization test and an end-to-end anastomosis. J Mech Behav Biomed Mater 61:36–44

    Article  CAS  Google Scholar 

  6. Anagnostopoulos A, Ledergerber B, Kuster SP, Scherrer AU, Näf B, Greiner MA, Rancic Z, Kobe A, Bettex D, Hasse B, VASGRA Cohort Study, Anagnostopoulos A, Bloemberg G, Eberhard N, Hasse B, Husman L, Keller P, Ledergerber B, Mayer D, Rancic Z, Scherrer A, Weber A, Weber R, Zbinden R, Zinkernagel A (2019) Inadequate perioperative prophylaxis and postsurgical complications after graft implantation are important risk factors for subsequent vascular graft infections: prospective results from the vascular graft infection cohort study. Clin Infect Dis 69(4):621–630

    Article  Google Scholar 

  7. Andercou O, Marian D, Olteanu G, Stancu B, Cucuruz B, Noppeney T (2018) Complex treatment of vascular prostheses infections. Medicine (Baltimore) 97(27):e11350

    Article  CAS  Google Scholar 

  8. Back MR (2019) Graft Infection. In: Sidway AN, Perler BA (eds) Rutherford’s vascular surgery and endovascular therapy, 9th edn. Elsevier, Philadelphia, pp 588–602

    Google Scholar 

  9. Samson RH, Veith FJ, Janko GS, Gupta SK, Scher LA (1988) A modified classification and approach to the management of infections involving peripheral arterial prosthetic grafts. J Vasc Surg 8(2):147–153

    Article  CAS  Google Scholar 

  10. Bunt TJ (1983) Synthetic vascular graft infections. Surgery 94(1):1–9

    CAS  PubMed  Google Scholar 

  11. Rosner B (2000) Fundamentals of biostatistics, 5th edn. Brooke/Cole Cengage Learning, Boston, pp 80–125

    Google Scholar 

  12. Riffenburg RH (2005) Statistics in medicine, 2nd edn. Elsevier, San Diego, pp 85–125

    Google Scholar 

  13. Sunder Rao P, Richard J (2006) An introduction to biostatistics, a manual for students in health sciences, 4th edn. Prentice hall of India, New Delhi, pp 86–160

    Google Scholar 

  14. Corfield L, Chan J, Chance T, Wilson N (2011) Early pyrexia after endovascular aneurysm repair: are cultures needed? Ann R Coll Surg Engl 93:111e3

    Article  Google Scholar 

  15. Szilagyi DE, Smith RF, Elliott JP et al (1972) Infection in arterial reconstruction with synthetic grafts. Presented at the Annual Meeting of the American Surgical Association, San Francisco, California, April 26-28

  16. Selvarajah S, Black JH 3rd, Malas MB, Lum YW, Propper BW, Abularrage CJ (2014) Preoperative smoking is associated with early graft failure after infrainguinal bypass surgery. J Vasc Surg 59(5):1308–1314

    Article  Google Scholar 

  17. Anagnostopoulos A, Ledergerber B, Kuster SP, Scherrer AU, Näf B, Zbinden R, Rancic Z, Bettex D, Lachat M, Hasse B (2017) Risk factors for incident vascular graft infections. Open Forum Infect Dis 4(Suppl 1):S653

    Article  Google Scholar 

  18. Ramachandran A, Snehalatha C, Vijay V (2004) Low risk threshold for acquired diabetogenic factors in Asian Indians. Diabetes Res Clin Pract 65(3):189–195

    Article  CAS  Google Scholar 

  19. Calligaro KD, Veith FJ, Schwartz ML, Savarese RP, DeLaurentis DA (1992c) Are gram-negative bacteria a contraindication to selective preservation of infected vascular grafts. J Vasc Surg 16:337–346

    Article  CAS  Google Scholar 

  20. Vicaretti M (2011) Pathophysiology of vascular graft infections. In: Fitridge R, Thompson M (eds) Mechanisms of vascular disease: a reference book for vascular specialists. University of Adelaide Press, Adelaide, p 29

    Google Scholar 

  21. Brothers TE, Robison JG, Elliott BM (2009) Predictors of prosthetic graft infection after infrainguinal bypass. J Am Coll Surg 208:557e6

    Article  Google Scholar 

  22. Genovese EA, Avgerinos ED, Baril DT, Makaroun MS, Chaer RA (2016) Bio-absorbable antibiotic impregnated beads for the treatment of prosthetic vascular graft infections. Vascular. 24(6):590–597

    Article  Google Scholar 

  23. Wübbeke LF, Elshof JW, Conings JZM, Scheltinga MR, Daemen JHC, Mees BME (2020) A systematic review on the use of muscle flaps for deep groin infection following vascular surgery. J Vasc Surg 71(2):693–700

    Article  Google Scholar 

  24. Birch L, Cardwell ES, Claytor H, Zimmerman SL (1956) Suture-line rupture of a nylon aortic bifurcation graft into the small bowel. AMA Arch Surg 73(6):947–950

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Vascular and Endovascular Surgery, Army Hospital (Research and Referral), New Delhi, 110010, India

    Vikram Patra, Rohit Mehra, Rishi Dhillan, Rakesh Kumar Jha, Suresh Reddy Thupakula & Rahul Merkhed

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  1. Vikram Patra
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  2. Rohit Mehra
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  3. Rishi Dhillan
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  4. Rakesh Kumar Jha
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  5. Suresh Reddy Thupakula
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  6. Rahul Merkhed
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Contributions

(a) Conceptualization: Vikram Patra

(b) Methodology: Vikram Patra and Rohit Mehra

(c) Formal analysis and investigation: Rohit Mehra, Rakesh Kumar Jha, Suresh R Thupakula, and Rahul Merkhed

(d) Writing and original draft preparation: Rohit Mehra, Vikram Patra, and Rishi Dhillan

(e) Writing, review, and editing: Rohit Mehra

(f) Supervision: Vikram Patra and Rishi Dhillan

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Correspondence to Rohit Mehra.

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The authors declare that they have no conflict of interest.

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Informed consent was obtained from all individual participants included in the study. The authors affirm that the participant provided informed consent for the publication of images in Figs. 1 and 2.

Ethical Approval

Ethical approval was waived by the local ethics committee in view of the retrospective nature of the study and all the procedures being performed were part of the routine care.

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Patra, V., Mehra, R., Dhillan, R. et al. Vascular Graft Infections: a Decade’s Clinical Experience in Indian Population. Indian J Surg 83, 1457–1463 (2021). https://doi.org/10.1007/s12262-021-02733-1

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  • DOI: https://doi.org/10.1007/s12262-021-02733-1

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