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

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. MATERIALS AND METHODS: Data of all patients who underwent debridement of the grafts and/or surrounding tissue using a ultrasonic generator (Genera, Italia Medica, Milan, Italy) were recorded and retrospectively reviewed. Based upon cultures, patients received specific antibiotic therapy. Partial graft removal, sartorius muscle flap rotation or Negative Pressure Wound Treatment (NPWT) were selectively employed. Early and late morbidity and mortality and recurrence were analyzed. RESULTS: Thirteen patients (median age 72 years, range 57-92; 8 male) 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 oedema due to 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.