Surgical treatment of infected composite graft after replacement of ascending aorta.

Infection of a composite graft is a serious complication. However, reports of such cases are rare even in large series. We report our experience with 4 patients in whom infection of a composite graft developed with pseudoaneurysm formation. Two of the patients had Marfan's syndrome and were treated by Bentall procedure and 2 were treated by Cabrol technique for non-Marfan cystic medial necrosis. Staphylococcus epidermidis was detected in 2 patients and Enterococcus in 1. Reoperation was carried out between 1 and 32 months after the first intervention. One patient died of cerebral embolism and 3 remained free of infection 11 to 82 months later. These cases and guidelines for managing abdominal and peripheral vascular prosthetic infection indicate the need for prompt reintervention when infection is suspected from chronic sepsis, septicemia, positive blood cultures, fistula, anastomotic leak, hemolysis, embolism, graft deformity, or false aneurysm. When the organism is isolated, appropriate antibiotic therapy should be administered. All prosthetic material should be removed and all adjacent infected or necrotic tissue excised. Local antiseptic irrigation may be helpful. Dead space around the prosthesis should be filled with well-vascularized transposed pedicled flaps. Antibiotic therapy should be intravenously administered for at least 6 weeks.