Medical College of Wisconsin
CTSICores SearchResearch InformaticsREDCap

In situ replacement of vascular prostheses infected by bacterial biofilms. J Vasc Surg 1991 May;13(5):575-83



Pubmed ID




Scopus ID

2-s2.0-0025868413   124 Citations


Late prosthetic graft infections are commonly the result of coagulase-negative staphylococci that survive within a biofilm on prosthetic surfaces and provoke perigraft inflammation. The indolent nature and microbiologic characteristics of bacterial biofilm infections coupled with the morbidity of graft excision and extraanatomic bypass grafting prompted us to use in situ graft replacement in 15 patients admitted to the hospital with 17 infected graft segments at a mean (+/- SEM) time interval of 70 +/- 16 months after graft implantation (n = 6) or revision (n = 9). Since 1986, 17 grafts (14 aortofemoral, 2 axillofemoral, and 1 femoropopliteal) infected by bacterial biofilms have been treated. Signs on admission included femoral pseudoaneurysm (n = 7), perigraft abscess (n = 6), or graft-cutaneous sinus tract (n = 4). No patient exhibited septicemia. At operation graft incorporation was absent and Gram's stain of perigraft exudate showed polymorphonuclear leukocytes but no bacteria. Culture of explanted graft material isolated coagulase-negative staphylococci (n = 12), Staphylococcus aureus (n = 1), and no growth (n = 2). All patients were successfully treated by a regimen that included parenteral antibiotics, removal of involved graft material, excision of inflamed perigraft tissue, and in situ replacement with an expanded polytetrafluoroethylene prosthesis. No deaths, graft thromboses, or deep wound infections occurred after operation. Recurrent graft infection did not develop during a follow-up interval that ranged from 5 to 50 months (mean, 21 months). Diagnosis of vascular prosthesis infection caused by bacterial biofilms can be based on signs at admission and operative findings. Complications of this perigraft infection can be eradicated by antibiotic administration, local debridement, and in situ graft replacement.

Author List

Bandyk DF, Bergamini TM, Kinney EV, Seabrook GR, Towne JB


Gary R. Seabrook MD Chief, Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Blood Vessel Prosthesis
Femoral Artery
Middle Aged
Popliteal Artery
Staphylococcal Infections
Staphylococcus aureus
Staphylococcus epidermidis
Tomography, X-Ray Computed
jenkins-FCD Prod-468 69a93cef3257f26b866d455c1d2b2d0f28382f14