Outcome after VAC® Therapy for Infected Bypass Grafts in the Lower Limb

Objective: To assess the outcome of vacuum-assisted wound closure (VAC (R)) therapy for infected bypass grafts. Methods: A retrospective 7-year review of patient records from 2004 to 2011 of all patients receiving VAC (R) therapy for infected bypass grafts. Results: Thirty-seven patients with 42 wounds and 45 infected bypass (28 synthetic) grafts received VAC (R) treatment. Two serious bleeding episodes from the suture lines occurred. The median VAC (R) therapy time was 20 days. The proportion of patent bypass grafts was 91% (41/45) at a median time of 3.5 months from the start of VAC (R) therapy. Five patients with seven bypasses had persistent infection or re-infection, and the total graft preservation rate was 76% (34/45). The median follow-up time was 15 months. The presence of two infected bypass grafts in one groin wound was associated with an increased major amputation rate (hazard ratio (HR) 7.4 [95% confidence interval (CI) 2.0-27.5]), and synthetic graft infection (HR 5.0 [95% CI 1.5-17.4]) and non-healed wound (HR 3.6 [95% CI 1.5-8.7]) were associated with mortality. Conclusion: VAC (R) therapy of infected bypass grafts was able to induce effective wound healing without compromising the early bypass function. Two infected synthetic bypasses in the wound were associated with the highest risk of adverse outcome. (C) 2012 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.