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Patients with functioning vein grafts may present with wound problems resulting in
exposure of the graft. We reviewed the courses of 16 patients presenting with this
problem to determine the causative factors and the most appropriate management of
this therapeutic dilemma.
Diabetes mellitus (11 of 16, 68.7%) and wound infection (12 of 16,75%) were frequent
pre-existing conditions associated with exposed venous grafts. All patients with exposed
vein grafts were initially treated conservatively with regular application of moist
sterile dressings, followed by split-thickness skin graft coverage of the wounds when
clean. The wounds healed in 7 patients, whereas 9 patients developed complications
of hemorrhage (7 patients) and graft thrombosis (2 patients). The outcome of therapy
was highly dependent on the type of organism originally cultured from the wounds.
The incidence of vein graft disruption was lowest when the wounds were sterile (25%)
or when gram-positive bacteria grew (25%). Gramnegative infection uniformly resulted
in disruption of the exposed venous graft. When a new graft was placed, the secondary
graft became reinfected in all patients with gram-negative primary graft infection.
There were no instances of secondary graft reinfection when gram-negative bacteria
were not present.
These data suggest that the outcome of patients presenting with exposed vein grafts
is highly dependent on the bacterial flora of the process. Vein graft disruption is
frequent in patients with gram-negative infection, suggesting that these patients
should be treated with distant graft ligation and extra-anatomic bypass. By contrast,
patients without gramnegative infection may be successfully managed with local wound
care.
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Article info
Footnotes
2Presented at the 18th Annual Meeting of the Society for Clinical Vascular Surgery, Palm Desert, California, March 7–11, 1990.
Identification
Copyright
© 1990 Reed Publishing USA. Published by Elsevier Inc.
