Infection of vascular grafts after infrainguinal reconstructions – the current state of the problem and possible solutions.

Introduction. Untimely recognition of an infection in a vascular prosthesis can lead to catastrophic consequences - sepsis, thrombosis, and graft failure with the development of massive bleeding.
The main part. Conservative therapy for infections of vascular grafts without removing the infected conduit has been proven ineffective due to the high mortality rate of patients (up to 45 %) within a follow-up period of up to 5 years, persistent infection, and high risks of anastomotic failure with the development of erosive bleeding. VAC therapy is an effective treatment for infections and is aimed at accelerating the healing of infected wounds using negative pressure. However, at present, this technique can be considered experimental, as the number of studies on the effectiveness of VAC therapy in treating infections of vascular grafts is extremely limited and is based on small patient samples. Active drainage and irrigation of infected wounds can be used in the treatment of vascular graft infections to reduce bacterial colonization of infected tissues; however, this method can be used as monotherapy only in patients in whom it is impossible to remove the infected graft.
Conclusion. The key to successful treatment is the accurate identification of the infecting agent, the prescription of specific antibacterial therapy, and properly planned surgical intervention. The method of treating vascular prosthesis infection should be selected individually, taking into account the severity and localization of the infectious process, the nature of limb ischemia, the presence of an autologous vein or alternative grafts, the experience of the surgical team, and the clinic’s equipment.

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