Gram-negative infections of arterial substitutes

Abstract Enteric contamination at the site of a vascular injury creates a difficult management problem. In order to more intelligently approach this problem we have compared the efficacy of arterial autografts, autogenous vein graft, and polytetrafluorethylene (PTFE) grafts in wounds contaminated with enteric organisms. Thirty mongrel dogs were divided into three groups. Group I had both femoral arteries replaced with autografts, Group II underwent bypass grafting with 4-mm PTFE grafts, and Group III had femoral arteries replaced with autogenous vein grafts. The right groin was closed aseptically and served as a control while the left groin was contaminated with a standard aliquot of stool and then closed. The groups were observed for loss of blood flow, death due to hemorrhage, or complete healing. Termination of the study was determined by the first of these to occur in each animal. In the animals with arterial autografts, seven demonstrated healing and the average time to termination of the study was 20.2 days. Only one of the PTFE grafts healed and the average survival was 8.9 days. In the group with vein grafts, five healed. The time to termination was 14.7 days. These data demonstrated that arterial autografts are superior to PTFE grafts in an infected wound due to their ability to heal without disruption. This study suggests that autogenous tissue grafts are the prostheses of choice for replacement of small vessels injured in the presence of significant contamination.