Gentamicin beads in vascular surgery: long-term results of implantation

The authors conducted a prospective study, with a subsequent review of case-notes and followup of patients, to review the results of insertion of gentamicin beads for the prevention and treatment of infection in vascular surgery. In particular, special reference was given to leaving chains of beads permanently implanted in the body. There were thirty-five patients in whom gentamicin beads were used in 62 sites. These were implanted completely in 45, left protruding for removal in 15: and in open wounds in two. Forty-two chains of beads were left permanently implanted, and these patients were followed up for 1-44 months (median 15) later, There was no further infection at 60% of the sites where gentamicin beads were used to treat proven graft sepsis, and 50% of sites in various sinuses. Infection developed at 16% of the sites where gentamicin beads were used prophylactically. Adverse effects were observed in three cases of long-term implantation: one chain of beads caused discomfort that required removal, the skin failed to heal over one chain, and one may possibly have caused a bypass graft to kink and occlude. In conclusion, gentamicin beads are a useful adjunct in the management of vascular graft infection and in prophylaxis for some high risk cases. Chains of beads can be implanted long term with few adverse sequelae. (C) 1999 The International Society for Cardiovascular Surgery. Published by Elsevier Science Ltd, All rights reserved.