Infections are a major setback of vascular reconstruction and associated with considerable morbidity and mortality. We evaluated retrospectively our results with self-made bovine pericardial grafts in infected vessel revascularization versus standard graft material.
Basic methods
Retrospective analysis of 9 patients with bovine reconstruction and 10 patients with miscellaneous grafts (vein, homograft) for vascular infections.
Principal findings
Infection-free rate of the pericardial group was 100% in 17 months. For patients after reconstructions with miscellaneous grafts, the infection-free rate was 82% in 45 months. Overall in-hospital mortality was 10.5%. There were no in-hospital deaths in the pericardial group. Graft patency of the whole cohort was 100%. The median follow up was 11.74 months.
Conclusion
Self-made bovine pericardial tube grafts can be crafted to almost any size and adjusted to complex anatomic requirements. The use was feasible in various situations and was associated with good preliminary results concerning patency and reinfection.
YeagerRAPorterJM. Arterial and prosthetic graft infection. Ann Vasc Surg1992; 6: 485–491.
2.
HerreraFAKohanzadehSNasseriY. Management of vascular graft infections with soft tissue flap coverage: improving limb salvage rates—a veterans affairs experience. Am Surg2009; 75: 877–881.
3.
NaylorARHayesPDDarkeS. A prospective audit of complex wound and graft infections in great britain and ireland: the emergence of MRSA. Eur J Vasc Endovas Surg2001; 21: 289–294.
4.
EarnshawJJWhitmanBHeatherBP. Two-year results of a randomized controlled trial of rifampicin-bonded extra-anatomic dacron grafts. Br J Surg2000; 87: 758–759.
5.
MeyerTSchweigerHLangW. Extraanatomic bypass in the treatment of prosthetic vascular graft infection manifesting in the groin. VASA. Zeitschrift fur Gefasskrankheiten1999; 28: 283–288.
6.
DorweilerBNeufangAChabanR. Use and durability of femoral vein for autologous reconstruction with infection of the aortoiliofemoral axis. J Vasc Surg2014; 59: 675–683.
7.
TopelIBetzTUhlC. Use of biosynthetic prosthesis (omniflow ii(r)) to replace infected infrainguinal prosthetic grafts–first results. VASA. Zeitschrift fur Gefasskrankheiten2012; 41: 215–220.
8.
RiccoJBAssadianO. Antimicrobial silver grafts for prevention and treatment of vascular graft infection. Semin Vasc Surg2011; 24: 234–241.
9.
BattMMagneJLAlricP. In situ revascularization with silver-coated polyester grafts to treat aortic infection: early and midterm results. J Vasc Surg2003; 38: 983–989.
10.
BisdasTWilhelmiMHaverichA. Cryopreserved arterial homografts vs silver-coated dacron grafts for abdominal aortic infections with intraoperative evidence of microorganisms. J Vasc Surg2011; 53: 1274–1281 e1274.
11.
CzernyMvon AllmenROpfermannP. Self-made pericardial tube graft: a new surgical concept for treatment of graft infections after thoracic and abdominal aortic procedures. Ann Thorac Surg2011; 92: 1657–1662.
12.
BerardXPinaquyJBSteckenL. Use of 18f-fluorodeoxyglucose positron emission tomography-computed tomography and sonication for detection of infection after peripheral stent fracture. Circulation2014; 129: 2437–2439.
13.
ShenHTangJWangQ. Sonication of explanted prosthesis combined with incubation in bd bactec bottles for pathogen-based diagnosis of prosthetic joint infection. J Clin Microbiol2015; 53: 777–781.
14.
SzilagyiDESmithRFElliottJP. Infection in arterial reconstruction with synthetic grafts. Ann Surg1972; 176: 321–333.
15.
WiltbergerGMatiaISchmelzleM. Mid- and long-term results after replacement of infected peripheral vascular prosthetic grafts with biosynthetic collagen prosthesis. J Cardiovasc Surg2014; 55: 693–698.
16.
MurphyEHSzetoWYHerdrichBJ. The management of endograft infections following endovascular thoracic and abdominal aneurysm repair. J Vasc Surg2013; 58: 1179–1185.
17.
KiefferEGomesDChicheL. Allograft replacement for infrarenal aortic graft infection: early and late results in 179 patients. J Vasc Surg2004; 39: 1009–1017.
18.
LuoCYKoWCKanCD. In situ reconstruction of septic aortic pseudoaneurysm due to salmonella or streptococcus microbial aortitis: long-term follow-up. J Vasc Surg2003; 38: 975–982.
19.
TeebkenOEPichlmaierMABrandS. Cryopreserved arterial allografts for in situ reconstruction of infected arterial vessels. Eur J Vasc Endovasc Surg2004; 27: 597–602.
20.
ShahSSinnoSVandevenderD. Management of thoracic aortic graft infections with the omental flap. Ann Plast Surg2013; 70: 680–683.
21.
VogtPRBrunner-LaRoccaHPLachatM. Technical details with the use of cryopreserved arterial allografts for aortic infection: influence on early and midterm mortality. J Vasc Surg2002; 35: 80–86.
22.
LesecheGCastierYPetitMD. Long-term results of cryopreserved arterial allograft reconstruction in infected prosthetic grafts and mycotic aneurysms of the abdominal aorta. J Vasc Surg2001; 34: 616–622.
23.
van ZitterenMvan der SteenhovenTJBurgerDH. Spiral vein reconstruction of the infected abdominal aorta using the greater saphenous vein: preliminary results of the tilburg experience. Eur J Vasc Endovasc Surg2011; 41: 637–646.
24.
Brown KG, Koh CE, Solomon MJ, et al. Spiral saphenous vein graft for major pelvic vessel reconstruction during exenteration surgery. Ann Vasc Surg 2015; 29: 1323–1326.
25.
BrahmanandamSClairDBenaJ. Adjunctive use of the superficial femoral vein for vascular reconstructions. J Vasc Surg2012; 55: 1355–1362.
