. Reduction of groin wound complications in vascular surgery patients using closed incision negative pressure therapy (ciNPT): a prospective, randomised, single-institution study. Int Wound J 2018; 15:75-83 AbstractGroin wound infections in patients undergoing vascular procedures often cause a lengthy process of wound healing. Several clinical studies and case reports show a reduction of surgical site infections (SSIs) in various wound types after using closed incision negative pressure therapy (ciNPT). The aim of this prospective, randomised, single-institution study was to investigate the effectiveness of ciNPT (PREVENA™ Therapy) compared to conventional therapy on groin incisions after vascular surgery. From 1 February to 30 October 2015, 100 patients with 129 groin incisions were analysed. Patients were randomised and treated with either ciNPT (n = 58 groins) or the control dressing (n = 71 groins). ciNPT was applied intraoperatively and removed on days 5-7 postoperatively. The control group received a conventional adhesive plaster. Wound evaluation based on the Szilagyi classification took place postoperatively on days 5-7 and 30. Compared to the control group, the ciNPT group showed a significant reduction in wound complications (P < 0⋅0005) after both wound evaluation periods and in revision surgeries (P = 0⋅022) until 30 days postoperatively. Subgroup analysis revealed that ciNPT had a significant effect on almost all examined risk factors for wound healing. ciNPT significantly reduced the incidence of incision complications and revision procedures after vascular surgery.

Wound healing complications (WHCs) in the groin after vascular surgeries are a serious problem for patients and surgeons in various surgical disciplines. The incidence of WHCs of up to 44% after incisions in the groin is often responsible for prolonged hospital stay and high treatment costs. An effective reduction of WHCs for various wound types after using closed incision negative pressure therapy (ciNPT) has been documented in many case reports and clinical studies. As the majority of studies have addressed the effect of ciNPT on primary groin incision wounds, concerning groin incision wounds after revision vascular surgery are extremely scarce. The aim of this prospective, randomized clinical study was to investigate the effectiveness of ciNPT compared with conventional therapy on groin incisions after revision vascular surgery. We analyzed the cases of a total of 94 patients with 100 groin incisions. Patients were randomized and treated with either PREVENA™ (n=47 groins) or a conventional adhesive dressing (n=53 groins; control group). PREVENA™ was applied intraoperatively and was removed on day 5, 6 or 7 postoperatively. Wound evaluation was carried out on the 5th to 7th and 30th postoperative day. Compared with the control group, the ciNPT group showed a reduction in the overall incidence of WHCs assessed 30 days postoperatively (p<0.0005). With regard to prevention of revision surgeries, the ciNPT had no significant impact (p=0.056). Subgroup analysis revealed a significant effect of ciNPT for almost all wound healing risk factors. Based on our results, ciNPT provides a promising therapeutic option to reduce the frequency of postoperative WHCs and the need for revision surgeries in the groin after revision vascular surgery in patients with wound healing risk factors.

Background The aim of this study was to investigate the prevalence of abdominal aortic aneurysm (AAA) and abdominal aortic ectasia (AAE) in coronary artery disease (CAD) patients in a multicenter setting to obtain significant data to establish an AAA screening program in our departments. Methods Between January and September 2016, 500 patients with suspected or diagnosed CAD planned for coronary angiography or coronary artery bypass graft (CABG) underwent a sonographic examination of the infrarenal abdominal aorta to diagnose AAA or AAE. We calculated the prevalence of AAA and AAE in patients diagnosed of CAD and investigated factors potentially associated with the occurrence of AAA. Results The overall prevalence in all grades of CAD for AAE was 35.1% and for AAA 5.4%. In patients with three-vessel CAD, the prevalence of AAE was 34% and of AAA 6.8%. Significant correlation was found between the three-vessel CAD and AAA (p = 0.039). The logistic regression analysis showed significant correlation between AAA and age > 65 years (p = 0.05). The multivariate analysis of risk factors and CAD revealed significant correlations between one-vessel CAD and arterial hypertension (AH) (p = 0.004) and age > 65 years (p = 0.001) as well as between three-vessel CAD and AH (p = 0.01), peripheral artery disease (p = 0.01), and age > 65 years (p = 0.03). Conclusion Our results confirm, that in comparison to other data, the prevalence of AAA in patients with CAD is high. Thus, it is recommended to include patients with CAD, especially elderly patients with three-vessel CAD, in future AAA screening programs.

Background  Endograft infections (EIs) are rare complications after endovascular procedures in the thoracic and abdominal aortas. The challenging treatment encloses antibiotic and surgical therapies. Case Description  A 74-year-old male patient developed an EI after an endovascular procedure (thoracic endovascular aortic repair [TEVAR]). Despite a long-term oral antibiotic therapy, the clinical symptoms showed no falling trend. Because of the expanded infection from above the celiac trunk up to the aortic arch, we decided to remove the infected endograft and to implant an extra-anatomic ascendobifemoral bypass. Conclusion  The implantation of an ascendobifemoral bypass was a successful treatment option for EIs after TEVAR.

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