Biosynthetic Grafts To Replace Infected Prosthetic Vascular Bypasses: A Single-Center Experience

Töpel, I.; Stigler, Theresa; Ayx, Isabelle; Betz, Thomas; Uhl, Christian; Steinbauer, Markus

doi:10.1089/sur.2016.203

Cited by 19 publications

(17 citation statements)

References 15 publications

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“…Omniflow, a biosynthetic collagen graft, has shown good results in several infected fields. 13,14 Another advantage is its off the shelf availability in different sizes. However, both Omniflow grafts and bovine vein grafts developed late re-infection, despite proper antibiotic therapy and completely healed groin wounds at discharge.…”

Section: Type Of Graft Used and Graft Related Complicationsmentioning

confidence: 99%

In situ Reconstruction of Infected Groin Pseudoaneurysms in Drug Abusers With Biological Grafts

Becker

Béguin

Weiss

et al. 2019

European Journal of Vascular and Endovascular Surgery

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WHAT THIS PAPER ADDS Management of infected groin pseudoaneurysms in drug abusers is controversial, especially the reconstruction technique and the type of graft material to be used. This study shows that in situ reconstruction with biological material is a viable option with low early graft related morbidity. However, in the longer term, a significant number of patients develop re-infection, graft occlusion, or stenosis. Objectives: The aim of this study was to evaluate outcomes after in situ reconstruction using biological grafts in infected groin pseudoaneurysms in drug abusers. Methods: This was a single centre retrospective analysis of all patients undergoing in situ reconstruction with biological vascular grafts for infected groin pseudoaneurysms in drug abusers from 2000 to 2017. Outcome measures included wound healing problems, re-infection, graft patency, lower limb amputation, and mortality. Results: Twenty-two patients (14 male) with a median age of 39 years (range 27e49) were identified. Fifteen patients (68%) underwent urgent in situ reconstruction with a xenograft, five patients (23%) with a homograft, and two patients (9%) with an autologous vein. There were no in hospital deaths, in hospital reinfections, or early major limb amputations. Four (18%) patients developed wound healing complications requiring re-operation. During a median follow up of 56 months (range 13e180 months), six patients (27%) developed re-infection requiring complete graft replacement with a new biological graft. Thereafter, three (14%) had re-re-infection. Seven patients (32%) had graft occlusions: two were treated endovascularly, two underwent re-operation, and three were treated conservatively. Two patients (9%) had patent grafts but significant stenosis: one had successful angioplasty and another one was left untreated. One patient required above knee amputation, resulting in an overall major amputation rate of 4%. Estimated primary patency was 87% after one year and 40% after five years. Six patients (27%) died during follow up from non-vascular causes. Conclusions: In situ reconstruction using biological grafts of infected groin pseudoaneurysms in drug abusers can be achieved with no peri-operative graft related complications, although rates of wound complications may be high. In the longer term, a significant number of patients develop re-infection, graft occlusion, or stenosis, although the amputation rate remains low. The management of this demanding group of patients remains a major challenge.

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Section: Type Of Graft Used and Graft Related Complicationsmentioning

confidence: 99%

In situ Reconstruction of Infected Groin Pseudoaneurysms in Drug Abusers With Biological Grafts

Becker

Béguin

Weiss

et al. 2019

European Journal of Vascular and Endovascular Surgery

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“…These grafts can also be utilized for septic vascular graft replacement, if no autologous vein is available. Due to the low infection rates in clinical use, initial attempts were published about their application for septic graft replacement [3, 23, 24]. Töpel et al [23] published a series of successful replacement of infected infrainguinal synthetic prostheses without reinfection during the mean follow-up of 24 months.…”

Section: Discussionmentioning

confidence: 99%

“…Due to the low infection rates in clinical use, initial attempts were published about their application for septic graft replacement [3, 23, 24]. Töpel et al [23] published a series of successful replacement of infected infrainguinal synthetic prostheses without reinfection during the mean follow-up of 24 months. Krasznai et al [24] published the successful in situ replacement of 3 infected aortic grafts with using biosynthetic grafts (Omniflow II), although 1 patient suffered from reinfection during the 2.2-year mean follow-up period.…”

Section: Discussionmentioning

confidence: 99%

Histological and Mechanical Assessment of Decellularized Porcine Biografts, and Its Biological Evaluation following Aortic Implantation during Mid-Term Follow-Up

et al. 2018

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Aims: Prosthetic graft infection frequently requires graft replacement. Among other options, a biological graft could serve as an alternative choice. Decellularization reduces tissue immunogenicity. Our aim was to determine an efficient decellularization method and to evaluate the decellularized porcine biografts’ adaptability. Methods: Four different protocols were implemented to decellularize porcine aortic segments (n = 4). Cell removal effectiveness and matrix structure preservation were histologically examined. Mechanical tests were performed. Decellularized porcine grafts were interpositioned in a porcine aorta. After a 6-month period, implanted samples were removed and evaluated using light and electron microscopy. Results: Histological results showed complete removal of cells and preserved connective tissue fiber structure following decellularization, using sodium dodecyl sulfate and sodium azide. Pressure tests demonstrated similar compliance to fresh vessels. In 9 out of 10 cases, pigs survived the follow-up period. Graft rejection, intimal hyperplasia, reocclusion and/or aneurysm formation were not observed. Presence of host cells and neoendothelialization were microscopically confirmed. Conclusions: This decellularization protocol enables a cost-effective preparation of biological grafts featuring reduced immunogenicity. The implanted grafts did not degenerate during the 6-month follow-up period, the lack of graft rejection suggests acceptable immunological tolerance, while recipient cells migrate into, proliferate and differentiate, thus creating the possibility for further use as an optional vascular graft.

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“…However, in absence of an autologous graft a biosynthetic conduit can be used since more resistant to infection with good results reported in literature [5] . For the new generation biosynthetic (Omniglow II) grafts the only complication reported so far is their occlusion with an average primary patency of 67.6% at one year and 61.5% at two years [2] , [5] , [6] . However the graft occlusion is not the only complication which may occur.…”

Section: Discussionmentioning

confidence: 99%

“…Infection of the surgical site might lead to early disruption of the anastomosis developing haematoma or late pseudoaneurysm. The most bacterial species drawn from infected sites and reported consist of Staphylococcus aureus, Enterococcus, Pseudomonas aeruginosa, Klebsiella pneumonia, Escherichia coli [5] , [6] . In the literature we did not find any quoting for Morganella morgani which is a gram-negative bacteria basically belonging to the intestinal flora and usually responsible of nosocomial infections in immunocompromised patients [7] .…”

Section: Discussionmentioning

confidence: 99%

Biosynthetic graft failure to replace infected infrainguinal bypass as developing infection due to Morganella morganii leading to disrupture of the anastomosis. Case report

Zenunaj

Spataro

Traina

et al. 2017

International Journal of Surgery Case Reports

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HighlightsInfection of infrainguinal bypass is a challenging complication with a high risk rate mortality and limb loss.Biosynthetic grafts are considered as the last chance to deal with bypass infection and if they fail other solutions are required.Besides occlusion of biosynthetic grafts other complications may occur during the follow up such as infection and haemorrhage.Recurrent infection of two different grafts used for infrainguinal bypass makes meaningless the use of other materials at the same surgical site.Extra- anatomical bypass avoiding the compromised and complicated surgical site could be a solution to assure limb salvage and patient survival.

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Biosynthetic Grafts To Replace Infected Prosthetic Vascular Bypasses: A Single-Center Experience

Abstract: Biosynthetic bypass grafts might be valuable to replace infected prosthetic grafts in the absence of a suitable vein. They have excellent re-infection resistance. Limb salvage, morbidity, and the mortality rate are similar to those obtained with autologous vein grafts in infected fields.

Cited by 19 publications

References 15 publications

In situ Reconstruction of Infected Groin Pseudoaneurysms in Drug Abusers With Biological Grafts

In situ Reconstruction of Infected Groin Pseudoaneurysms in Drug Abusers With Biological Grafts

Histological and Mechanical Assessment of Decellularized Porcine Biografts, and Its Biological Evaluation following Aortic Implantation during Mid-Term Follow-Up

Biosynthetic graft failure to replace infected infrainguinal bypass as developing infection due to Morganella morganii leading to disrupture of the anastomosis. Case report

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