In Situ Revascularisation with Silver-coated Polyester Prostheses and Arterial Homografts in Patients with Aortic Graft Infection – A Prospective, Comparative, Single-centre Study

Pupka, Artur; Skóra, Jan; Janczak, Dariusz; Płonek, Tomasz; Marczak, Jakub; Szydełko, Tomasz

doi:10.1016/j.ejvs.2010.10.005

Cited by 59 publications

(18 citation statements)

References 21 publications

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“…70,103,109,110 As with rifampin-bonded grafts, reinfection rates were higher with silver-coated grafts than with the use of cryopreserved arterial homografts. The major advantages of rifampin-bonded or silver-coated synthetic grafts were lower amputation rates, fewer conduit failures, lower earlier mortality rates, and the fact that they can be used in emergency surgery.…”

Section: Graft Excision and In Situ Reconstructionmentioning

confidence: 99%

“…A potential disadvantage of rifampin-bonded prosthesis is the development of rifampin resistance, which is not a concern with silver-coated synthetic grafts. 3,70,109,110 Bandyk et al 14 and O'Connor et al 4 suggested that rifampin-bonded or silver-coated grafts should be considered for patients with infection caused by less virulent microorganisms, such as coagulase-negative staphylococci or streptococci. These authors suggested that rifampin-bonded synthetic grafts should not be used in patients with aortoenteric fistulae or in infections caused by MRSA or Pseudomonas or with extensive perigraft abscess because of the risk of reinfection.…”

Section: Graft Excision and In Situ Reconstructionmentioning

confidence: 99%

“…14,83 rifampin-bonded coated or silver-coated prosthetic grafts. The use of rifampin-bonded synthetic grafts 3,8,11,14,71,106 or silver-coated grafts 70,103,109,110 has been reported. In a nonconcurrent study, Oderich and colleagues 11 clInIcal stateMents anD GuIDelInes compared outcomes in 52 patients who underwent resection of the infected portion of the vascular graft and in situ reconstruction with rifampin-bonded synthetic grafts with those of patients who underwent axillofemoral reconstruction and excision of the infected vascular graft.…”

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confidence: 99%

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Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: A Scientific Statement From the American Heart Association

Wilson¹,

Bower²,

Creager³

et al. 2016

Circulation

373

307

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The use of synthetic material for reconstructive vascular surgery was first reported during the early 1950s. Infection involving vascular graft prostheses is an infrequent but devastating complication of reconstructive vascular graft surgery and is associated with a high morbidity and, in some situations, mortality. Improvements in surgical techniques and graft design, including the use of native venous or arterial tissue, have reduced the frequency of infection and severity of complications from vascular graft infection (VGI). However, these advances have also led to more frequent vascular graft procedures occurring in a patient population with multiple underlying comorbidities that would have previously disqualified them as candidates for vascular reconstructive surgery. Underlying comorbidities, such as diabetes mellitus or immune compromise, increase the risk of infection and serious infection-related complications. The major complications of VGI include sepsis, amputation, disruption of infected anastomotic suture line with rupture or pseudoaneurysm formation, embolization of infected thrombi, reinfection of reconstructed vascular grafts, enteric fistulae to the small or large bowel, bacteremic spread of infection to other sites, and death. VGIs can be categorized broadly into those that occur in an extracavitary location, primarily in the groin or lower extremities, or in an intracavitary location, primarily within the abdomen or less commonly within the thorax. frequencyThe frequency of VGI depends on the anatomic location of the graft. The infection rate is 1.5% to 2% for most extracavitary grafts and as high as 6% with vascular grafts in the groin. [1][2][3][4][5][6][7][8][9] For intracavitary grafts, the infection rate is ≈1% to 5%. 1-6 Graft infection is most common after emergency procedures and after reoperation. [1][2][3][4]10 Aortic graft erosion or fistulous communication into the duodenum or other areas of the bowel reportedly occurs in 1% to 2% of patients after aortic reconstruction. 11,12 MicrobiologyThe microbiological cause of VGI has evolved over the years. 1 In early published studies, Staphylococcus aureus was the predominant microorganism recovered. 1,13 Improvements in surgical technique, administration of prophylactic antistaphylococcal antimicrobial therapy, and other factors have resulted in a changing microbiological epidemiology. Vascular graft surgery performed on patients with multiple underlying comorbidities and the increased frequency of emergency procedures have contributed to the changing spectrum of infection. Other factors such as changes in hospital flora, surgery in patients with complicated vascular anatomy, and multiple revisions of previous vascular surgery have resulted in a more diverse microbio- clInIcal stateMents anD GuIDelInes logical spectrum of infection, which includes multidrugresistant strains, polymicrobial infection, and Candida species. Gram-positive cocci accounts for at least two thirds of VGIs. 1,13 Infections caused by coagulase-negative staphylococ...

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Section: Graft Excision and In Situ Reconstructionmentioning

confidence: 99%

Section: Graft Excision and In Situ Reconstructionmentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: A Scientific Statement From the American Heart Association

Wilson¹,

Bower²,

Creager³

et al. 2016

Circulation

373

307

View full text Add to dashboard Cite

show abstract

“…Несомненным пре-имуществом импрегнированных серебром протезов явля-ется их готовность к использованию сразу после вскрытия упаковки (нет необходимости замачивания в растворе антибиотика или антисептика), аналогичные неимпрег-нированным графтам плотность, прочность, отсутствие выраженной тканевой реакции и в первую очередь анти-микробные качества [21,[23][24][25]. Ряд исследователей [26][27][28][29][30][31] считают возможным использовать их даже в ин-фекционном очаге в позиции in situ, указывая на результа-ты, схожие с использованием алло-или аутовенозных графтов. Основным аргументом скептически настроенных ис-следователей становится отсутствие таких данных о нали-чии и выраженности антибактериальной активности этих протезов, которые бы не вызывали сомнений в своей до-стоверности.…”

Section: Discussionunclassified

The choice of vascular prosthesis in high-risk aortic surgery

Andreychuk¹

2016

Kardiol. serdechno-sosud. khir.

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nikiforov all-Russian emergency and radiation medicine, Ministry of emergency situations, St. Petersburg, Russia the retrospective comparative analysis of prosthetic graft infection rate was done in two comparable groups. 267 high-risk patients underwent aortoiliac vascular procedures with implantation of silver-coated (Silvergraft, B.BRAun, germany) (main group, n=113) or simple dacron grafts (control group, n=154) in a single center. 22 cases of graft infection occurred (8.2%) 17 (77.3%) of which were registered in control group. Significant difference (p=0.0192) in infection rate between study groups had been revealed as early as one month and has been at the high by eight months. 45.5% of patients (all of them from control group) died due to infectious complications (sepsis, arrosive hemorrhage, endocarditis, multiorgan dysfunction) in 3-69 months' follow-up period. In conclusion, silver-coated grafts have a benefit in prevention of early and late infectious complication and prosthetic aortoiliac graft infection by high-risk patients.

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“…In the setting of infection, surgical explantation carries a mortality of 18-30% [12]. Revascularization is performed via extra-anatomic routes, however, in situ revascularization with autologous femoral vein or rifampinsoaked grafts is another viable option [14,28]. Regardless of the method of revascularization, expeditious diagnosis and treatment is paramount to patient survival.…”

Section: Treatment and Outcomesmentioning

confidence: 99%

Aortic Graft Infection Secondary to Iatrogenic Transcolonic Graft Malposition

Blank

Rothstein

Lee

et al. 2017

J Vasc Endovasc Surg

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Context: Aortic graft infections are a rare but devastating complication of aortic revascularization. Often infections occur due to contamination at the time of surgery. Iatrogenic misplacement of the limbs of an aortobifemoral graft is exceedingly rare, and principles of evaluation and treatment are not well defined. We report two cases of aortobifemoral bypass graft malposition through the colon.Case report: Case 1 is a 54 year old male who underwent aortobifemoral bypass grafting for acute limb ischemia. He had previously undergone a partial sigmoid colectomy for diverticulitis. Approximately six months after vascular surgery, he presented with an occult graft infection. Preoperative imaging and intraoperative findings were consistent with graft placement through the sigmoid colon. Case 2 is a 60 year old male who underwent aorto bifemoral bypass grafting due to a nonhealing wound after toe amputation. His postoperative course was complicated by pneumonia, bacteremia thought to be secondary to the pneumonia, general malaise, and persistent fevers. Approximately ten weeks after the vascular surgery, he presented with imaging and intraoperative findings of graft malposition through the cecum. Conclusions:Aortic graft infection is usually caused by surgical contamination, and presents as an indolent infection. Case 1 presented as such; Case 2 presented more acutely. Both grafts were iatrogenically misplaced through the colon at the index operation. The patients underwent extra-anatomic bypass and graft explantation and subsequently recovered.

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In Situ Revascularisation with Silver-coated Polyester Prostheses and Arterial Homografts in Patients with Aortic Graft Infection – A Prospective, Comparative, Single-centre Study

Abstract: Our study suggests that silver-coated prostheses can be as effective as arterial allografts in the treatment of infections of vascular prostheses.

Cited by 59 publications

References 21 publications

Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: A Scientific Statement From the American Heart Association

Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: A Scientific Statement From the American Heart Association

The choice of vascular prosthesis in high-risk aortic surgery

Aortic Graft Infection Secondary to Iatrogenic Transcolonic Graft Malposition

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