Xenografts in septic vascular surgery

Abstract

BackgroundIn general, autologous veins are the optimal replacement material for an infected vascular graft in terms of handling, durability and resistance to reinfection. In the absence of suitable autologous material, several options are available, each of which has specific advantages and drawbacks with regard to these characteristics.MethodsIn recent years, xenogeneic materials (in particular pericardial patches from different species and biosynthetic grafts) have been increasingly used as replacement material in the setting of infections. Bovine and equine pericardial patches are applied in particular as self-made tube grafts in the aortic region and also in infections of iliacofemoral prosthetic grafts and shunt infections.ResultsThe results of small clinical series on durability and resistance to reinfection are promising.ConclusionIt is feasible to use biosynthetic materials to replace infected intracavitary and extracavitary vascular grafts with remarkably low reinfection rates; however, the unique mechanical properties of the grafts as well as the initially increased thrombogenicity, need to be taken into consideration.

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

“…The advantages of xenogenic materials, compared with alloplastic materials, include the unlimited availability, superior handling, high resistance to infection and minimal bleeding tendency at the suture line [3]. These benefits, however, at this time, are only based on experience, not on clinical evidence [3].…”

“…The removal of veins prolongs the procedural time and increases the perioperative morbidity; thus, this method is not ideally suitable to all, particularly to high-risk patients [3]. In these cases, silver or antibiotic-impregnated grafts are generally applied, resulting in a variable success rate with regard to the potentiality of reinfection [8-10].…”

“…In these cases, silver or antibiotic-impregnated grafts are generally applied, resulting in a variable success rate with regard to the potentiality of reinfection [8-10]. Application of homografts is a well-known, recommended option, generally associated with good results and high resistance against infection; however, there is the potential risk of graft degeneration, in addition, the availability is limited [3, 11]. In consideration of vessel allo- and xenotransplantation, decellularization of the donor tissue may prevent or decrease graft-versus-host reaction, and subsequent graft degeneration.…”

“…Nevertheless, in the last two decades, xenograft (mostly bovine pericardium) has come into routine clinical use, not only in septic, but also in aseptic cardiovascular surgery. Homografts (veins or arteries) are useful in any localization (aortoiliac, femorodistal) such as bypass graft; however, xenografts are used almost exclusively as patch material for arterial closure, for example, in case of carotid endarterectomy [3, 11]. …”

“…Advantages of these grafts include adequate biomechanical properties as well as high resistance against infections and unlimited availability [1-3]. However, the most distinct disadvantage of biograft is the triggering of the immune response [1-4].…”