Bovine Pericardium as New Technical Option for In Situ Reconstruction of Aortic Graft Infection

Lutz, Brigitta; Reeps, Christian; Bíró, G.; Knappich, Christoph; Zimmermann, Alexander; Eckstein, Hans‐Henning

doi:10.1016/j.avsg.2016.07.098

Cited by 52 publications

(33 citation statements)

References 30 publications

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“…Nowadays, the utilization of biological xenografts (graft originates from another species) shows an increasing number, as a result of the growing demands in vascular surgery, decisively in the treatment of septic vascular prostheses [11][12][13][14]. However, frequent, late aneurysm formation due to their degeneration is the most unfavorable consequence of their use.…”

Section: Resultsmentioning

confidence: 99%

DSC and histological analysis of decellularized porcine biograft

Fazekas

Jancsó

Lőrinczy

2020

J Therm Anal Calorim

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Different types of biological grafts are useful for the replacement of infected prostheses in vascular surgery. In cases, when autologous grafts or homografts are not available, xenografts can be an alternative choice. To reduce immunogenicity, decellularization of the xenogeneic graft is necessary. Our goal was to determine the long-lasting stability of our decellularized porcine vascular grafts, in the mirror of differential scanning calorimetry (DSC) and routine histological examination. In the first experiment, light and electron microscopic confirmation of adequate decellularization of our used protocol was assessed. In the second series, DSC measurements were performed both on native and on treated samples; thereafter, histological evaluation of the analyzed samples was performed. Light and electron microscopy evaluation showed complete removal of cells and preserved connective tissue fiber structure after decellularization in the first series. In the second part of our investigation, DSC measurements demonstrated reversible change in the structure of elastic fibers and irreversible change in the structure of collagen fiber structure supported by histological findings. Our examination strengthens the earlier observations that decellularized biological grafts can tend to late aneurysmatic degeneration, due to their weakened fiber structure, besides the known immunological circumstances.

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Section: Resultsmentioning

confidence: 99%

DSC and histological analysis of decellularized porcine biograft

Fazekas

Jancsó

Lőrinczy

2020

J Therm Anal Calorim

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“…Commercially available patches are typically decellularized by glutaraldehyde and commonly originate from bovine pericardium. Several publications described successful application of pericardial xenografts used in treating infected areas; however, experiences with usage of these grafts in replacement of the descending and infrarenal aorta are limited [19]. McMillan et al [20] reported a high success rate without reinfection (50 from 51 cases in a 2.1-year mean follow-up period), following septic PTFE graft removal, replaced with a bovine pericardial patch in the inguinal region.…”

Section: Discussionmentioning

confidence: 99%

“…Dulbecco et al [22] made a successful reconstruction with a bovine pericardial tubular aortobifemoral graft in case of an aortic graft infection. Lutz et al [19] used a hand-sewn bovine pericardial xenoprosthesis for in situ graft replacement of an infected descending or infrarenal aortic graft. Technical success and primary patency rates were 100%, and complete initial healing could be achieved in 76.9%.…”

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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“…39,40,44e46,48e50,52e 56,58,59,61,62,65,66,68,70,72,73,76,79e86,90,91,96e98,100,102e109,111,113e 118,120,121,124,127e129,131,132 Sixteen more studies were excluded because they described irrelevant topics other than abdominal AGI. 37,57,60,63,69,74,75,78,87,89,92,112,119,122,123,126 Finally, studies were excluded because of study design (n ¼ 5), 47,51,94,95,125 overlapping data (n ¼ 3), 42,43,99 language (n ¼ 9), 38,41,64,67,71,77,88,101,130 or a MINORS score < 9 (n ¼ 2). 93,110 A flow chart of the selection procedure is shown in Fig.…”

Section: Description Of Studiesmentioning

confidence: 99%

Systematic Review and Meta-Analysis on the Management of Open Abdominal Aortic Graft Infections

Post

Vos

2019

European Journal of Vascular and Endovascular Surgery

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WHAT THIS PAPER ADDS A systematic review of the literature was performed adhering to the PRISMA guidelines with strict selection criteria for study design, patient inclusion and exclusion criteria, and outcome reporting. This contributed to comparability of the individual study data. Since 2006 many new studies have been performed and these are included in the systematic review. Strict definitions and outcome criteria were used to improve comparability between the outcome data of the included studies. Objective: Aortic graft infection (AGI) is a disastrous complication with an incidence of 0.2e6% in operated patients. With little or no high quality evidence, the best treatment option remains unclear. Therefore, the literature on the management of open abdominal AGI was systematically reviewed to determine optimal treatment. Methods: In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic review and meta-analysis was conducted for AGI. MEDLINE, Embase, and the Cochrane Database of Systematic Reviews were searched. Methodological quality was assessed using the Methodological Index for Non-randomised Studies (MINORS) score. Primary outcomes were 30 day mortality and one year survival. Secondary outcomes were survival, infection recurrence, limb salvage, and graft patency. Results: Of 1574 studies identified, 32 papers were included in the study. The overall quality of the studies was moderate, with an average MINORS score of 11.9. Pooled overall 30 day mortality and one year survival were 13.5% (95% CI 10.5e16.4) and 73.6% (95% CI 68.8e78.4), respectively. The lowest 30 day mortality and highest one year survival were found for in situ repair compared with extra-anatomic repair and for prosthetic grafts compared with venous grafts or arterial allografts. The infection recurrence rate was highest for prosthetic grafts. Conclusions: There is a lack of well designed, qualitative comparative studies making conclusive recommendations impossible. The current best available data suggests that partial graft removal should be avoided and the lowest 30 day mortality and best one year survival are achieved with in situ repair using prosthetic grafts. Initiatives such as the MAGIC database to collaboratively collect prospective data are an important step forward in obtaining more solid answers on this topic.

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Bovine Pericardium as New Technical Option for In Situ Reconstruction of Aortic Graft Infection

Cited by 52 publications

References 30 publications

DSC and histological analysis of decellularized porcine biograft

DSC and histological analysis of decellularized porcine biograft

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

Systematic Review and Meta-Analysis on the Management of Open Abdominal Aortic Graft Infections

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