Prosthetic Infection: Lessons from Treatment of the Infected Vascular Graft

Herscu, Gabriel; Wilson, Samuel E.

doi:10.1016/j.suc.2008.09.007

Cited by 41 publications

(26 citation statements)

References 44 publications

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“…Aortic graft infections can present with gastrointestinal hemorrhage from an aortoenteric fistula, rupture from a pseudoaneurysm, and sepsis; these are associated with a 20% mortality rate and 5–25% amputation rate. 1 Peripheral vascular graft infections are also associated with significant morbidity including sepsis, anastomotic disruption, thrombosis, limb loss, and up to 22% mortality. 1,2 …”

Section: Introductionmentioning

confidence: 99%

Bio-absorbable antibiotic impregnated beads for the treatment of prosthetic vascular graft infections

et al. 2016

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Objective There is limited investigation into the use of bio-absorbable antibiotic beads for the treatment of prosthetic vascular graft infections. Our goal was to investigate the rates of infection eradication, graft preservation, and limb salvage in patients who are not candidates for graft explant or extensive reconstruction. Methods A retrospective review of patients implanted with antibiotic impregnated bio-absorbable calcium sulfate beads at a major university center was conducted. Results Six patients with prosthetic graft infections were treated with bio-absorbable antibiotics beads from 2012–2014. Grafts included an aortobifemoral, an aorto-hepatic/superior mesenteric artery, and four extra-anatomic bypasses. Pathogens included Gram-positive and Gram-negative bacteria. Half of the patients underwent graft explant with reconstruction and half debridement of the original graft, all with antibiotic bead placement around the graft. Mean follow-up was 7.3±8.3 months; all patients had infection resolution, healed wounds, and 100% graft patency, limb salvage, and survival. Conclusion This report details the successful use of bio-absorbable antibiotic beads for the treatment prosthetic vascular graft infections in patients at high risk for graft explant or major vascular reconstruction. At early follow-up, we demonstrate successful infection suppression, graft preservation, and limb salvage with the use of these beads in a subset of vascular patients.

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Section: Introductionmentioning

confidence: 99%

Bio-absorbable antibiotic impregnated beads for the treatment of prosthetic vascular graft infections

et al. 2016

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“…[1][2][3][4] Classic management of this challenging problem includes complete removal of a prosthetic implant with extra-anatomic reconstruction. 5 Other management strategies have included selected in situ replacement or graft preservation.…”

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confidence: 99%

Antibiotic-loaded polymethylmethacrylate beads for the treatment of extracavitary vascular surgical site infections

Stone

Mousa

Hass

et al. 2012

Journal of Vascular Surgery

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Antibiotic-loaded PMMA beads may serve as an adjunct in the management of VSSIs and may also expand treatment options for graft preservation or in situ reconstruction, with expected recurrent infection rate approaching 20%. Further experience with this adjunct may help elucidate its role in the management of this complicated problem, including the need for bead exchanges, until perigraft cultures are free of microbes.

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“…The use of synthetic material, such as PTFE and GORE-TEX, shortens operation time and avoids iatrogenic morbidity when harvesting an autologous vein [13,29]. Although two recent studies showed good results using PTFE interposition grafts for mesentorico-portal vein repair, controversial reports on reduced patency and increased risk of prosthetic infections after in situ placement limit its widespread application in abdominal surgery [13,29,30,31]. Also, long-term anticoagulation is deemed necessary after the implementation of synthetic grafts.…”

Section: Discussionmentioning

confidence: 99%

Bovine Pericardium for Portal Vein Reconstruction in Abdominal Surgery: A Surgical Guide and First Experiences in a Single Center

et al. 2015

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Background: Resection and reconstruction of infiltrated vessels achieve resectability of extended pancreatic tumors. The aim of the present study was to assess the feasibility of bovine pericardium as graft material for the individualised portal vein reconstruction and demonstrate a surgical technique for abdominal vein repair. Methods: We performed a MEDLINE search to review the methods for complex abdominal vein reconstruction in the course of extended pancreatectomy. Moreover, clinical data of patients receiving portal vein reconstruction using a bovine pericardial patch at our institution were retrospectively analyzed. Results: Based on the results of a review of the literature, autologous venous grafts using the internal jugular vein represent the most popular option for segmental portal vein reconstruction in case of impossible direct suture. At our center, segmental portal vein reconstruction with bovine pericardial patch in course of pancreatic surgery was performed in 4 patients. No case of vascular complications such as occlusion, segmental stenosis or thrombosis occurred. Conclusions: Our experience suggests a surgical procedure for an individual size-matched portal vein reconstruction using bovine pericardium. Although first results appear promising, prospective studies are required to objectively assess the patency of bovine pericardium compared with autologous and synthetic interposition grafts for portal vein reconstruction.

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Prosthetic Infection: Lessons from Treatment of the Infected Vascular Graft

Cited by 41 publications

References 44 publications

Bio-absorbable antibiotic impregnated beads for the treatment of prosthetic vascular graft infections

Bio-absorbable antibiotic impregnated beads for the treatment of prosthetic vascular graft infections

Antibiotic-loaded polymethylmethacrylate beads for the treatment of extracavitary vascular surgical site infections

Bovine Pericardium for Portal Vein Reconstruction in Abdominal Surgery: A Surgical Guide and First Experiences in a Single Center

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