Use of a Silver-Impregnated Vascular Graft: Single-Center Experience

Abstract

Introduction: Vascular graft infection is a life threatening situation with significant morbidity and mortality. Bacterial graft infection can lead to false aneurysms, bleeding and sepsis. There are a lot of risky situations where grafts can become infected. It is therefore highly desirable to have a vascular graft that is resistant to infection. In this retrospective clinical study, a silver-impregnated vascular graft was evaluated in various indications. Methods: Our study included a total of 71 patients who received a silver-impregnated vascular graft during the period from 2013 to 2018. Patients had an aortoiliac localization of vascular graft in 61 cases (86%), and a peripheral localization on the lower limbs in 10 cases (14%). Indications for the use of these special vascular grafts were trophic lesions or gangrene in the lower limbs in 24 cases (34%), suspicious mycotic abdominal aortic aneurysm (mAAA) in 4 cases (5.5%), salmonela aortitis or aneurysms in 4 cases (5.5%), infection of the previous vascular graft in 11 cases (15.5%), other infections in 12 cases (17%), AAA rupture in 10 cases (14%) and other reasons (pre-transplant condition, multiple trauma, graft-enteric fistula) in 6 cases (8.5%). Thirty-day mortality, morbidity, the need for reintervention and amputation, primary and secondary graft patency, and finally the presence of a proven vascular graft infection were evaluated. Results: The 30-day mortality was 19.7%, and morbidity was 42.2%. The primary patency of the vascular graft was 91.5%. Reoperation was necessary in 10 cases (14%) and amputation was necessary in 10 cases (14%). The median length of hospital stay was 13 days and the mean follow-up period was 48 ± 9 months. During the follow-up period, six patients (8.5%) died from reasons unrelated to surgery or without any relation to the vascular graft. Secondary patency after one year was 88%. Infection of the silver graft was observed in three patients (4.2%). Conclusions: Based on our results, the silver graft is a very suitable alternative for solving infectious, or potentially infectious, situations in vascular surgery. In particular, in urgent or acute cases, a silver graft is often the only option.

Infection of Vascular Prostheses: A Comprehensive Review

“…There are no wide studies on these materials, and, therefore, no definitive conclusions can be drawn. There is still little evidence for silver-coated grafts and bovine-pericardium xenogenous grafts, and further studies are needed to confirm their efficacy in VGEIs [16,22,[129][130][131][132][133][134][135][136]. Autologous femoral veins may also be used for an in situ reconstruction of the aorto-iliac segment in VGEIs [137][138][139][140].…”

Influence of Electrospun Fibre Secondary Morphology on Antibiotic Release Kinetic and Its Impact on Antimicrobic Efficacy

“…Currently, few antimicrobial VGs are commercially available, including elemental or acetate-silver-coated/impregnated PET grafts, or rifampicin-bonded or -soaked PET grafts. The latter could be with or without the synergistic effect of silver and triclosan [11,12]. These grafts have proven to be effective in aorta or lower limb vascular surgery but are not available in a calibre compatible with small-diameter arteries.…”