The safety of bovine tissue arterial repair in removal of infected prosthetic hemodialysis grafts

2020 ◽  
pp. 112972982094787
Author(s):  
Patrick Sowa ◽  
Peggie Halandras ◽  
Matthew Blecha
Keyword(s):  
Graft Infection ◽  
Morbidity And Mortality ◽  
Causative Organism ◽  
Arteriovenous Graft ◽  
Significant Morbidity ◽  
Autologous Vein ◽  
Wound Debridement ◽  
Bovine Tissue ◽  
Arterial Repair

Background: More than 400,000 Americans require dialysis, and many receive it via a prosthetic arteriovenous graft. Infection of these grafts is rare, but associated with significant morbidity and mortality. The gold standard is total graft excision with arteriotomy closure. This was previously done with autologous vein, but bovine tissue offers a reasonable alternative. The objective of this article is to evaluate a community hospital experience with bovine tissue arterial repair after total graft excision of infected prosthetic arteriovenous graft. Methods: A retrospective review was performed of all cases of infected prosthetic arteriovenous graft removal with bovine tissue arterial repair was performed. Thirteen cases were identified. Presentation, location of graft, and causative organism were reviewed; outcomes including reoperation and mortality were recorded. Results: Of the 13 patients, 12 (92%) had positive cultures of the graft, bloodstream, or wound. Methicillin-resistant Staphylococcus aureus was the most commonly isolated organism (54%). There were two unplanned reoperations including hematoma drainage and wound debridement within the first year. Over the 1-year follow-up period, 1 patient died for a mortality of 8%. There were no re-infections during follow-up. Discussion: Prosthetic arteriovenous graft infection remains a difficult challenge and is associated with significant morbidity and mortality. It presents in a variety of ways, including within an old thrombosed graft. Over the last several years, the causative organism has increasingly become drug resistant. Treatment with total graft excision requires arteriotomy closure, and for this bovine tissue has been demonstrated to be a viable option.

Community Hospital Experience With Bovine Tissue in Infected Vascular Fields

2020 ◽  
pp. 000313482095281
Author(s):  
Patrick Sowa ◽  
Michael Soult ◽  
Matthew Blecha
Keyword(s):  
Community Hospital ◽  
Graft Infection ◽  
Prosthetic Graft ◽  
Causative Organism ◽  
High Morbidity ◽  
Wound Debridement ◽  
Prosthetic Graft Infection ◽  
Hospital Experience ◽  
Bovine Tissue

Background Vascular prosthetic graft infections are rare but associated with high morbidity and mortality. Treatment involves removal of the infected graft requiring arteriotomy closure. Previously this was performed with autologous graft, but bovine tissue has increasingly been used. The objective of this paper is to review the community hospital experience with bovine tissue repair in an infected vascular field. Materials and Methods A retrospective review of all cases performed by a single surgeon in a community hospital for infected prosthetic grafts was completed. Sixteen cases were included where bovine tissue was used for repair. Presentation, location of graft, and causative organism were reviewed, and outcomes including reoperation and mortality were recorded. Results Of the 16 patients, 15 (94%) had positive cultures of the graft. Methicillin-Resistant Staph Aureus was the most commonly isolated organism (50%). There were 3 unplanned reoperations including a revision from below to above knee amputation, drainage of a hematoma, and a wound debridement within the first year. Over the 1 year follow up period, 3 patients died for a mortality of 19%. There were no reinfections during follow-up. Discussion Prosthetic graft infection is a rare but serious vascular surgery complication. The causative organism has shifted in the last few years to become increasingly drug resistant. Treatment requires excision, and bovine tissue has been demonstrated to provide a safe and durable method of repair.

scholarly journals Treatment of Snake Bites at a Regional Burn Center

2013 ◽  
Vol 6 (2) ◽  
pp. 44-50
Author(s):  
Gie N Yu ◽  
Stephen D Helmer ◽  
Anjay K Khandelwal
Keyword(s):  
Chart Review ◽  
Retrospective Chart Review ◽  
Time Frame ◽  
Morbidity And Mortality ◽  
Significant Morbidity ◽  
Wound Debridement ◽  
Burn Center ◽  
Snake Bites ◽  
Anaphylactoid Reactions ◽  
Complex Wounds

Background. Although uncommon, snakebites can cause significant morbidity and mortality. The objective of this study was to review the characteristics, treatment, and outcome of patients with a suspected or known snakebite who were treated at a regional verified burn center. Methods. A retrospective chart review of all snakebite victims was conducted for the time frame between January 1991 and June 2009. Results. During the study period, 12 patients were identified. One of the twelve patients was excluded because he had been admitted as an outpatient for wound debridement after being initially treated at another facility. Ten of the remaining 11 patients were male (90.9%). Rattlesnakes were responsible for the majority of bites. One of the eleven patients needed a fasciotomy. The majority of patients received antivenin (ACP/fabAV). No anaphylactoid reactions to either antivenin were recorded. There were no deaths. Conclusion. With burn centers evolving into centers for the care of complex wounds, patients with snakebite injuries can be managed safely in a burn center.

Midterm outcome of biosynthetic collagen prosthesis for treating aortic and peripheral prosthetic graft infections

Vascular ◽  
2021 ◽  
pp. 170853812110253
Author(s):  
Thomas Betz ◽  
Markus Steinbauer ◽  
Ingolf Toepel ◽  
Christian Uhl
Keyword(s):  
Femoral Artery ◽  
Graft Infection ◽  
Prosthetic Graft ◽  
Graft Occlusion ◽  
Infrarenal Aorta ◽  
Aortic Graft ◽  
Reinfection Rate ◽  
Autologous Vein

Objectives To report the midterm outcomes of treating prosthetic peripheral and aortic graft infections using a biosynthetic collagen prosthesis in a tertiary vascular center. Methods A retrospective analysis of all patients with prosthetic peripheral and aortic graft infections who underwent in situ reconstruction using a biosynthetic collagen prosthesis between March 2015 and November 2020 was conducted. Perioperative and midterm outcomes were analyzed. Results A biosynthetic collagen prosthesis was used in 19 patients (14 males, median age 66 years) to reconstruct the femoral artery ( n = 6), iliac artery ( n = 1), and infrarenal aorta ( n = 12). All patients were treated for a prosthetic vascular graft infection. The median follow-up period was 26.6 months (range 1–66 months). The 30-day graft failure rate was 15.7% ( n = 3), leading to a major amputation in one patient (5.3%). All grafts were occluded aortofemoral reconstructions in patients with occluded superficial femoral artery and were treated by immediate thrombectomy. The 30-day mortality rate was 5.3% ( n = 1), and survival after 3 years was 63.2%. The reinfection rate was 5.3% ( n = 1). At 13.6 months, the occlusion of a femoral graft was detected in 5.3% ( n = 1) and was treated with a new interposition graft. We observed no graft rupture or degeneration during follow-up. Conclusions Although results of in situ repair with autologous vein seem to be superior with little or none reinfection and low number of occlusions, biosynthetic collagen prostheses show acceptable midterm outcomes in terms of graft occlusion and mortality after prosthetic peripheral and aortic graft infections. Similar to other xenogenous materials, the reinfection rate is low with this prosthesis. With regard to immediate availability and easy handling, the use of a biosynthetic collagen prosthesis might be favorable compared to other replacement materials while treating prosthetic graft infections.

scholarly journals Patients with Single-Ventricle Physiology over the Age of 40 Years

2020 ◽  
Vol 9 (12) ◽  
pp. 4085
Author(s):  
Claudia Pujol ◽  
Sandra Schiele ◽  
Susanne J. Maurer ◽  
Julia Hock ◽  
Celina Fritz ◽  
...  
Keyword(s):  
Renal Disease ◽  
Single Ventricle ◽  
Independent Predictor ◽  
Demographic Data ◽  
Univariate Analysis ◽  
Morbidity And Mortality ◽  
Significant Morbidity ◽  
Single Ventricle Physiology ◽  
All Cause Mortality

Background: Single-ventricle physiology (SVP) is associated with significant morbidity and mortality at a young age. However, survival prospects have improved and risk factors for a negative outcome are well described in younger cohorts. Data regarding older adults is scarce. Methods: In this study, SVP patients under active follow-up at our center who were ≥40 years of age at any point between January 2005 and December 2018 were included. Demographic data, as well as medical/surgical history were retrieved from hospital records. The primary end-point was all-cause mortality. Results: Altogether, 49 patients (19 female (38.8%), mean age 49.2 ± 6.4 years) were included. Median follow-up time was 4.9 years (interquartile range (IQR): 1.8–8.5). Of these patients, 40 (81.6%) had undergone at least one cardiac surgery. The most common extracardiac comorbidities were thyroid dysfunction (n = 27, 55.1%) and renal disease (n = 15, 30.6%). During follow-up, 10 patients (20.4%) died. On univariate analysis, renal disease and liver cirrhosis were predictors of all-cause mortality. On multivariate analysis, only renal disease (hazard ratio (HR): 12.5, 95% confidence interval (CI): 1.5–106.3, p = 0.021) remained as an independent predictor. Conclusions: SVP patients ≥40 years of age are burdened with significant morbidity and mortality. Renal disease is an independent predictor of all-cause mortality.

scholarly journals Successful preoperative bridge with extracorporeal membrane oxygenation in three neonates with D-transposition of the great vessels and pulmonary hypertension

2018 ◽  
Vol 28 (9) ◽  
pp. 1175-1177 ◽  
Author(s):  
Ahmed S. Said ◽  
Mary E. McBride ◽  
Avihu Z. Gazit
Keyword(s):  
Pulmonary Hypertension ◽  
Cardiopulmonary Bypass ◽  
Extracorporeal Membrane Oxygenation ◽  
Postoperative Care ◽  
Morbidity And Mortality ◽  
Significant Morbidity ◽  
Membrane Oxygenation ◽  
Great Vessels ◽  
Extracorporeal Support

AbstractPulmonary hypertension with transposition of the great arteries is associated with significant morbidity and mortality. At the worst end of the spectrum are patients who undergo extracorporeal support perioperatively. We describe our experience with three patients who received preoperative extracorporeal support and separated from cardiopulmonary bypass successfully on conventional postoperative care, with no significant deficits on follow-up.

Cryopreserved human allografts for arterial repair in case of graft infection

2006 ◽  
Vol 54 (S 1) ◽  
Author(s):  
S Brand ◽  
O Teebken ◽  
A Haverich ◽  
M Pichlmaier
Keyword(s):  
Graft Infection ◽  
Arterial Repair

Prevalence of Asymptomatic Cryptococcal Antigenemia and Association with Follow-up risk of Cryptococcal Meningitis and Mortality among HIV Infected Patients in North West India – A Prospective Cohort Study

2020 ◽  
Vol 18 ◽  
Author(s):  
Rajendra Bhati ◽  
Pramendra Sirohi ◽  
Bharat Sejoo ◽  
Deepak Kumar ◽  
Gopal K Bohra ◽  
...  
Keyword(s):  
Cryptococcal Meningitis ◽  
Morbidity And Mortality ◽  
People Living With Hiv ◽  
Cryptococcal Antigen ◽  
North West ◽  
Cryptococcal Disease ◽  
Increased Risk ◽  
Living With Hiv ◽  
Inflammatory Syndrome

Objective: Cryptococcal meningitis is an important cause of morbidity and mortality in HIV infected individuals. In the era of universal antiretroviral therapy incidence of immune reconstitution inflammatory syndrome (IRIS) related cryptococcal meningitis has increased. Detection of serum cryptococcal antigen in asymptomatic PLHIV (People Living With HIV) and pre-emptive treatment with fluconazole can decrease the burden of cryptococcal disease. We conducted this study to find the prevalence of asymptomatic cryptococcal antigenemia in India and its correlation with mortality in PLHIV. Method and material: This was a prospective observational study. HIV infected ART naïve patients with age of ≥ 18 years who had CD4 counts ≤ 100 /µL were included and serum cryptococcal antigen test was done. These patients were followed for six months to look for the development of Cryptococcal meningitis and mortality. Results: A total of 116 patients were analysed. Asymptomatic cryptococcal antigenemia was detected in 5.17% patients and it correlated with increased risk of cryptococcal meningitis and mortality on follow-up in PLHIV. Conclusion: Serum cryptococcal positivity is correlated with increased risk of Cryptococcal meningitis and mortality in PLHIV. We recommend the screening of asymptomatic PLHIV with CD4 ≤ 100/µL for serum cryptococcal antigen, so that pre-emptive treatment can be initiated to reduce morbidity and mortality.

Punch Grafting for the Management of Hard-to-Heal Diabetic Foot Ulcers: A Prospective Case Series

2021 ◽  
pp. 153473462110310
Author(s):  
Marta García-Madrid ◽  
Irene Sanz-Corbalán ◽  
Aroa Tardáguila-García ◽  
Raúl J. Molines-Barroso ◽  
Mateo López-Moral ◽  
...  
Keyword(s):  
Wound Healing ◽  
Clinical Outcomes ◽  
Diabetic Foot ◽  
Donor Site ◽  
Case Series ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Wound Debridement ◽  
Prospective Case Series

Punch grafting is an alternative treatment to enhance wound healing which has been associated with promising clinical outcomes in various leg and foot wound types. We aimed to evaluate the clinical outcomes of punch grafting as a treatment for hard-to-heal diabetic foot ulcers (DFUs). Six patients with chronic neuropathic or neuroischemic DFUs with more than 6 months of evolution not responding to conventional treatment were included in a prospective case series between May 2017 and December 2020. All patients were previously debrided using an ultrasound-assisted wound debridement and then, grafted with 4 to 6 mm punch from the donor site that was in all cases the anterolateral aspect of the thigh. All patients were followed up weekly until wound healing. Four (66.7%) DFUs were located in the heel, 1 (16.7%) in the dorsal aspect of the foot and 1 (16.7%) in the Achilles tendon. The median evolution time was 172 (interquartile range [IQR], 25th-75th; 44-276) weeks with a median area of 5.9 (IQR; 1.87-37.12) cm2 before grafting. Complete epithelization was achieved in 3 (50%) patients at 12 weeks follow-up period with a mean time of 5.67 ± 2.88 weeks. Two of the remaining patients achieved wound healing at 32 and 24 weeks, respectively, and 1 patient showed punch graft unsuccessful in adhering. The median time of wound healing of all patients included in the study was 9.00 (IQR; 4.00-28.00) weeks. The wound area reduction (WAR) at 4 weeks was 38.66% and WAR at 12 weeks was 88.56%. No adverse effects related to the ulcer were registered through the follow-up period. Autologous punch graft is an easy procedure that promotes healing, achieving wound closure in chronic DFUs representing an alternative of treatment for hard-to-heal DFUs in which conservative treatment has been unsuccessful.

Evaluation of an Electronic Dosing Calculator to Reduce Pediatric Medication Errors

2019 ◽  
Vol 58 (4) ◽  
pp. 413-416
Author(s):  
Brian Murray ◽  
Matthew J. Streitz ◽  
Michael Hilliard ◽  
Joseph K. Maddry
Keyword(s):  
Patient Safety ◽  
Medication Errors ◽  
Prospective Cohort ◽  
Pediatric Patients ◽  
Cohort Analysis ◽  
Morbidity And Mortality ◽  
Patient Visit ◽  
Significant Morbidity ◽  
Potential Source ◽  
Medication Dosage

Introduction. Adverse medication events are a potential source of significant morbidity and mortality in pediatric patients, where dosages frequently rely on weight-based formulas. The most frequent occurrence of medication errors occurs during the ordering phase. Methods. Through a prospective cohort analysis, we followed medication errors through patient safety reports (PSRs) to determine if the use of a medication dosage calculator would reduce the number of PSRs per patient visits. Results. The number of PSRs for medication errors per patient visit occurring due to errors in ordering decreased from 10/28 417 to 1/17 940, a decrease by a factor of 6.31, with a χ2 value of 4.063, P = .0463. Conclusion. We conclude that the use of an electronic dosing calculator is able to reduce the number of medication errors, thereby reducing the potential for serious pediatric adverse medication events.

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