Biosynthetic vascular graft: a valuable alternative to traditional replacement materials for treatment of prosthetic aortic graft infection?

Background and Aims: To report the experience of a tertiary vascular surgery center using Omniflow II® biosynthetic vascular grafts for treatment of prosthetic aortic graft infection. Materials and methods: Retrospective analysis of all patients with prosthetic graft infections who underwent in situ aortic reconstruction using Omniflow II® grafts or other conduits between March 2015 and May 2017. Early and late mortality, perioperative complications, and reinfection rate were analyzed. Results: Sixteen patients (14 males, median age 68.5, range 57–89) with prosthetic aortic graft infection were treated at our center. Eight patients received an Omniflow II® biosynthetic graft, two patients silver-triclosan coated grafts, three patients bovine pericardial tube grafts, and three patients composite bovine pericardial tube grafts with Omniflow II® graft extensions. Perioperative complications occurred in seven patients (43.8%). Early mortality rate was 18.7% (n = 3). In addition, four patients died during follow-up after a median of 11 months (range 0–34 months). We did not observe any reinfections. Bypass grafts were patent in all patients. No major limb amputations were performed during follow-up. Conclusion: Treatment of prosthetic aortic graft infection with Omniflow II® vascular grafts is feasible. Graft material seems to have an excellent resistance to infection and might be a valuable alternative to traditional replacement materials. Especially long-term durability has to be continuously monitored and documented.

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Ovine Biosynthetic Grafts for Aortoiliac Reconstructions in Nonsterile Operative Fields

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0041-1723000 ◽

2021 ◽

Author(s):

Hazem El Beyrouti ◽

Mohammad Bashar Izzat ◽

Angela Kornberger ◽

Nancy Halloum ◽

Kathrin Dohle ◽

...

Keyword(s):

Treatment Group ◽

Vascular Grafts ◽

Graft Infection ◽

Prosthetic Graft ◽

Vascular Graft Infection ◽

Vascular Prostheses ◽

Graft Thrombosis ◽

Life Threatening ◽

Omniflow Ii

Abstract Background Prosthetic vascular grafts placed surgically or via endovascular techniques can be subject to the risk of life-threatening graft infections. The Omniflow II vascular prosthesis is a biosynthetic graft that was reported to have favorable properties in resisting infections. Materials and Methods We retrospectively reviewed our 3 years' experience of using the Omniflow II prostheses for aortoiliac reconstructions in patients considered to carry a substantial risk of subsequent prosthetic graft infections (prevention group) as well as in patients with actively infected prosthetic vascular grafts (treatment group). Results Aorto-bi-iliac (n = 4) and aortobifemoral (n = 12) vascular reconstructions were performed using bifurcated Omniflow II prostheses in nine patients in the prevention group and seven patients in the treatment group. During mean follow-up of 28.6 ± 17.2 months, there was one case of graft infection (6.3%) and graft thrombosis (6.3%) with subsequent successful thrombectomy. Early and late surgical revisions were required in eight (50%) and two (12.6%) patients, respectively. All graft prostheses were patent at last follow-up. Conclusion Using bifurcated Omniflow II vascular prostheses in patients with or at a high risk of vascular graft infection is advisable, and is associated with acceptable reinfection and patency rates.

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Surgical Treatment of the Infected Aortic Graft

10.2310/vasc.3057 ◽

2017 ◽

Author(s):

Jayer Chung

Keyword(s):

Preoperative Evaluation ◽

Graft Infection ◽

Prosthetic Graft ◽

Vascular Reconstruction ◽

Graft Material ◽

Aortic Graft ◽

Operative Planning ◽

Femoral Vessels ◽

Aortic Graft Infection ◽

Autogenous Reconstruction

The primary goal of treatment in dealing with an infected aortic graft is to save life and limb. This goal is best accomplished by eradicating all infected graft material and maintaining adequate circulation with appropriate vascular reconstruction. This review describes the choice of procedures, including an extra-anatomic bypass, an aortic allograft, an antibiotic-treated prosthetic graft, and an in situ autogenous reconstruction. Once a procedure has been decided on, preoperative evaluation and operative planning must take place. The review describes operative technique from the thigh incision and exposure of the femoral vessels to closure. Postoperative care is described. Outcomes and complications are discussed. Special consideration is given to aortoenteric fistulas. This review contains 8 figures, 2 tables, and 83 references. Key words: antibiotic-impregnated Dacron, aortic graft infection, aortoenteric erosion, aortoenteric fistula, axillobifemoral bypass, cryopreserved allograft, neoaortoiliac surgery

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SURGICAL MANAGEMENT AND BACTERIOLOGICAL OUTCOME OF INFRARENAL ABDOMINAL AORTIC GRAFT INFECTION AT A SINGLE CENTRE

Indian Journal of Medical Research and Pharmaceutical Sciences - September-2020 ◽

10.29121/ijmrps.v8.i5.2021.4 ◽

2021 ◽

Vol 8 (5) ◽

pp. 25-29

Keyword(s):

Graft Infection ◽

Treatment Result ◽

Secondary Outcome ◽

Clinical Consequence ◽

Secondary Outcome Measure ◽

Infrarenal Aorta ◽

Aortic Graft ◽

Aortic Graft Infection

Aim: Primary outcome measures was to analyze the clinical consequence of patients who treated for infrarenal aorta synthetic graft infection ( SGI) with extra-anatomical bypass (axillobifemoral (AXF)) or in situ reconstruction (ISR). Secondary outcome measure was to show bacteriological analysis of abdominal aorta graft infection. Method: Analysis of medical records of 24 patients treated for SGI at Jordanian Royal Medical Services between June 2010 and Aug 2020 were retrospectively reviewed. For all patients, we recorded clinical features , morbidity and mortality , as well as bacteriology results, and antibiotic treatment . Result: We identified 24(3%) patients with SGI .The median follow up duration was 22 months range (8-84months). The median age was 52 years and 18 were males. An in situ prosthetic graft replacement, using rifampin-soaked polyester graft was performed in 10 patients(42%) and AXF in 14 patients((58%). The early hospital mortality rate was 4 (17 %.) owing to bowel ischemia 1 patient, 2 patients with septicemia and one patient with aortic stump blowout . There were no late procedure-related deaths during follow up period Primary patency and limb salvage rates at 3 years were 80 %(2 patients ) for ISR and 90%( 2 patients) for AXF. The incidence of graft reinfection was 10% (1 patient) for ISR and 8 %(2 patients) for AXF. Graft reinfection occurred in 3 patients (12.5%) was not associated with procedure-related death .Microbiology specimens obtained from the graft and the tissues were positive in 21 patients(88%). Poly microbial Gram-positive organisms were the most dominant bacteria found in 10 patients (42%). The mean length of hospital stay was 17 days . Conclusion: According to our study ISR and AXF is a safe and effective in treatment of aortic graft infection. Graft reinfection occurred in 12.5% of the patients. The graft patency and limb salvages rates were considered satisfactory.

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

Vascular ◽

10.1177/17085381211025380 ◽

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.

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Treatment of aortic graft infection by in situ reconstruction with Omniflow II biosynthetic prosthesis

Vascular ◽

10.1177/1708538115621195 ◽

2016 ◽

Vol 24 (6) ◽

pp. 561-566 ◽

Cited By ~ 8

Author(s):

AG Krasznai ◽

MGJ Snoeijs ◽

MP Siroen ◽

T Sigterman ◽

A Korsten ◽

...

Keyword(s):

Structural Integrity ◽

Graft Infection ◽

Anastomotic Dehiscence ◽

Vascular Prosthesis ◽

Aortic Graft ◽

In Situ Reconstruction ◽

Aortic Graft Infection ◽

Omniflow Ii ◽

Low Incidence

Currently available conduits for in situ reconstruction after excision of infected aortic grafts have significant limitations. The Omniflow II vascular prosthesis is a biosynthetic graft associated with a low incidence of infection that has succesfully been used in the treatment of infected infrainguinal bypass. We report on the first use of the Omniflow II prosthesis for in situ reconstruction after aortic graft infection. A bifurcated biosynthetic bypass was created by spatulating and anastomosing two 8-mm tubular Omniflow II grafts. This bypass was used for in situ reconstruction after excision of infected aortic grafts in three cases. After a mean follow-up of 2.2 years, no occlusion, degeneration, or rupture of the Omniflow II grafts was observed. Although one patient suffered from graft reinfection, the bypass retained structural integrity and no anastomotic dehiscence was observed. Treatment of aortic graft infection by in situ reconstruction with the Omniflow II vascular prosthesis is feasible. Its resistance to infection and off-the-shelf availability make this graft a promising conduit for aortoiliac reconstruction.

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Aortic Graft Infection as a Cause of Multiple Brain Infarcts

Case Reports in Cardiology ◽

10.1155/2012/575169 ◽

2012 ◽

Vol 2012 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Vassiliki Tsirka ◽

Jelena Maletic ◽

Panagiotis Ioannidis ◽

Dimitrios Karacostas

Keyword(s):

Previous History ◽

Graft Infection ◽

Prosthetic Graft ◽

Acute Onset ◽

Aortic Graft ◽

Aortic Valves ◽

Brain Infarcts ◽

History Of ◽

Aortic Graft Infection ◽

Echocardiographic Evidence

Brain embolism of cardiac origin is common in clinical practice. However, embolic brain infarcts due to aortic graft infection are very rare. We present a case of a 53-year-old woman with multiple brain infarcts, following an infection of ascending aortic graft. She was presented with fever and acute onset neurological deficit, and she had a previous history of replacement of ascending aorta with a prosthetic graft, because of aortic aneurysm 2 years before her admission. The patient had positive blood cultures and echocardiographic evidence of vegetation in the graft aortic joint, nearby the aortic valves. Despite the severe clinical condition and the poor prognosis, because of the coexistence of cardioembolism and aortic graft infection, our patient had a good outcome with conservative treatment and she will be considered for surgical graft replacement after her full recovery.

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705 Aortic Graft Infection Managed with Bovine Patch, A Case Report and Literature Review

British Journal of Surgery ◽

10.1093/bjs/znab259.314 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

T El-nakhal ◽

S Eid ◽

W Al-Jundi

Keyword(s):

Case Report ◽

Literature Review ◽

Vascular Surgery ◽

Literature Search ◽

Graft Infection ◽

Aortic Graft ◽

Aortic Graft Infection ◽

Bovine Patch

Abstract Aim to describe good outcomes in a case with Aortic graft infection (AGI) managed with Bovine patch and outline management of AGI. Method Literature review utilising keywords ‘’Aortic graft infection’’AND’’Bovine Patch’’ revealed initially 1350 articles, all studies in English were included, all duplicates were removed, screening was performed using the PRISMA flow. To correlate with the findings, we followed up a 72-year-old patient who presented with aortic graft infection followed by graft explantation and a fashioned Bovine graft insertion and followed up for 1 year for any re-infection in the clinics. Results Literature search resulted 73 articles discussing the role of Bovine Patch as a choice in prevention of Aortic graft re-infection. In our case, there was no clinical nor radiological evidence of Bovine patch re-infection for over a year. Literature review showed that AGI is a rare but serious complication with mortality up to 60%.The main management is IV antibiotics, followed by graft explantation and consideration of re-implantation of various types of grafts. The European society of vascular surgery (ESVS) guidelines recommend re-implantation with an aortic antibiotic soaked graft, yet re-infection rate is quoted at 20%. however, in our case Bovine graft was free from re-infection at 1 year follow up. Conclusions IV anitbioics and explantation remain the mainstay for treatment of aortic grafts infection, however, there is increasing evidence that Bovine grafts show excellent freedom from re-infection at follow up. Hence, this might be the conduit of choice when performing such surgeries; however, more evidence is needed.

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