Own Superficial Femoral Vein Versus Silver Bonded Artificial Graft in Patients with Vascular Prosthesis Infection in Aorto-Femoral Position: Treatment Results Comparison

• Authors: Stanisław Molski , Aleksander Łukasiewicz
• Languages of publication: EN

Abstracts

EN

Vascular prosthesis infection in aorto-femoral position presents a life-threatening complication. Two operative modalities are utilized in the authors center: own superficial femoral veins (SFVR) and silver salts bonded anatomic reconstruction (AgR).The aim of the study was comparison of the two treatment methods in terms of early and distant clinical resultsMaterial and methods. 35 patients were qualified for infected aorto-femoral graft removal. In years 2000-2004 SFVR was conducted in 19 patients and in years 2005-2007 16 patients had AgR done. These groups were compared in terms of demographic, co-morbidity, vascular reconstructions history, infection symptoms and bacterial contamination. Then treatment results analysis was performed including: operation course, mortality, postoperative morbidity, amputation rate and further observation results.Results. There were no differences in demographic and co-morbidity between the groups. First operation/clinical symptoms onset interval was significantly longer for AgR patients (8 vs 3.3 years, p=0.001). Purulent inguinal sinus was dominating infection manifestation in both groups. Swab results were similar for both groups (Gram+ species dominated in both). Analysis of course and results of operative treatment revealed that AgR operation time was shorter than SFVR (195 vs 317, p<0.001), intraoperative blood requirement was also lower for AgPR (1.6 vs 3.1, p<0.05). Postoperative death, postoperative bleeding, reinterventions and amputation rate were higher for SFVR than AgR, however differences were not significant. During follow-up no infection recurrence was observed.Conclusions. We believe that AgPR is superior comparing with SFVR for patients with infected vascular prosthesis in the aorto-femoral prosthesis. Further investigations are mandatory to confirm our results.

Keywords

EN

vascular graft; infection; surgery

• Publisher: Index Copernicus International
• Journal: Polish Journal of Surgery
• Year: 2009
• Volume: 81
• Issue: 4
• Pages: 165-171

Dates

published

1 - 4 - 2009

online

14 - 5 - 2009

Contributors

author

Stanisław Molski

• Department of General and Vascular Surgery, CM UMK in Toruń

author

Aleksander Łukasiewicz

• Department of General and Vascular Surgery, CM UMK in Toruń

References

• Franke S, Voit R: The superficial femoral vein as arterial substitute in infections of the aortoiliac region. Ann Vasc Surg 1997; 11: 406-12.[Crossref][PubMed]
• Bunt TJ: Synthetic vascular graft infections. I: graft infections. Surgery 1983; 93: 733-46.[PubMed]
• Clagett GP, Bowers BL, Lopez-Viego MA, et al.: Creation of a neo-aortoiliac system from lower extremity deep and superficial veins. Ann Surg 1993; 218: 239-48.
• Nevelsteen A, Lacroix H, Suy R: The superficial femoral vein as autogenous conduit in the treatment of prosthetic arterial infection. Ann Vasc Surg 1993; 7: 556-60.[PubMed][Crossref]
• Molski S, Jundziłł W, Łukasiewicz A: Autologus superficial femoral vein reconstruction in vascular prosthetic graft infections in aorto-femoral position-own experience. Acta Angiol 2004; Vol. 10: 4; 189-96.
• Wojciechowski J, Halena G, Trener M, et al.: Superficial femoral vein versus extra-anatomic bypass in treatment of vascular prosthesis infection. Acta Angiol 2005; 11; 50-60.
• Pukacki F, Gabriel M, Chęciński P i wsp.: Sześcioletnie doświadczenia w zastosowaniu mrożonych tętniczych przeszczepów alogenicznych w leczeniu chorych z zakażeniem dużych protez naczyniowych. Pol Przegl Chir 2003; 75: 579-95.
• Verhelst R, Lacroix V, Vraux H: Use of cryopreserved arterial homografts for management of infected prosthetic grafts: a multicentric study. Ann Vasc Surg 2000; 14: 602-07.[Crossref][PubMed]
• Torsello G, Sandmann W, Gehrt A, et al.: In situ replacement of infected vascular prostheses with rifampin-soaked vascular grafts: early results. J Vasc Surg 1993; 17: 768-73.[Crossref]
• Ricco JB: InterGard silver bifurcated graft: features and results of a multicenter clinical study. J Vasc Surg 2006; 44: 339-46.[WoS][PubMed][Crossref]
• Hardman S, Cope A, Swann A, et al.: An in vitro model to compare the antimicrobial activity of silver-coated versus rifampicin-soaked vascular grafts. Ann Vasc Surg 2004; 18: 308-13.[Crossref]
• Staszkiewicz W: Zakażenia w chirurgii naczyniowej. W: Chirurgia tętnic i żył obwodowych red. W. Noszczyk. PZWL, Warszawa 1998.
• Gabriel M, Oszkinis G, Stanisić M, et al.: Prosthetic graft infection treated by local surgery - comparative analysis of 64 consecutive cases. Acta Angiol 2006; 12(4): s. 167-79.
• Yeager RA, Moneta GL, Taylor LM, et al.: Improving survival and limb salvage in patients with aortic graft infection. Am J Surg 1989; 159: 466-69.
• Seeger JM, Back MR, Albright JL, et all Influence of patient characteristics and treatment options on outcome of patients with prosthetic aortic graft infections. Ann Vasc Surg 1999; 13: 413-20.[Crossref]
• Pupka A, Skóra J, Janczak D i wsp.: The treatment of massive prosthetic grafts infection with the use of silver/collagen coated dacron vascular prosthesis. Polim Med 2003; 33: 41-45.

Identifiers

DOI

10.2478/v10035-009-0025-x