Cellular Growth Factors for Preventing Clinical Prosthetic Graft Infection

Abstract

Introduction: Prosthetic vascular graft infection is a challenging fatal complication after an aortic surgery. The tissue surrounding a prosthetic graft does not generate a vascular network very well, making it difficult for immunocompetent cells and antibiotics to penetrate the infected area around the prosthetic graft. For improved mobilization of immunocompetent cells and delivery of therapeutic antibiotics, the omental transfer and pectoral muscle flap techniques are often employed as a treatment of graft infection, leveraging capillary richness of omentum and pectoral muscles. We have previously demonstrated in a rat model that sustained release of basic fibroblast growth factor (bFGF) from gelatin hydrogel microspheres-incorporated prosthetic Dacron graft can induce angiogenesis around the graft with or without concomitant systemic administration of granulocyte-colony stimulating factor (G-CSF). We have also shown that increased vascularity around the graft can exert a preventive role against bacterial infection. The purpose of this study is to evaluate the clinical outcome of sustained local administration of bFGF and systemic G-CSF. Methods: Six patients underwent replacement of descending thoracic aorta or thoracoabdominal aorta through left thoracotomy. Biodegradable polyglycol acid (PGA) felt was coated with gelatin hydrogel, impregnated with 100 μg of bFGF, and used at the anastomotic site. Two days after the operation, 5 μg/kg of G-CSF was injected subcutaneously. Results: There was no prosthetic graft infection or adverse event. Conclusions: No adverse event was found by using bFGF incorporated into prosthetic grafts with systemic G-CSF. This method may prevent prosthetic graft infection.