Human Thrombin–Gelatin Matrix With Rifampin: A Novel Technique for Treating Vascular Graft Infections

Abstract

Approximately 1% to 6% of prosthetic vascular grafts will be complicated by infection. However, the mortality rates have ranged from 17% to 40%, and the morbidity is also high, including reinfection rates reported at 18% and limb loss close to 11%. Early aggressive surgical management, including graft excision and wide wound debridement with extra-anatomic bypass creation is the reference standard. Graft preservation techniques have been increasingly used, with high cure rates. Muscle flap, coverage, and antibiotic-coated absorbable and nonabsorbable beads have been reported to provide high cure rates but with associated technical difficulties and suboptimal graft salvage rates. We implemented a novel technique for localized antibiotic therapy using a human thrombin–gelatin matrix with rifampin (HTGM+R) at our institution for the past 5 years (Figs 1 and 2). We have described the rates of graft salvage, reintervention, limb salvage, and infection recurrence. We performed a retrospective cohort study of patients who had presented with prosthetic vascular graft infection from January 2016 through June 2021 and had been treated using our novel technique. Statistical analysis included descriptive frequencies of the demographic variables and outcomes of interest. A total number of 16 patients with a total of 32 interventions were included in the present study. Approximately 76.5% had required two or more interventions. HGTM+R was used for 15 interventions (46.9%) in 14 patients. Thrombectomy was the second most common intervention (n = 11; 34.4%). The mean age was 65.2 years, and the mean body mass index was 26.7 kg/m2. The common comorbidities are shown in the Table. The graft salvage rate was 80%, the limb salvage rate was 93.3%, and the freedom from infection rate was 86.7% for HGTM+R. However, the reintervention rate was 28.6%. Only four patients had required graft excision at an average follow-up of 12 months. Hypertension was the most common comorbidity, followed by diabetes and steroid use. Finally, no association with specific bacteria was seen. To date and to the best of our knowledge, the present study is the only study to describe this novel technique for treating prosthetic vascular graft infections. Moreover, it is the only study to describe the outcomes of HGTM+R in the treatment of prosthetic vascular graft infection.Fig 2View Large Image Figure ViewerDownload Hi-res image Download (PPT)