Prosthetic Vascular Graft Infection Research Articles

Nocardia Bacteremia Associated with a Prosthetic Vascular Graft Infection.

Nocardia Bacteremia Associated with a Prosthetic Vascular Graft Infection.

Actinomyces spp. Prosthetic Vascular Graft Infection (PVGI): A Multicenter Case-Series and Narrative Review of the Literature.

Actinomycosis represents a challenging and under-reported complication of vascular surgery. Optimal management of Actinomyces spp. prosthetic vascular graft infection (PVGI) is highly uncertain because of the paucity of reports on this disease. We conducted a retrospective case-series of Actinomyces-PVGI that occurred in the last five years in two major university hospitals in northern Italy. We searched for previously published cases in the scientific literature. We report five original cases of Actinomyces spp. prosthetic vascular graft infection following aortic aneurysm repair. Our literature review retrieved eight similar cases. Most patients were immunocompetent males. Most infections were polymicrobial (11/13 cases), with a prevalence of A. odontolyticus involvement (3/13 cases were associated with. Salmonella spp. infection). All cases had a late presentation (≥4 months from graft placement), with 61% associated with an aorto-enteric fistula. All patients received antibiotic therapy, but the duration was highly heterogeneous (from two weeks to life-long antibiotics). The patients without surgical revision experienced septic recurrences (2/13), permanent dysfunction (1/13), or a fatal outcome (2/13), while of the remainder who underwent vascular graft explant, six recovered completely and one developed a periprosthetic abscess. In two cases follow-up was not available. This case-series aims to raise the diagnostic suspicion and to describe the current management of Actinomyces-PVGIs. We highlight a high heterogeneity in antibiotic duration, choice of the antibiotic regimen, and surgical management. Higher reporting rate is advisable to produce better evidence and optimize management of this rare complication of vascular surgery.

Long-Term Suppressive Therapeutic-Drug-Monitoring-Guided Dalbavancin Therapy for Cardiovascular Prosthetic Infections.

Dalbavancin represents a promising treatment for cardiovascular prosthetic infections due to its prolonged half-life, bactericidal activity, large spectrum of activity, and excellent biofilm penetration. However, the use of dalbavancin in this setting is limited, and only a few cases have performed therapeutic drug monitoring (TDM) analysis to optimize dosage in suppressive treatments longer than 4 weeks. Our retrospective case series reports the use of dalbavancin in a small cohort of patients with cardiovascular prosthetic infections (cardiac implantable electronic device infections (CEDIs), prosthetic valve endocarditis (PVE), prosthetic vascular graft infections (PVGIs)) treated with dalbavancin as sequential therapy. From May 2019 to May 2023, 14 patients were included: eight cases of PVE (57.1%), seven cases of PVGI (50%), three cases of CEDI (21.4%), and four cases with overlap of infection sites (28.6%). The main pathogen was Staphylococcus aureus (35.7%). Prosthesis replacement was obtained in four patients (28.6%). The median time between symptom onset and the end of treatment was 15 weeks (IQR 7-53), with a median duration of dalbavancin therapy of 8 weeks (IQR 1 to 45 weeks) and 3.5 doses per patient. Among patients managed with TDM-guided strategy, dalbavancin infusion intervals ranged from 4 to 9 weeks. The median length of follow-up was 65 weeks (IQR 23 to 144 weeks). Clinical success was achieved in 10 cases (76.9%); all clinical failures occurred in patients with the implant retained. Among patients monitored by TDM, clinical success was 87.5% vs. 60% in patients treated without TDM. Because of pharmacokinetic individual variability, dalbavancin TDM-guided administration could improve clinical outcomes by individualizing dosing and selecting dosing intervals. This case series seems to suggest a promising role of long-term suppressive dalbavancin treatment for difficult-to-treat cardiovascular prosthesis infection, also with limited surgical indications.

Human gelatin thrombin matrix with rifampin for the treatment of prosthetic vascular graft infections

We aim to describe and report on a novel graft preservation technique using a human gelatin thrombin matrix with rifampin for the treatment of vascular graft infections. Eight patients with vascular graft infections were included, one with bilateral infections, for a total of nine cases from January 2016 through June 2021. All the patients underwent wound exploration and placement of human gelatin thrombin matrix with rifampin. No deaths or allergic reactions had been reported at the 30-day follow-up, with only one major amputation. The graft and limb salvage rates were 77.8% at the 1-year follow-up. The mean time to a major amputation was 122 days, and the mean time to graft excision was 30 days.

Efficacy of boric acid used to treat experimental vascular graft infection by methicillin-resistant Staphylococcus aureus.

We aimed to investigate the efficacy of local boric acid (BA) and teicoplanin in prosthetic vascular graft infection (PVGI) caused by methicillin-resistant Staphylococcus aureus (MRSA) in a rat model. Fourty rats were divided into five groups. Group 1 received no treatments (control group); group 2 was uncontaminated polytetrafluoroethylene (PTFE) graft group; group 3 was untreated and the PTFE graft was contaminated with 2×107 CFU/mL MRSA; group 4 received local BA (8 mg/kg) and was contaminated with with 2×107 CFU/mL MRSA; group 5 received local BA (8 mg/kg) and intraperitoneal teikoplanin (10 mg/kg), and was contaminated with 2×107 CFU/mL MRSA; On the 3rd day, grafts and serums were removed for microbiological, histological and serological tests. The amounts of culture growth in groups 4 and 5 were significantly lower compared to group 3 (p < 0.001). TNF-α was significantly higher in Group 3 than the other groups (p = 0.001). There was no significant difference between the groups in serum IL-1 levels (p = 0.138). Monocyte chemotactic protein-1 (MCP-1) was not significantly different between groups 3, 4, and 5, but it was significantly higher than groups 1 and 2 (p < 0.001). The severity of inflammation was significantly higher in group 3 than the other groups, and fibroblastic proliferation, granulation tissue and collagen synthesis were significantly lower (p < 0.05). Our study showed that local BA and combined teicoplanin treatment is effective in preventing PVGI.

Fungal versus non-fungal supra-inguinal prosthetic vascular graft infections: A cohort study

ObjectivesFungal prosthetic vascular graft infections are rare and mainly supra-inguinal. Current guidelines are based on the few studies that have specifically investigated this population, with few risk factors described. The objective of this study is to compare fungal and non-fungal supra-inguinal prosthetic vascular graft infections (PVGI), describing their specificities, identifying risk factors, and evaluating outcomes. Patients and MethodsThis is a single-center retrospective cohort study carried out at the Pitié-Salpêtrière Hospital in Paris, including all patients who were treated for a supra-inguinal PVGI between January 1st, 2009 and February 28th, 2021. Preoperative, intraoperative and postoperative data were compared between fungal and non-fungal PVGI. ResultsOut of the 475 patients screened, 148 developed a supra-inguinal PVGI: 32 fungal and 116 non-fungal. Factors independently associated with fungal PVGI were presence of a prostheto-digestive fistula (OR 5.98; 95% CI 2.29–15.62) and preoperative antibiotic therapy of seven days or more (OR 2.87; 95% CI 1.12–7.38). Mortality rate at 180 days was significantly higher for fungal as compared to non-fungal PVGIs (38% vs. 16% p = 0.009) and for fungal PVGI with prostheto-digestive fistula. However, there was no statistically significant relation between mortality due to prostheto-digestive fistula in contrast with fungal PVGI alone (p = 0.21). ConclusionProstheto-digestive fistula was strongly associated with fungal PVGI, which leads us to suggest that in such cases, an anti-fungal agent should be prescribed.

Appearance of aseptic vascular grafts after endovascular aortic repair on [(18)F]fluorodeoxyglucose positron emission tomography/computed tomography.

Diagnosis of prosthetic vascular graft infection with [(18)F]fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) allows for early detection of functional changes associated with infection, based on increased glucose utilization by activated macrophages and granulocytes. Aseptic vascular grafts, like all foreign bodies, can stimulate an inflammatory response, which can present as increased activity on 18F-FDG PET/CT. Consequently, distinguishing aseptic inflammation from graft infection, though important, can be difficult. In the case of endovascular aneurysm repair (EVAR), a minimally invasive procedure involving the transfemoral insertion of an endoprosthetic stent graft, the normal postoperative appearance of these grafts on 18F-FDG PET/CT can vary over time, potentially confounding study interpretation. To investigate the visual, semiquantitative, and temporal characteristics of aseptic vascular grafts in patients status post EVAR. In this observational retrospective cohort study, patients with history of EVAR who underwent 18F-FDG PET/CT for indications other than infection were identified retrospectively. All patients were asymptomatic for graft infection - no abdominal pain, fever of unknown origin, sepsis, or leukocytosis - at the time of imaging and for ≥ 2 mo after each PET/CT. Imaging studies such as CT for each patient were also reviewed, and any patients with suspected or confirmed vascular graft infection were excluded. One hundred two scans performed on 43 patients (34 males; 9 females; age = 77 ± 8 years at the time of the final PET/CT) were retrospectively reviewed. All 43 patients had an abdominal aortic (AA) vascular graft, 40 patients had a right iliac (RI) limb graft, and 41 patients had a left iliac (LI) limb graft. Twenty-two patients had 1 PET/CT and 21 patients had from 2 to 9 PET/CTs. Grafts were imaged between 2 mo to 168 mo (about 14 years) post placement. Eight grafts were imaged within 6 mo of placement, including three that were imaged within three months of placement. The mean interval between graft placement and PET/CT for all 102 scans was 51 ± 39 mo. PET/CT data was reconstructed with region-of-interest analysis of proximal, mid and distal portions of the grafts and background ascending aorta. Maximum standardized uptake value (SUVmax) was recorded for each region. SUVmax-to-background uptake ratios (URs) were calculated. Visual assessment was performed using a 2-pattern grading scale: Diffuse (homogeneous uptake less than liver uptake) and focal (one or more areas of focal uptake in any part of the graft). Statistical analysis was performed. In total, there were 306 AA grafts, 285 LI grafts, 282 RI grafts, and 306 ascending aorta background SUVmax measurements. For all 102 scans, mean SUVmax values for AA grafts were 2.8-3.0 along proximal, mid, and distal segments. Mean SUVmax values for LI grafts and RI grafts were 2.7-2.8. Mean SUVmax values for background were 2.5 ± 0.5. Mean URs were 1.1-1.2. Visual analysis of the scans reflected results of quantitative analysis. On visual inspection, 98% revealed diffuse, homogeneous 18F-FDG uptake less than liver. Graft URs and visual pattern categories were significantly associated for AA graft URs (F-ratio = 21.5, P < 0.001), LI graft URs (F-ratio = 20.4, P < 0.001), and RI graft URs (F-ratio = 30.4, P < 0.001). Thus, visual patterns of 18F-FDG uptake corresponded statistically significantly to semiquantitative URs. The age of grafts showing focal patterns was greater than grafts showing diffuse patterns, 87 ± 89 vs 50 ± 37 mo, respectively (P = 0.02). URs were significantly associated with graft age for AA grafts (r = 0.19, P = 0.001). URs were also significantly associated with graft age for LI grafts (r = 0.25, P < 0.0001), and RI grafts (r = 0.31, P < 0.001). Quartiles of similar numbers of graft (n = 25-27) grouped by graft age indicated that URs were significantly higher for 4th quartile vs 2nd quartile URs (F-ratio = 19.5, P < 0.001). When evaluating URs, graft SUVmax values within 10%-20% of the ascending aorta SUVmax is evident in aseptic grafts, except for grafts in the oldest quartiles. In this study, grafts in the oldest quartiles (> 7 years post EVAR) showed SUVmax up to 30% higher than the ascending aorta SUVmax. Characteristics of an aseptic vascular stent graft in the aorta and iliac vessels on 18F-FDG PET/CT include graft SUVmax values within 10%-20% of the ascending aorta background SUVmax. The SUVmax of older aseptic grafts can be as much as 30% above background. The visual uptake pattern of diffuse, homogeneous uptake less than liver was seen in 98% of aseptic vascular grafts, making this pattern particularly reassuring for clinicians.

Reconstruction of a Prosthetic Vascular Graft Infections in the Femoral Region with Gracilis and Sartorius Muscle Flaps

Reconstruction of a Prosthetic Vascular Graft Infections in the Femoral Region with Gracilis and Sartorius Muscle Flaps

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

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)

Repeated prosthetics of the ascending aorta and aortic arch with a homograft for prosthesis infection and ruptured aorta after Bentalla de Bono operation

Prosthetic vascular graft infection is a formidable complication after cardiac surgery. Until now, the question on the tactics of managing such patients remains open, as well as the timing of each of the treatment methods such as conservative antibiotic therapy and surgery. In addition, the choice of a method of surgical treatment in itself poses new questions for specialists in regard to what methods to adhere to including prosthesis-preserving technique, prosthesis explantation and its replacement with a synthetic or biological graft, and the use of omentum to cover the infected bed. We present a case of treating a patient with an infected synthetic valve-containing conduit after Bentall de Bono operation and aortic rupture with the formation of false aneurysms. Attention is drawn to the prolonged clinical patient condition manifesting with fever, and the lack of data suggesting an infectious process according to positron-emission tomography and blood cultures. We chose a homograft of the ascending aortic and aortic arch with aortic valve as a conduit. It is also of interest that cultures of infectious prosthesis and aortic valve did not reveal any infectious agent. Aggressive antibiotic therapy in combination with surgical replacement of the infected prosthesis with a cryoprepared allograft allowed for successful treatment of patient without complications.

Methicillin‑sensitive Staphylococcus aureus prosthetic vascular graft infection after a Fontan procedure in an adult patient: A case report

Heart infections are not limited to infectious endocarditis. In fact, prosthetic vascular graft infections are among the most severe complications associated with vascular and cardiac surgery. The risk of developing an infection on prosthetic material is estimated to be ~5%. The mortality rate associated with the infection is estimated to be ~10‑25% within 30 days of infection and 50% after 1 year. The present article describes a case of a methicillin‑sensitive <em>Staphylococcus aureus</em> (MSSA) infection on the prosthetic material following a heart Fontan procedure. To the best of our knowledge, only one other case of extracardiac prosthesis‑related infection following Fontan surgery has been reported to date in adults. Prosthetic vascular graft infections (PVGIs) are a rare complication of heart surgery. However, PVGIs can seldomly occur and are burdened by a decreased survival rate. Therefore, physicians need to promptly suspect and recognize such cases. Further studies are required however, in order to determine the feasibility and long‑term survival rates of a conservative therapeutic approach.

Antimicrobial vascular grafts: experimental development and implementation in clinical practice

Prosthetic vascular graft infections, followed by severe complications and high mortality rates, remain one of the main issues in cardiovascular surgery. Therefore, the development of antimicrobial coating for vascular prostheses that is capable of preventing the infection is a very relevant field. This review outlines the main factors of development of antibiotic-resistant bacteria, the main directions in the development of vascular prostheses with an antimicrobial coating, and the prospects for the application of antimicrobial peptides and cationic amphiphiles as antimicrobial coating to develop an infection-resistant vascular prosthesis.

Prosthetic vascular graft infection: A systematic review and meta-analysis on diagnostic accuracy of 18FDG PET/CT.

There is a high risk of mortality and morbidity associated with Vascular Graft Infections (VGI) which requires early diagnosis. The aim of the present systematic review and meta-analysis was to evaluate the diagnostic accuracy, sensitivity and specificity of 18FDG PET/CT in diagnosing VGI. A systematic review was conducted according to the PRISMA guidelines through a search in Embase, PubMed, and Cochrane databases. We evaluated five parameters including specificity, sensitivity, negative and positive predictive values (NPV and PPV), and accuracy. We used STATA/MP 15.0 (StataCorp, College Station, TX) for all of our analyses. Overall 10 studies including 320 patients undergone 18FDG PET/CT were included. The sensitivity, specificity, positive and negative likelihood ratios along with their 95% CI were 0.92 (95% CI 0.88-0.95), 0.76 (95% CI 0.76-0.70), 3.49 (95% CI 3.49-2.32) and 0.14 (95% CI 0.09-0.23), respectively. The diagnostic odds ratio (DOR) for diagnosis of VGI was 37.12 (95% CI 14.84-92.82). The mean cut-off value of the maximum standardized uptake value (SUVmax) for diagnosis of VGI was 5.39 while the overall mean SUVmax among patients with VGI was 8.47. According to our results, 18FDG PET/CT is a useful diagnostic method in detecting active VGI with high diagnostic accuracy. Because of its ability to evaluate morphology and main texture using SUVmax, the 18FDG PET/CT provides an objective assessment of aspects and extent of disease activity, which results in preventing unnecessary surgery, proper treatment planning, and evaluating the effectiveness of treatment.

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

To report the midterm outcomes of treating prosthetic peripheral and aortic graft infections using a biosynthetic collagen prosthesis in a tertiary vascular center. 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. A biosynthetic collagen prosthesis was used in 19 patients (14 males, median age 66years) 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 26.6months (range 1-66months). 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 3years was 63.2%. The reinfection rate was 5.3% (n = 1). At 13.6months, 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. 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.

Ovine Biosynthetic Grafts for Aortoiliac Reconstructions in Nonsterile Operative Fields.

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. 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). 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. 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.

Use of rifampicin and graft removal are associated with better outcomes in prosthetic vascular graft infection.

Prosthetic vascular graft infection (PVGI) is a very severe disease. We aimed to determine the factors associated with treatment failure. Patients admitted to two University Hospitals with PVGI were included in this retrospective study. PVGI was classified as possible, probable or proven according to an original set of diagnostic criteria. We defined treatment failure if one of the following events occurred within the first year after PVGI diagnosis: death and infection recurrence due to the same or another pathogen. One hundred and twelve patients were diagnosed with possible (n = 26), probable (n = 22) and proven (n = 64) PVGI. Bacterial documentation was obtained for 81% of patients. The most frequently identified pathogen was Staphylococcus aureus (n = 39). Surgery was performed in 96 patients (86%). Antibiotics were administered for more than 6weeks in 41% of patients. Treatment failure occurred in 30 patients (27.5%). The factors associated with a lower probability of treatment failure were total removal of the infected graft (OR = 0.2, 95% CI [0.1-0.6]), rifampicin administration (OR = 0.3 [0.1-0.9]) and possible PVGI according to the GRIP criteria (OR = 0.3 [0.1-0.9]). Treatment failure occurred in 27.5% of patients with PVGI. Total removal of the infected graft and rifampicin administration were associated with better outcomes.

Majör Protez Vasküler Greft Enfeksiyonlarının Tedavisi ve Erken Dönem Sonuçların Değerlendirilmesi: Retrospektif Klinik Araştırma

Amaç: Protez vasküler greft enfeksiyonları (PVGE), tedavisinde güçlükleri olan bir patoloji olarak güncel bir alandır. PVGE'lerin klinik süreci fazlaca değişiklik göstermektedir. Bu durum, hastalığın yönetiminde rehberlik edebilecek bir kılavuzun hazırlanmasını güçleştirmektedir. Çalışmamızda, hastanemizde tedavi ettiğimiz 23 majör PVGE olgusunun seyrini, sonuçlarını paylaştık. Gereç ve Yöntemler: 2011-2018 yılları arasında periferik arter hastalığı nedeniyle ameliyat edilmiş 336 hastanın verileri taranarak, 23 majör PVGE hastası tespit edildi. Verileri retrospektif olarak toplandı. Demografik özellikler, eşlik eden patolojiler ve advers olaylar literatür örneklerine göre çalışmaya dâhil edildi. PVGE'nin lokasyonuna ve Samson sınıflamasına göre alt gruplar oluşturuldu. Hastalara greft koruyucu cerrahi yöntemleri veya total enfekte greft eksizyonu ameliyatları uygulandı. Erken dönem tekrarlayan enfeksiyon, tromboz ve kanamaya bağlı ikincil arteriyel operasyon, amputasyon, uzamış hastane yatışı ve mortalite incelediğimiz erken dönem postoperatif parametrelerdi. Bulgular: Samson sınıflandırmasına göre 5 hasta (%21,7) sınıf III, 9 hasta (%39,1) sınıf IV ve 9 hasta (%39,1) sınıf V alt gruplarına ayrıldı. PVGE'lerin 7 tanesi intrakaviter (%30,4) ve 16 tanesi periferik (%69,6) yerleşimliydi. Preoperatif dönemde perigreft hematom bulunan hastaların postoperatif dönemde daha çok revizyona alındığı tespit edildi. Dacron greft materyali kullanılan hastalarda anlamlı C-reaktif protein yüksekliği görüldü. Hastane içi mortalite oranı 4 hasta ile %17,4 idi. Sonuç: PVGE, mortalite ve morbiditesi yüksek bir klinik tablo olup, tanı ve tedavi süreçlerinin yürütülmesine yönelik multidisipliner yaklaşım önemlidir. PVGE'ler amputasyon ve sepsis açısından yakın izlem, erken müdahale önem arz etmektedir. Çalışmalarla ortaya konulabilecek bir kılavuza ihtiyaç duyulmaktadır. Sentetik greft kullanırken en üst düzey cerrahi özen gösterilmesi, sterilite şartlarına azami dikkat edilmesi gerekmektedir.

Development of local vancomycin delivery system from fibrin gel to prevent Staphylococcus aureus biofilms graft infection

Prosthetic vascular graft infection is one of the most severe vascular surgery complications. Fibrin gel (FG) has many useful characteristics as biocompatibility, biodegradation, adhesion, and haemostasis to develop the local antibiotic delivery system. In this study, human plasma was collected from peripheral blood that was used to create fibrin gel by supplement ion Ca2+. Antibiotic-containing fibrin gel was then evaluated in some characteristics such as surface structure, biodegradation, antibiotic delivery, cytotoxicity, and bacterial biofilm prevention in vitro and in vivo. The results showed that fibrin gel was excellent material for the extended delivery of antibiotics. Most importantly, antibiotic-containing fibrin gel was not toxic for human fibroblast cells in vitro and inhibited bacterial biofilm growth in vitro and in vivo. This research is the first step in developing an antibiotic delivery system for effective graft infection treatments.

Polyester Vascular Graft Material and Risk for Intracavitary Thoracic Vascular Graft Infection1.

Prosthetic vascular graft infections of the thoracic aorta are rare but can be fatal. Our comparison of collagen- and gelatin-coated grafts showed that collagen-coated grafts were associated with increased biofilm formation and bacterial adherence in vitro and with higher rates of perioperative vascular graft infections in vivo.

Patterns of vascular graft infection in 18F-FDG PET/CT.

18F-FDG PET/CT has become an important tool in diagnosis of prosthetic vascular graft infections (PVGI). The aim of the study was to identify the patterns of vascular graft infection in 18F-FDG PET/CT. The study was performed in 24 patients with vascular graft infection, in 17 patients implanted in an open surgery mode and in 7 patients by endovascular aortic repair (EVAR). Vascular prostheses were evaluated by two visual scales and semi-quantitative analysis with maximum standardized uptake values (SUV max). In the 3-point scale: 23 patients were in grade 1 and one patient was in grade 2. In the 5-point scale: 19 patients were in grade 5 with the highest activity in the focal area, 4 patients were in grade 4 and one patient in grade 3. The visual evaluation of 18F-FDG PET/CT study revealed that peri-graft high metabolic activity was associated with occurrence of morphological abnormalities (n = 21) like gas bubbles and peri-graft fluid retention or without abnormal CT findings (n = 3). The presence of the gas bubbles was linked to higher uptake of 18F-FDG (p < 0.01, SUVmax 11.81 ± 4.35 vs 7.36 ± 2.80, 15 vs 9 pts). In EVAR procedure, the highest metabolic activity was greater than in classical prosthesis (SUVmax 21.5 vs 13). 18F-FDG PET/CT is a very useful tool for assessment of vascular graft infections. CT findings like gas bubbles, or peri-graft fluid retention were associated with significantly higher glucose metabolism; however, in some cases without anatomic alterations, increased metabolic activity was the only sign of infection.