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Ultrastructural analysis of an infected collagen-coated vascular graft
C C Freytag1, J Tautenhahn, W König
1Institut für Medizinische Mikrobiologie, Medizinische Fakultät der Otto-von-Guericke Universität Magdeburg, Germany. ccfreytag@t-online.de
Abstract:
The incidence of infection following arterial reconstruction using synthetic graft materials varies from less than 1 to 5%. One of three mechanisms is thought to be responsible: 1. intraoperative contamination, 2. extension from adjacent infected or colonized tissue, or 3. hematogenous or lymphogenous seeding. We present ultrastructural data of a patient with a polymicrobial graft infection due to a prostheto-enteric fistula 16 years after reconstruction of an aortobifemoral graft. The polymer surface showed signs of biodegradation and was completely covered with a layer of plasma proteins. Disrupted fibroblasts on the intersegmental graft surface were surrounded by bundles of collagen. Gram-negative rods and grampositive cocci were embedded in an extracellular EPS matrix. Bacterial culture confirmed growth of Eikenella corrodens, Fusobacterium nucleatum and Peptostreptococcus species. Fibrin and granulation tissue from the neoadventitia started to mark off the inflammatory process. Transmission electron microscopy is a valuable tool for the investigation of alloplastic arterial devices. After 16 years of implantation the graft shows different signs of biodegradation.
Insights
Synthetic arterial graft infections can occur years after surgery. This study reveals graft biodegradation and polymicrobial infection in a patient 16 years post-implantation, highlighting long-term material degradation.
Area of Science:
- Biomaterials Science
- Infectious Diseases
- Vascular Surgery
Background:
- Infection following synthetic arterial graft reconstruction occurs in 1-5% of cases.
- Potential causes include intraoperative contamination, adjacent tissue infection, or hematogenous/lymphogenous seeding.
- Long-term graft integrity and infection mechanisms require further investigation.
Observation:
- A patient presented with a polymicrobial graft infection 16 years after aortobifemoral graft reconstruction.
- The synthetic graft material exhibited signs of biodegradation and was covered by plasma proteins.
- Ultrastructural analysis revealed disrupted fibroblasts, collagen bundles, and bacteria within an extracellular matrix.
Findings:
- The graft infection was caused by Eikenella corrodens, Fusobacterium nucleatum, and Peptostreptococcus species.
- The polymer surface showed biodegradation, with bacteria embedded in the extracellular polymeric substance (EPS) matrix.
- Inflammatory processes were being contained by fibrin and granulation tissue from the neoadventitia.
Implications:
- Transmission electron microscopy is crucial for evaluating alloplastic arterial devices.
- Synthetic grafts can undergo biodegradation over extended implantation periods.
- Understanding long-term graft biodegradation is essential for preventing late-onset infections.