[The use of silver/collagen coated vascular prostheses in infected environment]

Area of Science:

• Vascular Surgery
• Infectious Diseases
• Biomaterials Science

Background:

• Massive vascular graft infections pose significant challenges in surgical practice.
• Limited treatment options exist, often necessitating complex reconstructive procedures.
• Silver-coated prostheses offer potential antimicrobial properties for infected grafts.

Purpose of the Study:

• To evaluate the efficacy and safety of silver-coated medical prostheses in managing massive vascular graft infections.
• To assess the outcomes of in situ replacement using silver-coated dacron grafts when other options are unavailable.
• To analyze imaging findings and clinical responses in patients undergoing this procedure.

Main Methods:

• Retrospective analysis of 29 patients with massive dacron graft infections treated with silver-coated prostheses.
• In situ replacement of infected grafts using silver-coated dacron vascular prostheses.
• Pre- and post-operative imaging studies, including Duplex-Doppler Ultrasound and Technetium-labeled leukocyte scintigraphy.

Main Results:

• Duplex-Doppler Ultrasound identified perigraft fluid collections, indicating infection.
• Leukocyte scintigraphy revealed significant migration to the infected prosthesis, suggesting ongoing inflammation.
• Positive clinical effects and remission of infection symptoms were observed in most patients post-operatively.
• Postoperative follow-up showed no perigraft fluid collections, but scintigraphy indicated persistent graft infection.

Conclusions:

• Silver-coated medical prostheses can be a viable option for in situ replacement in critical cases of massive vascular graft infection.
• While clinical improvement is often achieved, persistent subclinical infection, as indicated by leukocyte scintigraphy, warrants caution.
• The application of silver-coated prostheses should be carefully considered and limited to situations with no alternative treatment options.