A pathological study of arterial prostheses surgically excised after overt clinical infection

Infection caused regarding vascular grafts in vascular surgery still remains a major problem. To reduce this problem and the complications which follow, the surgeon must be able to apply the best surgical management and also be confident with the vascular substitute used. There are two important factors to be considered: the biomaterial must have low propensity to infection and good stability if and when infected. In an attempt to verify this problem, 93 vascular grafts surgically excised for overt infection were examined. Techniques used for examinations were gross morphology, histopathology and scanning electron microscopy (SEM) evaluation. There were 23 human umbilical vein (HUV) grafts, 51 Dacron grafts and 19 expanded polytetrafluoroethylene (ePTFE) grafts. Histopathological signs of infection were absent in 57% of the ePTFE and Dacron grafts and in 17.4% of the HUV grafts. The latter were more heavily histologically infected and in some cases the walls were destructed. Histopathological signs of infection were seen on all the prosthetic walls in 36% of all the specimens and were mainly on the external portion of the grafts for the remaining prostheses. Bacteria were seen in respectively 21.7, 15.7 and 20% of the HUV, Dacron and ePTFE grafts with the Gram stain and in 86.9, 84.3 and 94.7% with SEM. The implantation period was shorter for the bioprostheses compared to that of the synthetic grafts because of the site and the indication of implantation. The stability of the bioprostheses was lower compared to that of the synthetic grafts when infected, leading to a breakdown of the wall along the length of the graft. The infection was found on the external capsule of the grafts rather than on the luminal surface.