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Surgical Technique for the Implantation of Tissue Engineered Vascular Grafts and Subsequent In Vivo Monitoring
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Vascular graft infections

Barbara Hasse1, Lars Husmann, Annelies Zinkernagel

  • 1Division of Infectious Diseases and Hospital Epidemiology, University Hospital and University of Zurich, Switzerland. barbara.hasse@usz.ch

Swiss Medical Weekly
|January 26, 2013
PubMed

Insights

Prosthetic vascular graft infection (PVGI) has high morbidity and mortality. A combined approach of debridement, graft preservation or partial excision, and negative-pressure wound therapy (NPWT) is recommended for managing PVGI.

Area of Science:

  • Vascular Surgery
  • Infectious Diseases
  • Wound Management

Background:

  • Prosthetic vascular graft infection (PVGI) is a rare but serious complication with high morbidity and mortality.
  • Risk factors for PVGI are not well-validated, and the etiology involves bacterial colonization from operative contamination.
  • There is a lack of consensus on diagnostic criteria and optimal management strategies for PVGI.

Purpose of the Study:

  • To advocate for a comprehensive surgical approach to managing prosthetic vascular graft infections.
  • To discuss the role of negative-pressure wound therapy (NPWT) and antimicrobial strategies in PVGI treatment.
  • To provide recommendations for empirical antimicrobial therapy based on likely pathogens.

Main Methods:

  • Advocacy for a surgical approach combining repeated radical local debridement.
  • Graft preservation or partial excision based on graft condition.
  • Simultaneous application of negative-pressure wound therapy (NPWT) and antimicrobial therapy.

Main Results:

  • The proposed management strategy aims to reduce morbidity and mortality associated with PVGI.
  • Negative-pressure wound therapy (NPWT) may play a role in treating certain PVGI cases.
  • Empirical antimicrobial therapy should cover common pathogens like staphylococci and Gram-negative rods.

Conclusions:

  • A combined surgical approach with debridement, potential graft preservation/excision, and NPWT is recommended for PVGI.
  • Antimicrobial therapy is crucial, with empirical choices including penicillinase-resistant beta-lactams/glycopeptides and aminoglycosides.
  • Rifampicin is suggested for empirical treatment due to its biofilm penetration properties.

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