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Treatment of aortic and peripheral prosthetic graft infections with bovine pericardium
Veronika Almási-Sperling1, Damaris Heger1, Alexander Meyer1
1Department of Vascular Surgery, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nuremberg (FAU), Erlangen, Germany.
Insights
Bovine pericardium in situ reconstruction offers a promising solution for infected aortic and peripheral vascular grafts, demonstrating good patency and no reinfection in a recent study. This method presents a viable option when other graft materials are unsuitable.
Area of Science:
- Vascular Surgery
- Biomaterials in Medicine
- Infectious Disease Management
Background:
- Graft infections are rare but severe complications following vascular surgery.
- Effective management strategies for infected vascular grafts are crucial to improve patient outcomes.
Purpose of the Study:
- To evaluate the efficacy and short-term outcomes of in situ reconstruction using bovine pericardium in patients with infected aortic and peripheral vascular grafts.
Main Methods:
- A retrospective cohort study of 19 patients who underwent in situ repair of infected grafts with bovine pericardium between March 2015 and January 2018.
- Procedures involved excision of infected grafts, radical debridement, and reconstruction with bovine pericardium.
- Short-term outcomes analyzed included primary patency, freedom from reinfection, mortality, and complication rates.
Main Results:
- Bovine pericardium was used in 19 patients (median age 70 years) for various aortic and peripheral reconstructions.
- Complications occurred in 53% of patients, with a 30-day mortality of 10.5% and a 1-year mortality of 32%.
- No reinfections were observed post-reconstruction, and graft occlusion occurred in 2 cases during follow-up.
Conclusions:
- In situ reconstruction with bovine pericardium demonstrates favorable short-term outcomes for infected aortic and peripheral grafts.
- The technique is associated with good graft patency, a low rate of reinfection, and acceptable early mortality.
- Bovine pericardium serves as a valuable therapeutic option for prosthetic graft infections when alternative repair methods are not feasible or recommended.
Objective:
Graft infections are rare but serious complications of vascular operations. The aim of this study was to evaluate the results of in situ reconstruction with bovine pericardium in infected aortic and peripheral vessel fields.
Methods:
A retrospective cohort study was conducted with a focus on the treatment of infected grafts with bovine pericardium. We retrospectively reviewed 19 consecutive patients with prosthetic graft infections and in situ repair with bovine pericardium. All operations were done between March 2015 and January 2018. No other materials were used. Excision of the infected graft, radical débridement of the infected tissue, and in situ reconstruction with bovine pericardium were applied in all patients. Short-term outcomes including primary patency, freedom of reinfection, mortality, and complication rates were analyzed.
Results:
Bovine pericardium was used in 19 patients (84% male) with a median age of 70 years (range, 56-84 years) to reconstruct the descending aorta (n = 1), abdominal aorta (n = 5), iliac artery (n = 4), and femoral artery (n = 9). Graft infections were observed in all patients (one thoracic endovascular aneurysm repair, three infrarenal endovascular aneurysm repairs, two open aortic repairs, four iliac-femoral reconstructions, and nine femoral reconstructions including two closure device infections after coronary angiography). Ten patients (53%) had a complication perioperatively and postoperatively. The 30-day mortality was 10.5%; the total mortality rate after 1 year was 32%. There was no reinfection after bovine reconstruction observed in our cohort. Graft occlusions were detected in two cases during follow-up (median, 6 months; range, 1-47 months).
Conclusions:
Bovine pericardium reconstruction shows a good short-term outcome after aortic or peripheral graft infections. It is associated with good patency, low reinfection rate, and acceptably low early mortality rate. It can be a good therapeutic option in prosthetic graft infections when in situ repair with a prosthetic (even soaked) or autologous vein or homograft is not recommended or is not possible.
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