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Prefabricated pericardial bovine grafts for reconstruction of lower extremity under infectious conditions
Anna Sotir1, Christopher K Burghuber1, Wolf Eilenberg1
1Division of Vascular Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria.
Background:
Biological graft options for vascular reconstruction following graft infection (VGI) of lower extremity remain scarce. Custom-made nature of previously reported bovine pericardial grafts (BPG) comes at an expense of serious material complications, including graft rupture and pseudoaneurysm. Lack of diagnostic modality defining VGI of lower limb entails inconsistency in VGI reporting rates. This study aimed to assess the outcome on prefabricated BPG for lower limb revascularization following VGI as classified using recently introduced MAGIC criteria.
Material And Methods:
A retrospective analysis of patients undergoing revascularization of lower extremity with pBPG between 2014 and 2022 was undertaken. Study population included two groups-cases with diagnosed VGI (VGI group), and cases with clinical suspicion for present/future graft infection in which pBPG were used prophylactically (PIV group). Limb salvage, 30-day mortality rates as well as primary, primary assisted and secondary patency rates comprised part of primary end points. Secondary endpoints included long-term mortality and the incidence of graft infection.
Results:
A total of 50 patients underwent reconstruction with pBPG in a timespan of 8.5 years at a single institution. The underlying indication for surgery was lower extremity peripheral artery disease, 65.6% in VGI (n = 32) and 72.2% in PIV (n = 18) group. Two patients in VGI group (6.3%) died within 30-days postoperatively. Limb salvage could be achieved in 77.8% VGI and 81.3% in PIV group. Postoperative graft infection was observed more frequently in VGI (43.8%) vs. PIV (16.7%) groups. The microbial etiology of VGI, remained persistent (57.1%) and was diagnosed with an early onset (< 4 months postoperatively).
Conclusion:
The present study confirms the applicability of MAGIC criteria for peripheral VGI diagnosis and presents the largest case-series experience for the use of pBPG as a reliable biological substitute for revascularization procedures of lower extremity.
