[Prevention and therapy of prosthesis infections in the thoracic area]

Infections of vascular prostheses following replacement of the thoracic aorta remain a rare complication, fortunately. The incidence of prosthetic infection amounts to approximately 1.6%, however, there is only limited information from single center studies, and linearized actuarial data for more exact estimations are not available. Experience with prophylaxis and treatment of bacterial endocarditis as well as data available from peripheral vascular reconstruction nevertheless allow the development of treatment strategies concerning this complication. Experimentally, there is clear evidence that pretreatment of Dacron-grafts using the fibrin sealant-antibiotic compound results in a significant protection from infection, created by artificial contamination with staphylococcus aureus. This concept could clearly be confirmed in clinical series involving treatment of prosthetic valve endocarditis. Currently, the concept of implantation of cryopreserved human vascular allografts is studied clinically. Its efficiency in infected areas and following prosthetic replacement of the thoracic aorta has not been proven. Some preliminary results as well as studies on treatment for bacterial endocarditis would suggest a clear advantage of this strategy, however statistically significant improvements have not been published. Currently available data, however, appear to be sufficient to advocate potentially successful techniques as a prophylaxis in routine thoracic aortic replacement as well as for treatment in case of a vascular prosthetic infection following such procedures.