Year 2017 Vol. 25 No 3

REVIEWS

A.V. ROMANOVICH 1, V.Y. KHRYSHCHANOVICH 2

PARAPROSTHETIC INFECTION IN VASCULAR SURGERY: CURRENT STATE OF THE PROBLEM

EE "Belarusian State Medical University" 1,
SEE "Belarusian Medical Academy of Post-Graduate Education" 2,
Minsk
The Republic of Belarus

Infection of synthetic vascular grafts after the emergency and scheduled arterial reconstructive operations is considered to be the most dangerous complication in vascular surgery. Postoperative wound suppuration occurred in 0.2-5% of patients and mortality rate varies from 25% to 88% of cases; the risk to lose the lower limbs reaches 60%. The article presents the etiology, symptoms, clinical presentation and diagnosis of synthetic prosthesis suppuration after the arterial reconstructive surgery. The existing treatment methods of the infected synthetic vascular grafts are described in details; the advantages and disadvantages of then each are discussed. Immediate and long-term results of various kinds of surgical treatment of local prosthetic graft infection have been presented. Then short-term high complications and amputation rates related to extra-anatomic bypass requires a search for alternative technique for infective paraprosthetic leakage repair. The advantages of reconstruction-associated procedure in situ are the adequate lower-limb revascularization and the best long-term treatment results compared with extra-anatomic bypass. This article reviews the currently available biological and synthetic graft materials routinely used in world practice for the repeated reconstructive surgeries: coated synthetic vascular prostheses, autovenous grafts, native and cryopreserved arterial allografts.

Keywords: aorta, diagnosis, graft, infection, prosthetic, treatment outcomes, complications
p. 292-299 of the original issue
References
  1. Darouiche RO. Treatment of infections associated with surgical implants. N Engl J Med. 2004 Apr 1;350(14):1422-29.
  2. Lyons OT, Baguneid M, Barwick TD, Bell RE, Foster N, Homer-Vanniasinkam S, et al. Diagnosis of Aortic Graft Infection: A Case Definition by the Management of Aortic Graft Infection Collaboration (MAGIC). Eur J Vasc Endovasc Surg. 2016 Dec;52(6):758-63. doi: 10.1016/j.ejvs.2016.09.007.
  3. Ehsan O, Gibbons CP. A 10-year experience of using femoro-popliteal vein for re-vascularisation in graft and arterial infections. Eur J Vasc Endovasc Surg. 2009 Aug;38(2):172-79. doi: 10.1016/j.ejvs.2009.03.009.
  4. O'Connor S, Andrew P, Batt M, Becquemin JP. A systematic review and meta-analysis of treatments for aortic graft infection. J Vasc Surg. 2006 Jul;44(1):38-45.
  5. Perera GB, Fujitani RM, Kubaska SM. Aortic graft infection: update on management and treatment options. Vasc Endovascular Surg. 2006 Jan-Feb;40(1):1-10.
  6. Lawrence PF. Conservative treatment of aortic graft infection. Semin Vasc Surg. 2011 Dec;24(4):199-204. doi: 10.1053/j.semvascsurg.2011.10.014.
  7. Vogel TR, Symons R, Flum DR. The incidence and factors associated with graft infection after aortic aneurysm repair. J Vasc Surg. 2008 Feb; 47(2):264-69. doi: 10.1016/j.jvs.2007.10.030.
  8. Yeager RA, Taylor LM Jr, Moneta GL, Edwards JM, Nicoloff AD, McConnell DB, et al. Improved results with conventional management of infrarenal aortic infection. J Vasc Surg. 1999 Jul; 30(1):76-83.
  9. Wilson WR, Bower TC, Creager MA, Amin-Hanjani S, O'Gara PT, Lockhart PB, et al. Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: A Scientific Statement From the American Heart Association. Circulation. 2016 Nov 15;134(20):e412-e60.
  10. Frei E, Hodgkiss-Harlow K, Rossi PJ, Edmiston CE Jr, Bandyk DF. Microbial pathogenesis of bacterial biofilms: a causative factor of vascular surgical site infection. Vasc Endovascular Surg. 2011 Nov;45(8):688-96. doi: 10.1177/1538574411419528.
  11. Rohde H, Frankenberger S, Zähringer U, Mack D. Structure, function and contribution of polysaccharide intercellular adhesin (PIA) to Staphylococcus epidermidis biofilm formation and pathogenesis of biomaterial-associated infections. Eur J Cell Biol. 2010 Jan;89(1):103-11. doi: 10.1016/j.ejcb.2009.10.005.
  12. Hayes PD, Nasim A, London NJ, Sayers RD, Barrie WW, Bell PR, et al. In situ replacement of infected aortic grafts with rifampicin-bonded prostheses: the Leicester experience (1992 to 1998). J Vasc Surg. 1999 Jul;30(1):92-98.
  13. Wilson SE. New alternatives in management of the infected vascular prosthesis. Surg Infect (Larchmt). 2001 Sum;2(2):171-75; discussion 175-77.
  14. Saleem BR, Meerwaldt R, Tielliu IF, Verhoeven EL, van den Dungen JJ, Zeebregts CJ. Conservative treatment of vascular prosthetic graft infection is associated with high mortality. Am J Surg. 2010 Jul;200(1):47-52. doi: 10.1016/j.amjsurg.2009.05.018.
  15. Swain TW 3rd, Calligaro KD, Dougherty MD. Management of infected aortic prosthetic grafts. Vasc Endovascular Surg. 2004 Jan-Feb;38(1):75-82.
  16. Hart JP, Eginton MT, Brown KR, Seabrook GR, Lewis BD, Edmiston CE, Jr., et al. Operative strategies in aortic graft infections: is complete graft excision always necessary? Ann Vasc Surg. Mar;19(2):154-60. doi: 10.1007/s10016-004-0168-5.
  17. Met R, Hissink RJ, Van Reedt Dortland RW, Steijling JJ, Verhagen H, Moll FL. Extra-anatomical reconstruction in the case of an inaccessible groin: the axillopopliteal bypass. Ann Vasc Surg. 2007 Mar;21(2):240-44.
  18. Yeager RA, Moneta GL, Taylor LM Jr, Harris EJ Jr, McConnell DB, Porter JM. Improving survival and limb salvage in patients with aortic graft infection. Am J Surg. 1990 May;159(5):466-69.
  19. Oderich GS, Bower TC, Cherry KJ Jr, Panneton JM, Sullivan TM, Noel AA, et al. Evolution from axillofemoral to in situ prosthetic reconstruction for the treatment of aortic graft infections at a single center. J Vasc Surg. 2006 Jun;43(6):1166-74.
  20. Reilly L. Aortic graft infection: evolution in management. Cardiovasc Surg. 2002 Aug;10(4):372-77.
  21. Beck AW, Murphy EH, Hocking JA, Timaran CH, Arko FR, Clagett GP. Aortic reconstruction with femoral-popliteal vein: graft stenosis incidence, risk and reintervention. J Vasc Surg. 2008 Jan;47(1):36-43; discussion 44.
  22. Daenens K, Fourneau I, Nevelsteen A. Ten-year experience in autogenous reconstruction with the femoral vein in the treatment of aortofemoral prosthetic infection. Eur J Vasc Endovasc Surg. 2003 Mar;25(3):240-45.
  23. Kitamura T, Morota T, Motomura N, Ono M, Shibata K, Ueno K, et al. Management of infected grafts and aneurysms of the aorta. Ann Vasc Surg. 2005 May;19(3):335-42.
  24. Nevelsteen A, Lacroix H, Suy R. Infrarenal aortic graft infection: in situ aortoiliofemoral reconstruction with the lower extremity deep veins. Eur J Vasc Endovasc Surg. 1997 Dec;14(Suppl A):88-92.
  25. Clagett GP, Valentine RJ, Hagino RT. Autogenous aortoiliac/femoral reconstruction from superficial femoral-popliteal veins: feasibility and durability. J Vasc Surg. 1997 Feb;25(2):255-66; discussion 267-70.
  26. Valentine RJ, Clagett GP. Aortic graft infections: replacement with autogenous vein. Cardiovasc Surg. 2001 Oct;9(5):419-25.
  27. Ali AT, Modrall JG, Hocking J, Valentine RJ, Spencer H, Eidt JF, et al. Long-term results of the treatment of aortic graft infection by in situ replacement with femoral popliteal vein grafts. J Vasc Surg. 2009 Jul;50(1):30-39. doi: 10.1016/j.jvs.2009.01.008.
  28. Kieffer E, Bahnini A, Koskas F, Ruotolo C, Le Blevec D, Plissonnier D. In situ allograft replacement of infected infrarenal aortic prosthetic grafts: results in forty-three patients. J Vasc Surg. 1993 Feb;17(2):349-55; discussion 355-56.
  29. Calligaro KD, Veith FJ. Diagnosis and management of infected prosthetic aortic grafts. Surgery. 1991 Nov;110(5):805-13.
  30. Becquemin JP, Qvarfordt P, Kron J, Cavillon A, Desgranges P, Allaire E, et al. Aortic graft infection: is there a place for partial graft removal? Eur J Vasc Endovasc Surg. 1997 Dec;14(Suppl 1):53-58.
  31. Blaisdell FW, Hall AD, Lim RC, Moore WC. Aorto-iliac arterial substitution utilizing subcutaneous grafts. Ann Surg 1970 Nov;172(5):775-80.
  32. Batt M, Jean-Baptiste E, O'Connor S, Saint-Lebes B, Feugier P, Patra P, et al. Early and late results of contemporary management of 37 secondary aortoenteric fistulae. Eur J Vasc Endovasc Surg. 2011 Jun;41(6):748-57. doi: 10.1016/j.ejvs.2011.02.020.
  33. Turnipseed WD, Berkoff HA, Detmer DE, Acher CW, Belzer FO. Arterial graft infections. Delayed v immediate vascular reconstruction. Arch Surg. 1983 Apr;118(4):410-14.
  34. Trout HH 3rd, Kozloff L, Giordano JM. Priority of revascularization in patients with graft enteric fistulas, infected arteries, or infected arterial prostheses. Ann Surg. 1984 Jun;199(6):669-83.
  35. Bacourt F, Koskas F. Axillobifemoral bypass and aortic exclusion for vascular septic lesions: a multicenter retrospective study of 98 cases. French University Association for Research in Surgery. Ann Vasc Surg. 1992 Mar;6(2):119-26.
  36. Chiesa R, Astore D, Frigerio S, Garriboli L, Piccolo G, Castellano R, et al. Vascular prosthetic graft infection: epidemiology, bacteriology, pathogenesis and treatment. Acta Chir Belg. 2002 Aug;102(4):238-47.
  37. Bandyk DF, Kinney EV, Riefsnyder TI, Kelly H, Towne JB. Treatment of bacteria-biofilm graft infection by in situ replacement in normal and immune-deficient states. J Vasc Surg. 1993 Sep;18(3):398-405; discussion 405-6.
  38. Bandyk DF, Novotney ML, Johnson BL, Back MR, Roth SR. Use of rifampin-soaked gelatin-sealed polyester grafts for in situ treatment of primary aortic and vascular prosthetic infections. J Surg Res. 2001 Jan;95(1):44-49.
  39. Tatterton MR, Homer-Vanniasinkam S. Infections in vascular surgery. Injury. 2011 Dec;42 Suppl 5:S35-41. doi: 10.1016/S0020-1383(11)70131-0.
  40. Batt M, Magne JL, Alric P, Muzj A, Ruotolo C, Ljungstrom KG, et al. In situ revascularization with silver-coated polyester grafts to treat aortic infection: early and midterm results. J Vasc Surg. 2003 Nov;38(5):983-89.
  41. Batt M, Jean-Baptiste E, O’Connor S, Bouillanne PJ, Haudebourg P, Hassen-Khodja R, et al. In-siturevascularisation for patients with aortic graft infection: a single centre experience with silver coated polyester grafts. Eur J Vasc Endovasc Surg. 2008 Aug;36(2):182-88.
  42. Heinola I, Kantonen I, Jaroma M, Albäck A, Vikatmaa P, Aho P, et al. Editor's Choice – Treatment of Aortic Prosthesis Infections by Graft Removal and In Situ Replacement with Autologous Femoral Veins and Fascial Strengthening. Eur J Vasc Endovasc Surg. 2016 Feb;51(2):232-39. doi: 10.1016/j.ejvs.2015.09.015.
  43. Koskas F, Plissonnier D, Bahnini A, Ruotolo C, Kieffer E. In situ arterial allografting for aortoiliac graft infection: a 6-year experience. Cardiovasc Surg. 1996 Aug;4(4):495-99. http://dx.doi.org/10.1016/0967-2109(95)00126-3.
  44. Koskas F, Goeau-Brissonnière O, Nicolas MH, Bacourt F, Kieffer E. Arteries from human beings are less infectible by Staphylococcus aureus than polytetrafluoroethylene in an aortic dog model. J Vasc Surg. 1996 Mar;23(3):472-76.
  45. Kieffer E, Gomes D, Chiche L, Fleron MH, Koskas F, Bahnini A. Allograft replacement for infrarenal aortic graft infection: early and late results in 179 patients. J Vasc Surg. 2004 May;39(5):1009-17.
  46. Shahmansouri N, Cartier R, Mongrain R. Characterization of the toughness and elastic properties of fresh and cryopreserved arteries. J Biomech. 2015 Jul 16;48(10):2205-9. doi: 10.1016/j.jbiomech.2015.03.033.
  47. Noel AA, Gloviczki P, Cherry KJ Jr, Safi H, Goldstone J, Morasch MD, et al. Abdominal aortic reconstructionin infected fields: early results of the United States cryopreserved aortic allograft registry. J Vasc Surg. 2002 May;35(5):847-52.
Address for correspondence:
210024, Republic of Belarus,
Minsk, Kizhevatov str., 58,
UZ "City Clinical Hospital of Emergency Medical Care"
department of surgical diseases N2, Belarusian State Medical University
Tel.: 375 44 760 33 70,
E-mail: romanovicha.v@mail.ru,
Aleksander V. Romanovich
Information about the authors:
Romanovich A.V. Assistant of department of surgical diseases N2, EE "Belarusian State Medical University".
Khryshchanovich V.Y. MD, Ass. Professor, Head of department of the emergency surgery, SEE "Belarusian Medical Academy of Post-graduate Education".
Contacts | ©Vitebsk State Medical University, 2007-2023