Srpski arhiv za celokupno lekarstvo 2013 Volume 141, Issue 11-12, Pages: 750-757
https://doi.org/10.2298/SARH1312750P
Full text ( 875 KB)
In situ replacement of infected vascular prosthesis with fresh arterial homograft: Early and long-term results in 18 patients
Pejkić Siniša (Klinički centar Srbije, Klinika za vaskularnu i endovaskularnu hirurgiju, Beograd)
Jakovljević Nenad (Klinički centar Srbije, Klinika za vaskularnu i endovaskularnu hirurgiju, Beograd)
Kuzmanović Ilija (Klinički centar Srbije, Klinika za vaskularnu i endovaskularnu hirurgiju, Beograd)
Marković Miroslav (Klinički centar Srbije, Klinika za vaskularnu i endovaskularnu hirurgiju, Beograd + Medicinski fakultet, Beograd)
Cvetković Slobodan (Klinički centar Srbije, Klinika za vaskularnu i endovaskularnu hirurgiju, Beograd + Medicinski fakultet, Beograd)
Činara Ilijas (Klinički centar Srbije, Klinika za vaskularnu i endovaskularnu hirurgiju, Beograd + Medicinski fakultet, Beograd)
Kostić Dušan (Klinički centar Srbije, Klinika za vaskularnu i endovaskularnu hirurgiju, Beograd + Medicinski fakultet, Beograd)
Maksimović Živan (Klinički centar Srbije, Klinika za vaskularnu i endovaskularnu hirurgiju, Beograd + Medicinski fakultet, Beograd)
Davidović Lazar (Klinički centar Srbije, Klinika za vaskularnu i endovaskularnu hirurgiju, Beograd + Medicinski fakultet, Beograd)
Introduction. Graft infection is rightly considered one of the severest
complications of vascular reconstruction. Treatment is nonstandardized and
associated with high mortality and morbidity rates. The choice of therapeutic
modality depends upon variety of factors. One increasingly used option is in
situ replacement of the infected prosthesis with the arterial allograft.
Objective. The aim of this prospective nonrandomized study was to evaluate
the effectiveness and durability of fresh arterial allograft as in situ
substitute for the infected vascular prosthesis. Methods. During period of
2002-2005, 18 patients with the synthetic vascular graft infection underwent
partial or complete prosthesis removal and secondary in situ reconstruction
using the fresh arterial allograft, preserved under hypothermic conditions in
buffered saline solution with an addition of antibiotics. Results. In 14 male
and 4 female patients, meanaged 62 years, 8 aortic and 10 peripheral arterial
infected prostheses were partially or completely replaced with the allograft.
Operative mortality was 27.8% and amputation rate was 22.2%. Systemic sepsis
at initial presentation and highly virulent nature of causative
microorganisms were identified as significant negative prognostic factors (χ²
test, p<0.05). During the longterm followup (mean 47 months), allograft
aneurysm developed in three patients, requiring allograft explantation,
followed in two cases by tertiary prosthetic reconstruction. Conclusion.
Substitution of the infected prosthesis with the arterial allograft could be
successful if used selectively - for less virulent and localized infections
of extracavitary grafts. Close followup is mandatory for timely diagnosis of
late homograft lesions and its eventual replacement with more durable
prosthetic material.
Keywords: vascular graft infection, infected prosthesis in situreplacement, arterial allograft