In situ revascularization with silver-coated polyester grafts to treat aortic infection: early and midterm results.
OBJECTIVE
In this prospective study we analyzed the immediate and midterm outcome in patients with abdominal aorta infection (mycotic aneurysm, prosthetic graft infection) managed by excision of the aneurysm or the infected vascular prosthesis and in situ replacement with a silver-coated polyester prosthesis.


METHODS
From January 2000 to December 2001, 27 consecutive patients (25 men, 2 women; mean age, 69 years) with an abdominal aortic infection were entered in the study at seven participating centers. Infection was managed with either total (n = 18) or partial (n = 6) excision of the infected aorta and in situ reconstruction with an InterGard Silver (IGS) collagen and silver acetate-coated polyester graft. Assessment of outcome was based on survival, limb salvage, persistent or recurrent infection, and prosthetic graft patency.


RESULTS
Twenty-four patients had prosthetic graft infections, graft-duodenal fistula in 12 and graft-colonic fistula in 1; and the remaining 3 patients had primary aortic infections. Most organisms cultured were of low virulence. The IGS prosthesis was placed emergently in 11 patients (41%). Mean follow-up was 16.5 months (range, 3-30 months). Perioperative mortality was 15%; all four patients who died had a prosthetic graft infection. Actuarial survival at 24 months was 85%. No major amputations were noted in this series. Recurrent infection developed in only one patient (3.7%). Postoperative antibiotic therapy did not exceed 3 months, except in one patient. No incidence of prosthetic graft thrombosis was noted during follow-up.


CONCLUSIONS
Preliminary results in this small series demonstrate favorable outcome with IGS grafts used to treat infection in abdominal aortic grafts and aneurysms caused by organisms with low virulence. Larger series and longer follow-up will be required to compare the role of IGS grafts with other treatment options in infected fields.
Batt
Michel
M
Department of Vascualr Surgery, Hospital Saint Roch, Nice, France. chir-vascualire@chu-nice.fr
Magne
Jean-Luc
JL
Alric
Pierre
P
Muzj
Antonio
A
Ruotolo
Carlo
C
Ljungstrom
Karl-Gosta
KG
Garcia-Casas
Roberto
R
Simms
Malcolm
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000785:Aneurysm, Infected / Q000382:microbiology / Q000601:surgery*; D001014:Aortic Aneurysm / Q000382:microbiology / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D020099:Coated Materials, Biocompatible / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011091:Polyesters / Q000627:therapeutic use*; D011446:Prospective Studies; D016459:Prosthesis-Related Infections / Q000382:microbiology / Q000601:surgery*; D012834:Silver / Q000627:therapeutic use*; D016896:Treatment Outcome
D020099:Coated Materials, Biocompatible; D011091:Polyesters; D012834:Silver