title: In-situ revascularisation for patients with aortic graft infection: a single centre experience with silver coated polyester grafts.
abstract: OBJECTIVE
  The aim of this study was to evaluate the early and mid term outcome of patients with aortic graft infection who underwent in-situ revascularisation with a silver coated prosthesis.
  
  
  METHODS
  From January 2000 to December 2006, 24 consecutive patients (22 male, 2 female) with mean age 67 years were prospectively entered in this study of aortic graft infection at our single centre. Infection was managed with either total (n=19) or partial (n=5) excision of the infected graft and in- situ reconstruction with a silver coated prosthesis, Inter Gard Silver (IGSG).
  
  
  METHODS
  The primary endpoint was recurrence of infection. Secondary endpoints were early and late mortality, peri-operative morbidity, primary graft patency, major amputation rates and patient survival.
  
  
  RESULTS
  Fourteen patients had a primary graft infection, however 10 of 24 patients had graft infection secondary to aorto digestive (n=9) or aorto urinary (n=1) tract fistulas. Bacteriological cultures were negative in 8 (33%) patients. Most organisms cultivated where virulent and the majority of graft infections were polymicrobial (71%). Silver grafts were placed emergently in 6 (25%) patients. Mean follow up 32.5+/-31.0 months (range 2-78 months). Peri-operative morbidity and mortality were 46% and 21% respectively. Early interventions occurred in 6 (25%) patients and late secondary intervention were required in 3 (15.7%), caused by silver graft reinfection. The late mortality was 26%.
  
  
  CONCLUSIONS
  In-situ reconstruction with the silver graft confirms similarity with other modalities. The greatest advantage for the silver graft is its ease of use but the risk of reinfection remains significant.
authors.affiliation: Department of Vascular Surgery, Hôpital Saint-Roch, Université de Nice Sophia-Antipolis, Nice, France. Electronic address: m.batt@chu-nice.fr.
authors.forename: M
authors.initials: M
authors.lastname: Batt
authors.affiliation: Department of Vascular Surgery, Hôpital Saint-Roch, Université de Nice Sophia-Antipolis, Nice, France.
authors.forename: E
authors.initials: E
authors.lastname: Jean-Baptiste
authors.affiliation: 4, The Green, Bromham, Bedfordshire, MK43 8JR, UK.
authors.forename: S
authors.initials: S
authors.lastname: O'Connor
authors.affiliation: Department of Vascular Surgery, Hôpital Saint-Roch, Université de Nice Sophia-Antipolis, Nice, France.
authors.forename: P-J
authors.initials: PJ
authors.lastname: Bouillanne
authors.affiliation: Department of Vascular Surgery, Hôpital Saint-Roch, Université de Nice Sophia-Antipolis, Nice, France.
authors.forename: P
authors.initials: P
authors.lastname: Haudebourg
authors.affiliation: Department of Vascular Surgery, Hôpital Saint-Roch, Université de Nice Sophia-Antipolis, Nice, France.
authors.forename: R
authors.initials: R
authors.lastname: Hassen-Khodja
authors.affiliation: Department of Vascular Surgery, Hôpital Saint-Roch, Université de Nice Sophia-Antipolis, Nice, France.
authors.forename: S
authors.initials: S
authors.lastname: Declemy
authors.affiliation: Department of Infectiology, Hôpital Archet I, Université de Nice Sophia Antipolis, Nice, France.
authors.forename: R
authors.initials: R
authors.lastname: Farhad
mesh_terms: D000085:Acetates; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D000890:Anti-Infective Agents; D001011:Aorta / Q000382:microbiology / Q000503:physiopathology / Q000601:surgery*; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D020878:Device Removal; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011091:Polyesters; D011446:Prospective Studies; D011474:Prosthesis Design; D016459:Prosthesis-Related Infections / Q000382:microbiology / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation; D018030:Silver Compounds; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency
chemical_list: D000085:Acetates; D000890:Anti-Infective Agents; D011091:Polyesters; D018030:Silver Compounds; C103100:silver acetate