In-situ revascularisation for patients with aortic graft infection: a single centre experience with silver coated polyester grafts.
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.
Batt
M
M
Department of Vascular Surgery, Hôpital Saint-Roch, Université de Nice Sophia-Antipolis, Nice, France. Electronic address: m.batt@chu-nice.fr.
Jean-Baptiste
E
E
Department of Vascular Surgery, Hôpital Saint-Roch, Université de Nice Sophia-Antipolis, Nice, France.
O'Connor
S
S
4, The Green, Bromham, Bedfordshire, MK43 8JR, UK.
Bouillanne
P-J
PJ
Department of Vascular Surgery, Hôpital Saint-Roch, Université de Nice Sophia-Antipolis, Nice, France.
Haudebourg
P
P
Department of Vascular Surgery, Hôpital Saint-Roch, Université de Nice Sophia-Antipolis, Nice, France.
Hassen-Khodja
R
R
Department of Vascular Surgery, Hôpital Saint-Roch, Université de Nice Sophia-Antipolis, Nice, France.
Declemy
S
S
Department of Vascular Surgery, Hôpital Saint-Roch, Université de Nice Sophia-Antipolis, Nice, France.
Farhad
R
R
Department of Infectiology, Hôpital Archet I, Université de Nice Sophia Antipolis, Nice, France.
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
D000085:Acetates; D000890:Anti-Infective Agents; D011091:Polyesters; D018030:Silver Compounds; C103100:silver acetate