title: Cryopreserved arterial homografts vs silver-coated Dacron grafts for abdominal aortic infections with intraoperative evidence of microorganisms.
abstract: OBJECTIVE
  The gold standard for the treatment of abdominal aortic infections remains controversial. Cryopreserved arterial homografts and silver-coated Dacron grafts have both been advocated as reasonable grafts. Direct clinical or experimental comparisons between these two treatment options have not been published before. This study compared cryopreserved arterial homografts and silver-coated Dacron grafts for the treatment of abdominal aortic infections in a contaminated intraoperative field.
  
  
  METHODS
  From January 2004 to December 2009, 56 patients underwent in situ arterial reconstruction for an abdominal aortic infection. Patients with negative intraoperative microbiologic specimens were excluded. We compared 22 of 36 patients (61%) receiving cryopreserved arterial homografts (group A) vs 11 of 20 (55%) receiving a silver-coated Dacron graft (group B). Primary outcomes were survival and limb salvage; secondary outcomes were graft patency and reinfection. Direct costs of therapy were also calculated.
  
  
  RESULTS
  Thirty-day mortality was 14% in group A and 18% in group B (P >.99), and 2-year survival rates were 82% and 73%, respectively (P = .79). After 2 years, limb salvage was 96% and 100%, respectively (P = .50), whereas graft patency was 100% for both groups. Major complications were an aneurysmal degeneration in group A and graft reinfection in group B (n = 2). Median direct costs of therapy (in US $) were $41,697 (range, $28,347-$53,362) in group A and $15,531 (range, $11,310-$22,209) in group B (P = .02).
  
  
  CONCLUSIONS
  Our results show comparable effectiveness between cryopreserved arterial homograft and silver-coated Dacron graft in the contaminated operative field with respect to early mortality and midterm survival. Graft-inherent complications, aneurysmal degeneration for homografts, and reinfection for silver graft, were also observed. The in situ arterial reconstruction with homografts is nearly three times more expensive than with silver graft.
authors.affiliation: Department for Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany. th.bisdas@gmail.com
authors.forename: Theodosios
authors.initials: T
authors.lastname: Bisdas
authors.forename: Mathias
authors.initials: M
authors.lastname: Wilhelmi
authors.forename: Axel
authors.initials: A
authors.lastname: Haverich
authors.forename: Omke E
authors.initials: OE
authors.lastname: Teebken
mesh_terms: D000368:Aged; D000785:Aneurysm, Infected / Q000382:microbiology / Q000601:surgery; D001014:Aortic Aneurysm / Q000382:microbiology / Q000601:surgery; D001018:Aortic Diseases / Q000175:diagnosis / Q000191:economics / Q000382:microbiology / Q000401:mortality / Q000601:surgery*; D001158:Arteries / Q000637:transplantation*; D001807:Blood Vessel Prosthesis / Q000009:adverse effects* / Q000191:economics; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000191:economics / Q000295:instrumentation / Q000401:mortality; D016009:Chi-Square Distribution; D020099:Coated Materials, Biocompatible; D003362:Cost-Benefit Analysis; D015925:Cryopreservation; D020878:Device Removal; D005260:Female; D005858:Germany; D017721:Hospital Costs; D006801:Humans; D007412:Intestinal Fistula / Q000382:microbiology / Q000601:surgery; D053208:Kaplan-Meier Estimate; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D011093:Polyethylene Terephthalates; D049268:Positron-Emission Tomography; D011474:Prosthesis Design; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000191:economics / Q000382:microbiology / Q000401:mortality / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012834:Silver; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014515:Ureteral Diseases / Q000382:microbiology / Q000601:surgery; D014548:Urinary Fistula / Q000382:microbiology / Q000601:surgery; D016157:Vascular Fistula / Q000382:microbiology / Q000601:surgery; D014654:Vascular Patency
chemical_list: D020099:Coated Materials, Biocompatible; D011093:Polyethylene Terephthalates; D012834:Silver