title: Self-made pericardial tube graft: a new surgical concept for treatment of graft infections after thoracic and abdominal aortic procedures.
abstract: BACKGROUND
  The aim of this study was to evaluate a new surgical concept for the treatment of graft infections after operation or endovascular treatment of thoracic, thoracoabdominal, and abdominal aortic diseases.
  
  
  METHODS
  Between 2004 and 2011, 15 patients (mean age 72 ± 10 years, 87% men) with prosthetic graft or endovascular graft infection were treated with complete removal of the infected prosthetic material, extensive debridement of the surrounding tissues, and orthotopic vascular reconstruction with self-made xenopericardial tube grafts constructed from a patch. Perioperative and long-term outcomes were evaluated.
  
  
  RESULTS
  Perioperative mortality was 27% (n = 4). All deaths were due to multiorgan failure resulting from uncontrolled septicemia from the local infectious process. Mean observational follow-up was 24 months (5 to 83 months). Control computed tomographic scans showed normal findings at the operative site in all patients. Antibiotic treatment was continued for a mean of 6 months. Freedom from reinfection was 100%. Freedom from reoperation was also 100%.
  
  
  CONCLUSIONS
  Treatment of graft infections after operation or endovascular treatment of thoracic, thoracoabdominal, and abdominal aortic diseases by complete removal of the infected prosthetic material and extensive debridement as well as orthotopic vascular reconstruction using self-made xenopericardial tube grafts as neoaortic segments provides excellent results with regard to durability and freedom from reinfection and reoperation. This new concept is an additional alternative to cryopreserved homografts that extends the armamentarium for treating patients with these highly complex conditions.
authors.affiliation: Department of Cardiovascular Surgery, University Hospital Berne, Berne, Switzerland. martin.czerny@insel.ch
authors.forename: Martin
authors.initials: M
authors.lastname: Czerny
authors.forename: Regula
authors.initials: R
authors.lastname: von Allmen
authors.forename: Philipp
authors.initials: P
authors.lastname: Opfermann
authors.forename: Gottfried
authors.initials: G
authors.lastname: Sodeck
authors.forename: Florian
authors.initials: F
authors.lastname: Dick
authors.forename: Arno
authors.initials: A
authors.lastname: Stellmes
authors.forename: Vladimir
authors.initials: V
authors.lastname: Makaloski
authors.forename: Roman
authors.initials: R
authors.lastname: Bühlmann
authors.forename: Urs
authors.initials: U
authors.lastname: Derungs
authors.forename: Matthias K
authors.initials: MK
authors.lastname: Widmer
authors.forename: Thierry
authors.initials: T
authors.lastname: Carrel
authors.forename: Jürg
authors.initials: J
authors.lastname: Schmidli
mesh_terms: D000368:Aged; D001012:Aorta, Abdominal; D001013:Aorta, Thoracic; D001018:Aortic Diseases / Q000601:surgery*; D001705:Bioprosthesis; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D010496:Pericardium / Q000637:transplantation*; D011446:Prospective Studies; D011474:Prosthesis Design; D016459:Prosthesis-Related Infections / Q000209:etiology* / Q000601:surgery*; D014656:Vascular Surgical Procedures / Q000379:methods