title: [Early results after peripheral vascular replacement with biosynthetic collagen prosthesis in cases of graft infection].
abstract: BACKGROUND
  Vascular graft infection in peripheral bypass surgery represents a highly significant risk with regard to limb loss and morbidity. In the absence of autologous superficial veins, finding a suitable replacement material can be difficult. Silver-coated polyester grafts, homografts, or use of deep veins can pose additional risks. Use of a biosynthetic collagen prosthesis on a Dacron matrix ("Omniflow-II®") was investigated as an alternative method, and the cost-effectiveness was evaluated.
  
  
  METHODS
  From December 2010 to December 2011, eight patients with clinical symptoms of vascular graft infection, confirmed by imaging, were treated. Graft function or acute graft failure due to the infection was necessary for enrollment in the study. Infected material was removed, microbiological specimens taken and, in the absence of superficial veins, an "Omniflow-II®" prosthesis was implanted in an orthotopic position. Patients were followed up to evaluate their outcome, and the cost-effectiveness of the procedure was also analysed.
  
  
  RESULTS
  The technical feasibility of the procedure was assessed in all cases. Pathogens were detected in five of eight cases. After a mean follow-up of 8 months, seven of eight patients showed that they were clinically cured of infection. Primary patency was 63%, secondary patency was 75%, and prevalence of limb salvage was 88%. One patient had to undergo limb amputation to avoid sepsis, and another unsuccessfully underwent thrombectomy after 12 months. Four PET-CT follow-up studies showed a reduction of uptake in the affected area. To generate adequate revenue by using this technique, specialised knowledge of the diagnosis-related group system is necessary.
  
  
  CONCLUSIONS
  Treatment of vascular graft infections in peripheral bypass surgery in the absence of endogenous material necessitates the use of infection-resistant materials. The present study showed promising results using a collagen-biosynthetic prosthesis. Due to a lack of long-term results, the graft should be used only after detailed informed consent is obtained from the patient. The expenses incurred by using the biosynthetic graft should be covered adequately by revenues from these patients.
authors: Klinik für Visceral-, Transplantations-, Thorax- und Gefäßchirurgie, Universitätsklinikum Leipzig, Deutschland.
authors: P T
authors: PT
authors: Fellmer
authors: Klinik für Visceral-, Transplantations-, Thorax- und Gefäßchirurgie, Universitätsklinikum Leipzig, Deutschland.
authors: G
authors: G
authors: Wiltberger
authors: Klinik für Visceral-, Transplantations-, Thorax- und Gefäßchirurgie, Universitätsklinikum Leipzig, Deutschland.
authors: H-M
authors: HM
authors: Tautenhahn
authors: Klinik für Visceral-, Transplantations-, Thorax- und Gefäßchirurgie, Universitätsklinikum Leipzig, Deutschland.
authors: I
authors: I
authors: Matia
authors: Klinik für Visceral-, Transplantations-, Thorax- und Gefäßchirurgie, Universitätsklinikum Leipzig, Deutschland.
authors: F
authors: F
authors: Krenzien
authors: Klinik für Visceral-, Transplantations-, Thorax- und Gefäßchirurgie, Universitätsklinikum Leipzig, Deutschland.
authors: S
authors: S
authors: Jonas
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001807:Blood Vessel Prosthesis / Q000191:economics; D003094:Collagen; D003362:Cost-Benefit Analysis; D005240:Feasibility Studies; D005260:Female; D005263:Femoral Artery / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011093:Polyethylene Terephthalates; D011150:Popliteal Artery / Q000601:surgery; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000601:surgery*; D011994:Recombinant Proteins; D012086:Reoperation / Q000191:economics / Q000193:education; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000601:surgery*; D013212:Staphylococcus epidermidis; D041181:Staphylococcus hominis
chemical_list: D011093:Polyethylene Terephthalates; D011994:Recombinant Proteins; D003094:Collagen