title: [In situ replacement of infected vascular prosthesis with fresh arterial homograft: early and long-term results in 18 patients].
abstract: BACKGROUND
  Graft infection is rightly considered one of the severest complications of vascular reconstruction. Treatment is non-standardized and associated with high mortality and morbidity rates. The choice of therapeutic modality depends upon variety of factors. One increasingly used option is in situ replacement of the infected prosthesis with the arterial allograft.
  
  
  OBJECTIVE
  The aim of this prospective nonrandomized study was to evaluate the effectiveness and durability of fresh arterial allograft as in situ substitute for the infected vascular prosthesis.
  
  
  METHODS
  During period of 2002-2005, 18 patients with the synthetic vascular graft infection underwent partial or complete prosthesis removal and secondary in situ reconstruction using the fresh arterial allograft, preserved under hypothermic conditions in buffered saline solution with an addition of antibiotics.
  
  
  RESULTS
  In 14 male and 4 female patients, mean-aged 62 years, 8 aortic and 10 peripheral arterial infected prostheses were partially or completely replaced with the allograft. Operative mortality was 27.8% and amputation rate was 22.2%. Systemic sepsis at initial presentation and highly virulent nature of causative microorganisms were identified as significant negative prognostic factors (chi2 test, p < 0.05). During the long-term follow-up (mean 47 months), allograft aneurysm developed in three patients, requiring allograft explantation, followed in two cases by tertiary prosthetic reconstruction.
  
  
  CONCLUSIONS
  Substitution of the infected prosthesis with the arterial allograft could be successful if used selectively--for less virulent and localized infections of extracavitary grafts. Close follow-up is mandatory for timely diagnosis of late homograft lesions and its eventual replacement with more durable prosthetic material.
authors: Clinic of Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia. spejkic@gmail.com
authors: Sinisa
authors: S
authors: Pejkić
authors: Clinic of Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia.
authors: Nenad
authors: N
authors: Jakovljević
authors: Clinic of Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia.
authors: Ilija
authors: I
authors: Kuzmanović
authors: Clinic of Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia.
authors: Miroslav
authors: M
authors: Marković
authors: Clinic of Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia.
authors: Slobodan
authors: S
authors: Cvetković
authors: Clinic of Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia.
authors: Ilijas
authors: I
authors: Cinara
authors: Clinic of Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia.
authors: Dusan
authors: D
authors: Kostić
authors: Clinic of Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia.
authors: Zivan
authors: Z
authors: Maksimović
authors: Clinic of Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia.
authors: Lazar
authors: L
authors: Davidović
mesh_terms: D064591:Allografts; D001011:Aorta / Q000601:surgery*; D001158:Arteries / Q000601:surgery / Q000637:transplantation*; D001807:Blood Vessel Prosthesis; D020878:Device Removal; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D016459:Prosthesis-Related Infections / Q000601:surgery*; D014184:Transplantation, Homologous; D016896:Treatment Outcome