title: Homografts and extra-anatomical reconstructions for infected vascular grafts.
abstract: Managing graft infections is a challenge in vascular surgery. The incidence of vascular graft infections varies between 2% and 6%. The number of patients treated by means of implantation of artificial prostheses is constantly growing. The treatment of vascular graft infections remains controversial. This article discusses in-situ repair and the role of extra-anatomic routes. Homografts present the lowest rate of reinfection with acceptable rates of degradation and aneurysm formation. Silvergrafts and synthetic grafts coated with antimicrobials show similar early and late mortality rates, but higher reinfection rates. The outcome extra-anatomic bypass surgery seems to be improved in actual series compared with historical results but their disadvantages (limited patency, higher rate of amputations as well as high rates of reintervention combined with higher early mortality) are obvious.
authors.affiliation: Department of Vascular Medicine University Heart Center, Hamburg, Germany - h.diener@uke.de.
authors.forename: H
authors.initials: H
authors.lastname: Diener
authors.forename: O
authors.initials: O
authors.lastname: Hellwinklel
authors.forename: S
authors.initials: S
authors.lastname: Carpenter
authors.forename: A
authors.initials: A
authors.lastname: Larena-Avellaneda
authors.forename: E S
authors.initials: ES
authors.lastname: Debus
mesh_terms: D064591:Allografts; D000671:Amputation, Surgical; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D001705:Bioprosthesis; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation / Q000401:mortality; D020099:Coated Materials, Biocompatible; D020878:Device Removal; D006801:Humans; D023821:Limb Salvage; D011474:Prosthesis Design; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000382:microbiology / Q000401:mortality / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D012086:Reoperation; D012307:Risk Factors; D055502:Secondary Prevention; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D020099:Coated Materials, Biocompatible