title: Prosthetic Graft Patency in the Setting of a Polymicrobial Infection in Swine (Sus scrofa).
abstract: BACKGROUND
  In the setting of vascular injury, vein interposition graft is the preferred conduit, but may have limited availability. This study seeks to develop a large animal model assessing the graft performance of polytetrafluoroethylene (PTFE) and Dacron in the setting of a polymicrobial infection.
  
  
  METHODS
  Thirty-seven animals were placed into 4 groups for a 21-day survival period. Six-millimeter PTFE or Dacron interposition grafts were placed in the right iliac artery with a standardized bacterial inoculation. Native vessel with and without contamination served as control groups. The inoculant was 1 × 107of genetically labeled Pseudomonas aeruginosa and Staphylococcus aureus. The primary end points were graft patency (determined by duplex ultrasound and necropsy) and graft infection (culture with molecular analysis). Secondary end points included physiological measurements, blood cultures, laboratory data, and histopathology.
  
  
  RESULTS
  PTFE and Dacron had similar infection rates of 85.7% and 75%, respectively. There was no significant difference in infectious organisms between graft materials. PTFE and Dacron exhibited bacterial ingrowth and transmigration to the intraluminal portion of the conduit. Forty-five percent of the Dacron group and 40% of the PTFE group remained patent at postoperative day 21 (P = 0.98). Clinical data, including white blood cell count, percent neutrophils, and lactate, did not vary significantly between groups.
  
  
  CONCLUSIONS
  PTFE and Dacron perform similarly in terms of infection rates and graft failure as both have a propensity toward bacterial ingrowth and occlusion when compared with controls. This is a valid animal model to assess graft performance in the setting of polymicrobial infection and provides an avenue for studying novel prosthetic conduits.
authors.affiliation: San Antonio Military Medical Center, Sam Houston, TX; Clinical Research Division, 59th Medical Wing, Joint Base San Antonio - Lackland, Sam Houston, TX. Electronic address: mamiestull@gmail.com.
authors.forename: Mamie C
authors.initials: MC
authors.lastname: Stull
authors.affiliation: San Antonio Military Medical Center, Sam Houston, TX; Clinical Research Division, 59th Medical Wing, Joint Base San Antonio - Lackland, Sam Houston, TX.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Clemens
authors.affiliation: San Antonio Military Medical Center, Sam Houston, TX.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Heafner
authors.affiliation: San Antonio Military Medical Center, Sam Houston, TX.
authors.forename: John Devin B
authors.initials: JDB
authors.lastname: Watson
authors.affiliation: San Antonio Military Medical Center, Sam Houston, TX.
authors.forename: Zachary M
authors.initials: ZM
authors.lastname: Arthurs
authors.affiliation: San Antonio Military Medical Center, Sam Houston, TX.
authors.forename: Brandon W
authors.initials: BW
authors.lastname: Propper
mesh_terms: D000818:Animals; D001431:Bacteriological Techniques; D001706:Biopsy; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation; D060085:Coinfection; D004195:Disease Models, Animal; D005260:Female; D006083:Graft Occlusion, Vascular / Q000175:diagnosis / Q000382:microbiology / Q000503:physiopathology*; D007083:Iliac Artery / Q000000981:diagnostic imaging / Q000382:microbiology / Q000503:physiopathology / Q000601:surgery*; D011093:Polyethylene Terephthalates; D011138:Polytetrafluoroethylene; D011474:Prosthesis Design; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000382:microbiology / Q000503:physiopathology*; D011552:Pseudomonas Infections / Q000175:diagnosis / Q000382:microbiology / Q000503:physiopathology*; D013290:Streptococcal Infections / Q000175:diagnosis / Q000382:microbiology / Q000503:physiopathology*; D034421:Sus scrofa; D013997:Time Factors; D018616:Ultrasonography, Doppler, Duplex; D014654:Vascular Patency
chemical_list: D011093:Polyethylene Terephthalates; D011138:Polytetrafluoroethylene