Use of biosynthetic prosthesis ( XXXX  ) to replace infected infrainguinal prosthetic grafts--first results.

@entity1 @entity1605 @entity55 @entity2348 @entity432 @entity282
BACKGROUND: The current treatment standard of infected infrainguinal prosthetic vascular grafts includes total graft explantation and autologous vascular reconstruction. In the absence of appropriate autologous venous graft material prosthetic grafts with increased bacterial resistance can be used, whereas reinfection rates are still higher than after autologous reconstruction. Biosynthetic grafts have shown @entity282 rates when used as elective bypass material. Their higher resistance to @entity2348 could make them an alternative to replace infected prosthetic grafts in the absence of autologous material. @entity1 AND METHODS: Between November 2009 and April 2011, 7 @entity1 with infected infrainguinal prosthetic grafts (Szilagyi 3; 3 supragenicular and 4 infragenicular reconstructions) presented to our institution. There were 4 early (< 3 months after implantation) and 3 late infections (> 3 months after implantation. All grafts were explanted and replaced by biosynthetic grafts ( @entity1605  ), because the @entity1 had no suitable peripheral vein for complete autologous replacement. In 2 cases a composite graft with greater saphenous vein was done. In 6 cases microbiological cultures from intraoperatively obtained species were positive. The initial broad spectrum antibiotic therapy was continued according to the antibiogram for 6 to 12 weeks. RESULTS: There was no early or late reinfection during follow up (mean 9 months, range 4 - 20 months). During follow up we observed graft occlusions in 3 @entity1 (1 due to kinking of the bypass, 1 due to progressive @entity432 of the outflow vessels and 1 iatrogenic by external compression with a pressure cuff during arthroscopy). There were no early or late major amputations. One @entity1 died with @entity55 11 months postoperatively. CONCLUSIONS: In the absence of appropriate autologous material biosynthetic grafts seem to be a possible alternative to replace infected infrainguinal grafts. The different mechanical properties of biosynthetic grafts may be of certain disadvantage in infragenicular reconstructions.
