Risk of infection of textile vascular prostheses in the aorto-iliac-femoral position in patients with chronic obliterating diseases of the arteries of the lower extremities

Objective. Evaluate the risk of textile vascular prosthesis infection in patients with peripheral artery disease (PAD) after reconstruction in the aortoiliac-femoral position.

Materials and methods. At the first stage, a retrospective analysis of the medical history of 317 patients who had tissue vascular prostheses implanted without antibacterial treatment during reconstructive operations on the aortoilioemoral segment was performed.
The operations were carried out at the Gomel Regional Clinical Cardiological Center. The patients were monitored for up to five years. At the second stage, patients who were scheduled for implantation of a woven prosthesis and had grade 4 chronic arterial insufficiency with purulent necrotic lesions of the feet and/or shins according to the Pokrovsky classification were selected.

Results. In all cases of prosthetic infection (100%), clinical signs were observed: from local inflammatory foci to systemic reactions caused by bacteria of the genus Staphylococcus. Thus, isolated paraprosthetic abscess occurred only once (5%), a combination of abscess and lymphorrhea – in eight cases (40%), and a combination of abscess, lymphorrhea and septic process – in two cases (10%). In eight cases (40%), a paraprosthetic hematoma with signs of infection was diagnosed, accompanied by arrosive hemorrhage.

Conclusions. In 100% of cases in patients with a high risk of infection, the textile vascular prosthesis was accompanied by characteristic local changes below the inguinal crease on the side of the affected lower limb, as well as the detection of Staphylococcus bacteria.

1. Doroshko YaY, Lyzikov AA. Biomechanical properties, pathogenetic mechanisms and pathways of infection of tissue-engineered vascular conduits in angiosurgery. Health and Ecology Issues. 2020;(4):79-86. (In Russ.). DOI: https://doi.org/10.51523/2708-6011.2020-17-4-5

2. Doroshko EYu, Lyzikov AA, Tikhmanovich VE, Kaplan ML. Analysis of infectious complications of artificial vascular prostheses after operations on the aorto-iliac-femoral segment. Surgery Eastern Europe. 2021;10(4):508-516. (In Russ.). DOI: https://doi.org/10.34883/PI.2021.10.4.019

3. Bokeria LA, Abdulgasanov RA, Ivanov AV, Arakelyan VS. Textile vascular prostheses in angiosurgery. Annals of Surgery. 2019;24(3):165-174. (In Russ.). DOI: https://doi.org/10.24022/1560-9502-2019-24-3-165-174

4. Shu H, Wang X, Wang M, Ding Y, Cheng H, Wang R, et al. Surgical management of abdominal aortic graft infection: network meta-analysis. BJS open. 2024;8(1), zrad151. DOI: https://doi.org/10.1093/bjsopen/zrad151

5. Kirişci Ö, Kirişci M, Özcan Metin T, et al. Efficacy of boric acid used to treat experimental vascular graft infection by methicillin-resistant Staphylococcus aureus. J Infect Dev Ctries. 2023;17(9):1317-1324. DOI: https://doi.org/10.3855/jidc.17865

6. Teebken OE, Bisdas T, Assadian O, Ricco J-B. Recommendations for Reporting Treatment of Aortic Graft Infections. European Journal of Vascular and Endovascular Surgery. 2012;43(2):174-178. DOI: https://doi.org/10.1016/j.ejvs.2011.11.003

7. Abdulgasanov RA. Infection of vascular grafts. Complex Issues of Cardiovascular Diseases. 2016;(1):12-17. (in Russ.). DOI: https://doi.org/10.17802/2306-1278-2016-1-12-17

8. Chakfé N, Diener H, Lejay A, et al. Editor’s Choice - European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Vascular Graft and Endograft Infections. Eur J Vasc Endovasc Surg. 2020;59(3):339-384. DOI: https://doi.org/10.1016/j.ejvs.2019.10.016

9. Doroshko EY, Kaplan ML, Lyzikov AA. Probability of infection of textile vascular prostheses in patients with chronic obliterative diseases of the lower extremity arteries. In: Infectious complications in surgery: Proceedings of the XXIX Plenum of Surgeons of the Republic of Belarus. Belorusskiy gosudarstvennyy meditsinskiy universitet; 2024:165-166.

10. Lyzikov AA, Pechenkin AA, Bontsevich DN. Purulent-septic complications of the use of woven artificial vascular prostheses in reconstructions of the aorto-iliac segment in patients with critical ischemia of the lower extremities. News of Surgery. 2007;15(3):97-101.

11. Donato F, Donati T, Minelli F, Borghetti A, Minucci M, Luparelli A, Tinelli G, Tshomba Y. Treatment of Aorto-iliac and Infrainguinal Vascular Infections with a Prefabricated Bovine Pericardial Graft. Annals of vascular surgery. 2024;105:177-188. DOI: https://doi.org/10.1016/j.avsg.2024.01.015

12. Stenehjem M, Holm DK, Riber L, Nielsen C, Schødt Riber S, Akgül Cengiz, Jes S. Lindholt. Transplantation of cryopreserved cardiovascular homografts. Ugeskr Laeger. 2024;186(15):V07230454. DOI: https://doi.org/10.61409/V07230454

13. Lew W, Moore W. Antibiotic-impregnated grafts for aortic reconstruction. Semin Vasc Surg. 2011;24(4):211-219. DOI: https://doi.org/10.1053/j.semvascsurg.2011.10.015

14. Bisdas T, Beckmann E, Marsch G, et al. Prevention of vascular graft infections with antibiotic graft impregnation prior to implantation: in vitro comparison between daptomycin, rifampin and nebacetin. Eur J Vasc Endovasc Surg. 2012;43(4):448-456. DOI: https://doi.org/10.1016/j.ejvs.2011.12.029

15. Berard X, Puges M, Pinaquy JB, et al. In vitro Evidence of Improved Antimicrobial Efficacy of Silver and Triclosan Containing Vascular Grafts Compared with Rifampicin Soaked Grafts. Eur J Vasc Endovasc Surg. 2019;57(3):424-432. DOI: https://doi.org/10.1016/j.ejvs.2018.08.053

16. Kahlberg A, Bilman V, Bugna C, et al. Silver acetate and Triclosan Antimicrobial Graft Evaluation for surgical Repair of aortic disease (STAGER Study). Int Angiol. 2023;42(5):402-411. DOI: https://doi.org/10.23736/S0392-9590.23.05101-5

17. Troisi N, Socrate AM, Vigliotti G, et al. Omniflow® II biosynthetic graft offers acceptable early and mid-term outcomes in redo surgery in patients with critical limb-threatening ischemia with no available autologous vein material. Int Angiol. 2024;43(2):255-261. DOI: https://doi.org/10.23736/S0392-9590.24.05152-6