In-situ-rekonstruktion mit alloplastischen prothesen beim gefäßinfekt. Evaluation mit silberacetat beschichteter prothesen

Objectives. This investigation was set up to consider whether in situ reconstruction of infected vascular grafts with a silver-impregnated Dacron graft would be a safe procedure and one that could be recommended. We established an open prospective, multicentre registry for which all data were collected from each hospital that had contracted to take part on a specific clinical record form. Materials and methods. We evaluated a reverse lock-knit polyester prosthesis coated with collagen and silver acetate (InterGuard Silver [IGS], Intervascular, France). In addition to removal of the infected graft material, the surgical technique involved debridement, in situ reconstruction and systemic antibiotic therapy. From July 1999 to February 2004, we evaluated 137 consecutive patients from 60 hospitals; follow-up information on each patient was requested 3, 6 and 12 months after the intervention and then annually. The end-point of the study was re-infection and/or death. Results. In 90 (65.7%) of the 137 cases the infected graft material was explanted completely, and this was followed by in situ reconstruction with IGS. In the remaining 47 (34.3%) patients removal of the indwelling infected graft was incomplete. The mean follow-up time was 28.2±17.5 months for the patients with complete removal and 18.0±16.3 months for those with incomplete removal. In the group with complete removal 9 (10%) of the 90 patients became re-infected, as against 20 (42%) of the 47 patients in the group with incomplete removal. This difference was highly significant (Gehan's Wilcoxon Test, p<0.0001). Conclusions. These data confirm that the concept of complete removal of an infected graft and in situ reconstruction with IGS is an effective and promising treatment and compares very favourably with other, more complex, surgical options.