Abstract：
BACKGROUND: The use of biological grafts provides acceptable mid- and long-term results in native or prosthetic vascular infections. Several reports describe the successful use of bovine pericardium in case of vascular infections, mainly as a large patch to be sutured as a tubular graft. Recently, a novel prefabricated bovine pericardium graft (Biointegral Surgical No-React® Inc, Mississauga, ON, Canada) has been introduced in clinical practice with promising results. In this study, we report our preliminary experience utilizing Biointegral Surgical graft in case of native and or prosthetic aorto-iliac and infrainguinal infection.
METHODS: We retrospectively analyzed data from 20 patients with native or prosthetic aorto-iliac and infrainguinal infection who underwent in situ reconstruction (ISR) with a Biointegral Surgical No-React bovine pericardium prosthesis between October 2020 and February 2023 at the Vascular Surgery Unit of the Fondazione Policlinico Universitario Gemelli - IRCCS in Rome, Italy. All patients followed a standardized protocol including postoperative anticoagulation and long-term intravenous antibiotics.
RESULTS: The indication for surgery was: mycotic aortic aneurysm in 4 patients (20%), graft infection after abdominal aortic repair in 11 patients (55%), peripheral graft infection in 5 patients (25%). Complete excision of the infected aorta or prosthetic graft, surgical debridement and ISR were performed in all patients. Hospital mortality rate was 5% (n = 1) and graft-related mortality of 0%. During follow-up (median 13 months, range 6-34 months), reinfection was 5.2% and primary graft patency 94.7%.
CONCLUSIONS: The use of prefabricated bovine pericardial grafts represents a promising option for the treatment of native and prosthetic aorto-iliac and infrainguinal infections. The application of this biological graft with a standardized postoperative protocol has been associated with a satisfactory patency and reinfection rate without increased bleeding complications.
METHODS: We retrospectively analyzed data from 20 patients with native or prosthetic aorto-iliac and infrainguinal infection who underwent in situ reconstruction (ISR) with a Biointegral Surgical No-React bovine pericardium prosthesis between October 2020 and February 2023 at the Vascular Surgery Unit of the Fondazione Policlinico Universitario Gemelli - IRCCS in Rome, Italy. All patients followed a standardized protocol including postoperative anticoagulation and long-term intravenous antibiotics.
RESULTS: The indication for surgery was: mycotic aortic aneurysm in 4 patients (20%), graft infection after abdominal aortic repair in 11 patients (55%), peripheral graft infection in 5 patients (25%). Complete excision of the infected aorta or prosthetic graft, surgical debridement and ISR were performed in all patients. Hospital mortality rate was 5% (n = 1) and graft-related mortality of 0%. During follow-up (median 13 months, range 6-34 months), reinfection was 5.2% and primary graft patency 94.7%.
CONCLUSIONS: The use of prefabricated bovine pericardial grafts represents a promising option for the treatment of native and prosthetic aorto-iliac and infrainguinal infections. The application of this biological graft with a standardized postoperative protocol has been associated with a satisfactory patency and reinfection rate without increased bleeding complications.
摘要：
目的：使用生物移植物可在天然或人工血管感染中提供可接受的中长期结果。一些报告描述了在血管感染的情况下成功使用牛心包膜，主要作为一个大的补丁缝合为管状移植物。最近,一种新型预制的牛心包移植物(BiointegralSurgicalNo-React®Inc，密西沙加,ON,加拿大）已在临床实践中引入，并取得了可喜的结果。在这项研究中,我们报告了在天然和/或人工主动脉-髂和腹股沟下感染的情况下使用Biointegral外科移植物的初步经验。
方法：我们回顾性分析了来自20例天然或人工主动脉-髂和腹股沟下感染患者的数据，这些患者在2020年10月至2023年2月期间在罗马的FondazionePoliclinico大学-IRCCS血管外科病房接受了Biointegral外科无反应牛心包假体原位重建，意大利。所有患者均遵循标准化方案，包括术后抗凝和长期静脉注射抗生素。
结果：手术指征为：4例（20%）合并霉菌性主动脉瘤，11例(55%)腹主动脉修复术后移植物感染,5例（25％）的外周移植物感染。完全切除受感染的主动脉或假体移植物，所有患者均进行了手术清创和原位重建。医院死亡率为5％（n=1），移植物相关死亡率为0％。在随访期间（中位数13个月，6-34个月)，再感染率为5.2％，原发性移植物通畅率为94.7％。
结论：使用预制牛心包移植物是治疗天然和人工主动脉-髂和腹股沟下感染的一种有希望的选择。这种生物移植物与标准化的术后方案的应用与令人满意的通畅性和再感染率相关，而不会增加出血并发症。
方法：我们回顾性分析了来自20例天然或人工主动脉-髂和腹股沟下感染患者的数据，这些患者在2020年10月至2023年2月期间在罗马的FondazionePoliclinico大学-IRCCS血管外科病房接受了Biointegral外科无反应牛心包假体原位重建，意大利。所有患者均遵循标准化方案，包括术后抗凝和长期静脉注射抗生素。
结果：手术指征为：4例（20%）合并霉菌性主动脉瘤，11例(55%)腹主动脉修复术后移植物感染,5例（25％）的外周移植物感染。完全切除受感染的主动脉或假体移植物，所有患者均进行了手术清创和原位重建。医院死亡率为5％（n=1），移植物相关死亡率为0％。在随访期间（中位数13个月，6-34个月)，再感染率为5.2％，原发性移植物通畅率为94.7％。
结论：使用预制牛心包移植物是治疗天然和人工主动脉-髂和腹股沟下感染的一种有希望的选择。这种生物移植物与标准化的术后方案的应用与令人满意的通畅性和再感染率相关，而不会增加出血并发症。
