1
|
Molacek J, Treska V, Houdek K, Opatrný V, Certik B, Baxa J. Use of a Silver-Impregnated Vascular Graft: Single-Center Experience. Antibiotics (Basel) 2022; 11:386. [PMID: 35326849 PMCID: PMC8944627 DOI: 10.3390/antibiotics11030386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 02/27/2022] [Accepted: 03/04/2022] [Indexed: 12/10/2022] Open
Abstract
INTRODUCTION Vascular graft infection is a life threatening situation with significant morbidity and mortality. Bacterial graft infection can lead to false aneurysms, bleeding and sepsis. There are a lot of risky situations where grafts can become infected. It is therefore highly desirable to have a vascular graft that is resistant to infection. In this retrospective clinical study, a silver-impregnated vascular graft was evaluated in various indications. METHODS Our study included a total of 71 patients who received a silver-impregnated vascular graft during the period from 2013 to 2018. Patients had an aortoiliac localization of vascular graft in 61 cases (86%), and a peripheral localization on the lower limbs in 10 cases (14%). Indications for the use of these special vascular grafts were trophic lesions or gangrene in the lower limbs in 24 cases (34%), suspicious mycotic abdominal aortic aneurysm (mAAA) in 4 cases (5.5%), salmonela aortitis or aneurysms in 4 cases (5.5%), infection of the previous vascular graft in 11 cases (15.5%), other infections in 12 cases (17%), AAA rupture in 10 cases (14%) and other reasons (pre-transplant condition, multiple trauma, graft-enteric fistula) in 6 cases (8.5%). Thirty-day mortality, morbidity, the need for reintervention and amputation, primary and secondary graft patency, and finally the presence of a proven vascular graft infection were evaluated. RESULTS The 30-day mortality was 19.7%, and morbidity was 42.2%. The primary patency of the vascular graft was 91.5%. Reoperation was necessary in 10 cases (14%) and amputation was necessary in 10 cases (14%). The median length of hospital stay was 13 days and the mean follow-up period was 48 ± 9 months. During the follow-up period, six patients (8.5%) died from reasons unrelated to surgery or without any relation to the vascular graft. Secondary patency after one year was 88%. Infection of the silver graft was observed in three patients (4.2%). CONCLUSIONS Based on our results, the silver graft is a very suitable alternative for solving infectious, or potentially infectious, situations in vascular surgery. In particular, in urgent or acute cases, a silver graft is often the only option.
Collapse
Affiliation(s)
- Jiri Molacek
- Vascular Surgery Department, University Hospital in Pilsen, Faculty of Medicine in Pilsen, Charles University, Husova 3, 301 00 Plzeň, Czech Republic; (V.T.); (K.H.); (V.O.); (B.C.)
| | - Vladislav Treska
- Vascular Surgery Department, University Hospital in Pilsen, Faculty of Medicine in Pilsen, Charles University, Husova 3, 301 00 Plzeň, Czech Republic; (V.T.); (K.H.); (V.O.); (B.C.)
| | - Karel Houdek
- Vascular Surgery Department, University Hospital in Pilsen, Faculty of Medicine in Pilsen, Charles University, Husova 3, 301 00 Plzeň, Czech Republic; (V.T.); (K.H.); (V.O.); (B.C.)
| | - Václav Opatrný
- Vascular Surgery Department, University Hospital in Pilsen, Faculty of Medicine in Pilsen, Charles University, Husova 3, 301 00 Plzeň, Czech Republic; (V.T.); (K.H.); (V.O.); (B.C.)
| | - Bohuslav Certik
- Vascular Surgery Department, University Hospital in Pilsen, Faculty of Medicine in Pilsen, Charles University, Husova 3, 301 00 Plzeň, Czech Republic; (V.T.); (K.H.); (V.O.); (B.C.)
| | - Jan Baxa
- Department of Imagine Methods, University Hospital in Pilsen, Faculty of Medicine in Pilsen, Charles University, Husova 3, 301 00 Plzeň, Czech Republic;
| |
Collapse
|
2
|
Sibuor W, Kipkorir V, Cheruiyot I, Gwala F, Olabu B. Prevalence of femoral vein duplication: systematic review and metaanalysis. J Ultrason 2021; 21:e326-e331. [PMID: 34970444 PMCID: PMC8678638 DOI: 10.15557/jou.2021.0054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 07/21/2021] [Indexed: 01/19/2023] Open
Abstract
Background: Duplication of the femoral vein is an important anatomical variation of the venous anatomy which has been shown to have an impact on the diagnosis of deep venous thrombosis by compression ultrasonography. The presence of duplication may result in false negative findings while evaluating for deep venous thrombosis, with serious consequences such as pulmonary embolism and death. This metaanalysis aims to determine the pooled prevalence of duplicated femoral veins. Methods: A systematic search was conducted through the major databases PubMed, Hinari, Embase and Medline to identify studies eligible for inclusion. Appropriate data were extracted and pooled into a random-effects metaanalysis using MetaXL software. The primary and secondary outcomes of the study included the pooled prevalence of duplicated femoral veins and the prevalence of bilaterally duplicated femoral veins, respectively. Results: A total of 11 studies (n = 3,682 limbs) were included. The overall pooled prevalence of duplicated femoral veins was 19.7% (95% CI 11–30). There was a significant difference in prevalence between cadaveric studies (2%, 95% CI 1–4) and imaging studies (25%, 95% CI 17–34). Conclusion: Duplication of the femoral vein is a common variation in the lower limbs. Routine watch-out should be practiced especially when performing lower limb Doppler studies in cases of deep venous thrombosis in order to avoid misdiagnosis and improve diagnostic accuracy.
Collapse
Affiliation(s)
- William Sibuor
- Department of Human Anatomy, University of Nairobi, Kenya
| | | | | | - Fidel Gwala
- Department of Human Anatomy, University of Nairobi, Kenya
| | - Beda Olabu
- Department of Human Anatomy, University of Nairobi, Kenya
| |
Collapse
|
3
|
Alonso W, Ozdemir B, Chassin-Trubert L, Ziza V, Alric P, Canaud L. Early outcomes of native and graft-related abdominal aortic infection managed with orthotopic xenopericardial grafts. J Vasc Surg 2020; 73:222-231. [PMID: 32442610 DOI: 10.1016/j.jvs.2020.04.513] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 04/21/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Reconstruction of infected aortic cases has shifted from extra-anatomic to in situ. This study reports the surgical strategy and early outcomes of abdominal aortic reconstruction in both native and graft-related aortic infection with in situ xenopericardial grafts. METHODS Included in the analysis are 21 consecutive patients (mean age, 69 years; 20 male) who underwent abdominal xenopericardial in situ reconstruction of native aortic infection (4) and endovascular (4) or open (13) graft aortic infection between July 2017 and September 2019. All repairs were performed on an urgent basis, but none were ruptured. All patients were followed up with clinical and biologic evaluation, ultrasound at 3 months, and computed tomography scan at 6 months and 1 year. RESULTS Technical success was 100%; 8 patients were treated with xenopericardial tubes and 13 with bifurcated grafts. Thirty-day mortality was 4.7% (one death due to pneumonia with respiratory hypoxic failure in critical care.). Six patients (28%) developed acute kidney injury, four (19%) requiring temporary dialysis; five fully recovered and one died. Four patients (19%) required a return to the operating room. After a median follow-up of 14 months (range, 1-26 months), overall mortality was 19% (n = 4). Two patients presented with recurrent sepsis after reconstruction, leading to death due to multiorgan failure. Other patients (17/21) have discontinued antibiotics with no evidence of recurrence of infection clinically, radiologically, or on blood tests. Computed tomography scans at 1 year demonstrated no stenosis or graft dilation and one asymptomatic left graft branch thrombosis. Primary patency is 95%. CONCLUSIONS In situ xenopericardial aortic reconstruction is a safe and effective management strategy for both native and graft-related abdominal aortic infection with good short-term results. The graft demonstrates appropriate resistance to infection such that reliable eradication of infection in this vascular bed is possible. Longer follow-up is required in future studies to determine the durability of the reconstruction and need for reinterventions.
Collapse
Affiliation(s)
- William Alonso
- Department of Thoracic and Vascular Surgery, Hôpital A de Villeneuve, Montpellier, France.
| | - Baris Ozdemir
- Department of Thoracic and Vascular Surgery, Hôpital A de Villeneuve, Montpellier, France
| | - Lucien Chassin-Trubert
- Department of Thoracic and Vascular Surgery, Hôpital A de Villeneuve, Montpellier, France
| | - Vicent Ziza
- Department of Thoracic and Vascular Surgery, Hôpital A de Villeneuve, Montpellier, France
| | - Pierre Alric
- Department of Thoracic and Vascular Surgery, Hôpital A de Villeneuve, Montpellier, France
| | - Ludovic Canaud
- Department of Thoracic and Vascular Surgery, Hôpital A de Villeneuve, Montpellier, France
| |
Collapse
|
4
|
Khan Y, Cheema MA, Abdullah HMA, Sattar Y, Haq S, Balaratna A, Cheema K, Ullah W. Great saphenous vein stump: a risk factor for superficial/deep venous thrombosis and an indication for prophylactic anticoagulation? - a retrospective analysis. J Community Hosp Intern Med Perspect 2019; 9:473-476. [PMID: 32002152 PMCID: PMC6968707 DOI: 10.1080/20009666.2019.1655626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 08/08/2019] [Indexed: 11/30/2022] Open
Abstract
Background: Great saphenous vein (GSV) grafts are used for coronary artery bypass surgeries, but the remaining stump of the GSV may be the nidus for superficial and deep vein thrombosis. This study aims to determine the risk of thrombosis in the GSV stump in patients who developed lower extremity swelling following coronary artery bypass graft (CABG). Methods: We conducted a single-center retrospective analysis at Abington Jefferson Hospital of 100 patients who underwent CABG with GSV. Patients were monitored via follow-up for seven days for the development of saphenous vein thrombosis without any prophylactic anticoagulation for venous thrombosis. Risk factors including age, diabetes, hypertension, smoking, familial thrombophilia’s, family history of thrombosis, malignancy, and confounding factor-like early mobilization that may potentially alter the results were recorded. Results: The mean age of included patients was 70 years, and 65% of participants were men, 35% were women. Fourteen percent of the patients developed pain, swelling and edema in a leg where the graft was taken. We included patients aged >50 years with coronary artery disease who underwent CABG with SVG and developed lower extremity symptoms concerning for thrombosis. These patients underwent duplex ultrasound for possible GSV stump thrombosis. Any patients with coronary artery disease but no CABG or no lower extremity edema were excluded from the study. We found no saphenous vein thrombosis in the stump of the GSV in patients with clinical symptoms of thrombosis in their lower extremities based on duplex imaging. Conclusion: Based on our findings, the postoperative risk of developing thrombosis at the GSV stump and its extension to the deep veins is low and does not warrant prophylactic anticoagulation for venous thromboembolism. However, we recommend that further prospective studies with larger samples for an extended duration are warranted for better assessment of the risk of venous thrombosis in the GSV stump with minimal confounding factors.
Collapse
Affiliation(s)
- Yasir Khan
- Department of Internal Medicine, Abington - Jefferson Health, Abington, USA
| | | | | | - Yasar Sattar
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai- Elmhurst Hospital, New York, NY, USA
| | - Shujaul Haq
- Department of Internal Medicine, Abington - Jefferson Health, Abington, USA
| | - Asoka Balaratna
- Department of Cardiology, Abington - Jefferson Health, Abington, PA, USA
| | | | - Waqas Ullah
- Department of Internal Medicine, Abington - Jefferson Health, Abington, USA
| |
Collapse
|
5
|
Hostalrich A, Ozdemir BA, Sfeir J, Solovei L, Alric P, Canaud L. Systematic review of native and graft-related aortic infection outcome managed with orthotopic xenopericardial grafts. J Vasc Surg 2019; 69:614-618. [DOI: 10.1016/j.jvs.2018.07.072] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 07/05/2018] [Indexed: 11/16/2022]
|
6
|
Etra JW, Hicks CW, Cooper MA, Arnold M, Reifsnyder T. Feasibility and Outcomes of Femoral Vein Harvest for Dialysis Access and Arterial Reconstruction. J Surg Res 2019; 237:50-55. [PMID: 30694791 DOI: 10.1016/j.jss.2018.11.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 10/24/2018] [Accepted: 11/20/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND We describe the feasibility and long-term outcomes of using femoral vein (FV) for arteriovenous fistula (AVF) and lower extremity bypass (LEB) creation. METHODS All patients undergoing AVF or LEB using autogenous FV by a single surgeon (April 2006 to September 2013) were reviewed. Perioperative (30-d) complications and long-term outcomes are described. RESULTS Forty-four patients underwent vascular reconstruction with FV (AVF = 27 and LEB = 17). Perioperative morbidity was 43.2%, including harvest site infection and or seroma in 15.9%. No patients suffered from compartment syndrome or venous thromboembolic event. At median follow-up of 50.0 mon, overall patency was 70.4% for AVF (primary = 37.0% and secondary = 70.3%) and 76.5% for LEB (primary = 70.6% and secondary = 76.5%). Long-term lower extremity swelling occurred in 18.2% of patients. CONCLUSIONS Perioperative morbidity following FV harvest is high, but long-term patency rates are excellent. FV harvest is feasible and should be considered as a valid conduit in patients without useable great saphenous vein or other more commonly used sources of autogenous vein.
Collapse
Affiliation(s)
- Joanna W Etra
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Johns Hopkins Medical Institutes, Baltimore, Maryland
| | - Caitlin W Hicks
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Johns Hopkins Medical Institutes, Baltimore, Maryland
| | - Michol A Cooper
- Division of Vascular and Endovascular Surgery, Department of Surgery, Massachusetts General Hospital, Boston Massachusetts
| | - Margaret Arnold
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Johns Hopkins Medical Institutes, Baltimore, Maryland
| | - Thomas Reifsnyder
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Johns Hopkins Medical Institutes, Baltimore, Maryland.
| |
Collapse
|
7
|
Lefroy R, Dattani N, Reyes M, Rajagopalan S, Fairhead J, Jaipersad A, Corfield L, Asquith J, Greenway MW, Pherwani A. The Transposed Femoral Vein Fistula: The Native Choice in Desperate Vascular Access. Ann Vasc Surg 2019; 54:318-327. [DOI: 10.1016/j.avsg.2018.07.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 06/25/2018] [Accepted: 07/09/2018] [Indexed: 11/25/2022]
|