An overview of aortofemoral graft infection

Hybrid aortoiliac revascularization to avoid nonautogenous groin reconstruction in an intravenous drug abuser

Traditional methods for revascularization of an occluded aortoiliac system have necessitated either in-line aortic reconstruction through an aortobifemoral bypass or extra-anatomic bypass. However, both these approaches require artificial material to be placed in the groin. The consequence of groin infection can be devastating leading to high rates of both limb loss and mortality. One of the most feared patient populations presenting with groin complications is that of the intravenous drug abuser. We present the case of a patient with a long history of intravenous drug abuse with severe aortoiliac disease. Instead of resorting to a more traditional open surgical approach necessitating artificial reconstruction in the groin, we chose to proceed with a hybrid open and endovascular procedure through a direct open surgical access to the aortic bifurcation. This allowed for revascularization without the placement of artificial material in the groin.

A comparative study of the rifampicin binding and elution characteristics for collagen- and albumin-sealed vascular grafts

OBJECTIVES

To assess the rifampicin binding and elution characteristics for three protein-sealed vascular grafts.

DESIGN

In vitro study.

MATERIALS

Cardial and Hemashield collagen-sealed and the DeBakey/Vasculour albumin-sealed vascular grafts.

METHODS

The grafts were soaked in a 60,000 mg/l solution of rifampicin at 37 degrees C for 15 min. Bound drug was eluted from the grafts at 37 degrees C and at timed intervals the concentrations of rifampicin remaining in the grafts were determined.

RESULTS

Although all three grafts contained high concentrations of rifampicin immediately after soaking these rapidly fell on washing and only a small fraction of the adsorbed rifampicin was tightly bound to the grafts. Rifampicin loading of this tightly bound fraction was similar for the two collagen-sealed grafts (1.7-2.0 mg/kg) but higher for the albumin-sealed graft (16.0 mg/kg). Elution of the tightly bound fraction appeared to follow first-order kinetics with elimination half-lives of 89-141 h. The concentrations of rifampicin remaining in the grafts after eight days were above those needed to inhibit sensitive staphylococci and were 0.7 mg/kg (collagen-sealed grafts) to 3.7 mg/kg (albumin-sealed graft).

CONCLUSIONS

There is broad equivalence between the rifampicin binding and elution for the two collagen-sealed grafts, but there appears to be slightly higher binding for the albumin-sealed graft.