Prevalence and risk factors for heparin-bonded expanded polytetrafluoroethylene vascular graft infection after infrainguinal femoropopliteal bypasses.
Aged
Aged, 80 and over
Amputation, Surgical
Anticoagulants
/ administration & dosage
Blood Vessel Prosthesis
/ adverse effects
Blood Vessel Prosthesis Implantation
/ adverse effects
Coated Materials, Biocompatible
Critical Illness
Female
Femoral Artery
/ surgery
Heparin
/ administration & dosage
Hospital Mortality
Humans
Ischemia
/ diagnosis
Italy
/ epidemiology
Limb Salvage
Male
Middle Aged
Peripheral Arterial Disease
/ mortality
Polytetrafluoroethylene
Popliteal Artery
/ surgery
Prevalence
Progression-Free Survival
Prosthesis Design
Prosthesis-Related Infections
/ epidemiology
Registries
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
Femoropopliteal bypass
Heparin-bonded ePTFE graft
Prosthetic vascular graft infection
Journal
Journal of vascular surgery
ISSN: 1097-6809
Titre abrégé: J Vasc Surg
Pays: United States
ID NLM: 8407742
Informations de publication
Date de publication:
10 2019
10 2019
Historique:
received:
05
11
2018
accepted:
10
03
2019
pubmed:
31
5
2019
medline:
26
5
2020
entrez:
1
6
2019
Statut:
ppublish
Résumé
To analyze the prevalence and predictors of prosthetic vascular graft infection (PVGI) in a multicenter registry. This registry-based, multicenter study retrospectively evaluated PVGI that developed after infrainguinal revascularization performed with a heparin-bonded expanded polytetrafluoroethylene graft that was used in 1400 interventions between 2002 and 2016. A prosthetic graft with infection was defined as direct involvement of the graft with positive bacterial cultures of graft or perigraft material, intraoperative gross purulence or failure of graft incorporation, or exposed graft in an infected wound. Critical limb ischemia (CLI) was the main indication for bypass (n = 915 [65%]). The median duration of follow-up was 29 months (range, 1-168 months; interquartile range, 12-60 months). A total of 33 heparin-bonded expanded polytetrafluoroethylene grafts (2.3%) became infected; the median time to occurrence was 5 months (range, 1-54 months; interquartile range; 2.00-13.25 months). Freedom from PVGI at 1 year was 98% (standard error, 0.4; 95% confidence interval [CI], 97.2-98.9), and 97% (standard error, 0.6; 95% CI, 95.6-98.0) at 5 years. The multivariate model identified CLI (P = .042; hazard ratio, 0.39; 95% CI, 0.164-0.969) to be independently associated with PVGI. In-hospital mortality of PVGI treatment was 12% (n = 4/33). Freedom from major amputation was significantly different between patients with PVGI and those who did not experience this complication (at 1 year, 67.0% vs 88.5%; Log-rank χ In our "real-world" multicenter experience the prevalence of PVGI after infrainguinal femoropopliteal bypasses was relatively low at 2.3%, but still associated with significant mortality and limb loss. CLI was the only significant predictor of PVGI. This conclusion is reasonable; however, more comprehensive data are required to confirm these findings, because the presence of ischemic ulcers or gangrene was not predictive of PVGI.
Sections du résumé
BACKGROUND
To analyze the prevalence and predictors of prosthetic vascular graft infection (PVGI) in a multicenter registry.
METHODS
This registry-based, multicenter study retrospectively evaluated PVGI that developed after infrainguinal revascularization performed with a heparin-bonded expanded polytetrafluoroethylene graft that was used in 1400 interventions between 2002 and 2016. A prosthetic graft with infection was defined as direct involvement of the graft with positive bacterial cultures of graft or perigraft material, intraoperative gross purulence or failure of graft incorporation, or exposed graft in an infected wound.
RESULTS
Critical limb ischemia (CLI) was the main indication for bypass (n = 915 [65%]). The median duration of follow-up was 29 months (range, 1-168 months; interquartile range, 12-60 months). A total of 33 heparin-bonded expanded polytetrafluoroethylene grafts (2.3%) became infected; the median time to occurrence was 5 months (range, 1-54 months; interquartile range; 2.00-13.25 months). Freedom from PVGI at 1 year was 98% (standard error, 0.4; 95% confidence interval [CI], 97.2-98.9), and 97% (standard error, 0.6; 95% CI, 95.6-98.0) at 5 years. The multivariate model identified CLI (P = .042; hazard ratio, 0.39; 95% CI, 0.164-0.969) to be independently associated with PVGI. In-hospital mortality of PVGI treatment was 12% (n = 4/33). Freedom from major amputation was significantly different between patients with PVGI and those who did not experience this complication (at 1 year, 67.0% vs 88.5%; Log-rank χ
CONCLUSIONS
In our "real-world" multicenter experience the prevalence of PVGI after infrainguinal femoropopliteal bypasses was relatively low at 2.3%, but still associated with significant mortality and limb loss. CLI was the only significant predictor of PVGI. This conclusion is reasonable; however, more comprehensive data are required to confirm these findings, because the presence of ischemic ulcers or gangrene was not predictive of PVGI.
Identifiants
pubmed: 31147126
pii: S0741-5214(19)30502-6
doi: 10.1016/j.jvs.2019.03.023
pii:
doi:
Substances chimiques
Anticoagulants
0
Coated Materials, Biocompatible
0
Polytetrafluoroethylene
9002-84-0
Heparin
9005-49-6
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
1299-1307.e1Investigateurs
Alessandro Alessi Innocenti
(AA)
Elena Giacomelli
(E)
Aaron Fargion
(A)
Giovanni De Blasis
(G)
Luciano Scalisi
(L)
Vincenzo Monaca
(V)
Giuseppe Battaglia
(G)
Enrico Vecchiati
(E)
Giovanni Casali
(G)
Fiore Ferilli
(F)
Raimondo Micheli
(R)
Francesco Grasselli
(F)
Paolo Bonanno
(P)
Marco Franchin
(M)
Matteo Tozzi
(M)
Nicola Rivolta
(N)
Massimo Ferrario
(M)
Marco Franchin
(M)
Matteo Tozzi
(M)
Nicola Rivolta
(N)
Massimo Ferrario
(M)
Maria Cristina Cervarolo
(MC)
Gaddiel Mozzetta
(G)
Emma Nahal
(E)
Informations de copyright
Copyright © 2019 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.