Treatment of Peripheral Vascular Graft Infections with Xenogeneic Grafts—A Single-Center Experience

TL;DR

This study examines the use of bovine pericardium grafts in treating vascular graft infections and finds low reinfection rates but high mortality and complications.

Contribution

The study provides a single-center experience on using No-React® xenogeneic grafts for vascular graft infections.

Findings

No reinfections were observed with No-React® grafts.

In-hospital mortality was high at 42%, mainly due to sepsis.

Early postoperative complications predicted overall survival.

Abstract

Introduction: Vascular graft infections (VGEIs) are rare but severe complications in vascular surgery. The choice of reconstruction material following graft removal is critical, particularly for infection prevention. This study evaluates the use of No-React® BioIntegral Surgical Grafts, made from bovine pericardium, in the treatment of VGEIs. Materials and Methods: A retrospective study of 12 patients (mean age 66.5 years; 67% male) treated between 2020 and 2022 was conducted. The follow-up period included in the study extended from the date of the procedure to 30 June 2024. Results: The study observed a 0% reinfection rate, underscoring the anti-infective potential of No-React® grafts. However, in-hospital complications were frequent, affecting six (50%) patients, with sepsis (3; 25%) related to preoperative VGEIs being the most common. Most importantly, in-hospital mortality was notably high (42%), primarily driven by infection-related sepsis. The overall complication rate after discharge was 14%, with only one case of graft occlusion (1/7) observed. Among discharged patients (7; 58%), the three-month survival rate was 71%. In-hospital complications were a predictive factor for overall survival (OS) (HR = 15.88, 95% CI = 1.81–139.47). Conclusions: Xenogeneic No-React® grafts show promise for managing VGEIs, offering low reinfection rates. However, high morbidity and mortality underline the challenges of treating patients with severe VGEIs. Early postoperative complications were a key predictor of OS. Further research is needed to confirm these findings and optimize treatment protocols for VGEIs.