Treatment of Aorto-iliac and Infrainguinal Vascular Infections with a Prefabricated Bovine Pericardial Graft

Federica Donato; Tommaso Donati; Fabrizio Minelli; Alberto Borghetti; Marta Minucci; Antonio Luparelli; Giovanni Tinelli; Yamume Tshomba

doi:10.1016/j.avsg.2024.01.015

Treatment of Aorto-iliac and Infrainguinal Vascular Infections with a Prefabricated Bovine Pericardial Graft

Ann Vasc Surg. 2024 Apr 9:105:177-188. doi: 10.1016/j.avsg.2024.01.015. Online ahead of print.

Authors

Federica Donato¹, Tommaso Donati², Fabrizio Minelli², Alberto Borghetti³, Marta Minucci², Antonio Luparelli², Giovanni Tinelli², Yamume Tshomba²

Affiliations

¹ Dipartimento Cardiovascolare, Università Cattolica del Sacro Cuore, Rome, Italy; Unit of Vascular Surgery, Fondazione Policlinico Universitario Gemelli IRCCS, Roma - Università Cattolica del Sacro Cuore, Rome, Italy. Electronic address: donatofederica@gmail.com.
² Dipartimento Cardiovascolare, Università Cattolica del Sacro Cuore, Rome, Italy; Unit of Vascular Surgery, Fondazione Policlinico Universitario Gemelli IRCCS, Roma - Università Cattolica del Sacro Cuore, Rome, Italy.
³ Dipartimento Cardiovascolare, Università Cattolica del Sacro Cuore, Rome, Italy; Unit of Infectious Diseases, Fondazione Policlinico Universitario Gemelli IRCCS, Roma - Università Cattolica del Sacro Cuore, Rome, Italy.

PMID: 38599483
DOI: 10.1016/j.avsg.2024.01.015

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.

Published by Elsevier Inc.