Ovine Biosynthetic Grafts for Aortoiliac Reconstructions in Nonsterile Operative Fields
Background Prosthetic vascular grafts placed surgically or via endovascular techniques can be subject to the risk of life-threatening graft infections. The Omniflow II vascular prosthesis is a biosynthetic graft that was reported to have favorable properties in resisting infections.
Materials and Methods We retrospectively reviewed our 3 years' experience of using the Omniflow II prostheses for aortoiliac reconstructions in patients considered to carry a substantial risk of subsequent prosthetic graft infections (prevention group) as well as in patients with actively infected prosthetic vascular grafts (treatment group).
Results Aorto-bi-iliac (n = 4) and aortobifemoral (n = 12) vascular reconstructions were performed using bifurcated Omniflow II prostheses in nine patients in the prevention group and seven patients in the treatment group. During mean follow-up of 28.6 ± 17.2 months, there was one case of graft infection (6.3%) and graft thrombosis (6.3%) with subsequent successful thrombectomy. Early and late surgical revisions were required in eight (50%) and two (12.6%) patients, respectively. All graft prostheses were patent at last follow-up.
Conclusion Using bifurcated Omniflow II vascular prostheses in patients with or at a high risk of vascular graft infection is advisable, and is associated with acceptable reinfection and patency rates.
Received: 14 October 2020
Accepted: 14 December 2020
04 February 2021 (online)
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- 1 Lyons OTA, Baguneid M, Barwick TD. et al. Diagnosis of aortic graft infection: a case definition by the Management of Aortic Graft Infection Collaboration (MAGIC). Eur J Vasc Endovasc Surg 2016; 52 (06) 758-763
- 2 Shiraev T, Barrett S, Heywood S. et al. Incidence, management and outcomes of aortic graft infection. Ann Vasc Surg 2019; 59: 73-83
- 3 Vogel TR, Symons R, Flum DR. The incidence and factors associated with graft infection after aortic aneurysm repair. J Vasc Surg 2008; 47 (02) 264-269
- 4 Post ICJH, Vos CG. Systematic review and meta-analysis on the management of open abdominal aortic graft infections. Eur J Vasc Endovasc Surg 2019; 58 (02) 258-281
- 5 O'Connor S, Andrew P, Batt M, Becquemin JP. A systematic review and meta-analysis of treatments for aortic graft infection. J Vasc Surg 2006; 44 (01) 38-45
- 6 Chakfé N, Diener H, Lejay A. et al; ESVS Guidelines Committee. Editor's choice - European Society for Vascular Surgery (ESVS) 2020 clinical practice guidelines on the management of vascular graft and endograft infections. Eur J Vasc Endovasc Surg 2020; 59 (03) 339-384
- 7 van Zitteren M, van der Steenhoven TJ, Burger DH, van Berge Henegouwen DP, Heyligers JM, Vriens PW. Spiral vein reconstruction of the infected abdominal aorta using the greater saphenous vein: preliminary results of the Tilburg experience. Eur J Vasc Endovasc Surg 2011; 41 (05) 637-646
- 8 Dorweiler B, Neufang A, Chaban R, Reinstadler J, Duenschede F, Vahl CF. Use and durability of femoral vein for autologous reconstruction with infection of the aortoiliofemoral axis. J Vasc Surg 2014; 59 (03) 675-683
- 9 Harlander-Locke MP, Harmon LK, Lawrence PF. et al; Vascular Low-Frequency Disease Consortium. The use of cryopreserved aortoiliac allograft for aortic reconstruction in the United States. J Vasc Surg 2014; 59 (03) 669-674
- 10 Batt M, Jean-Baptiste E, O'Connor S. et al. In-situ revascularisation for patients with aortic graft infection: a single centre experience with silver coated polyester grafts. Eur J Vasc Endovasc Surg 2008; 36 (02) 182-188
- 11 Krasznai AG, Snoeijs M, Siroen MP. et al. Treatment of aortic graft infection by in situ reconstruction with Omniflow II biosynthetic prosthesis. Vascular 2016; 24 (06) 561-566
- 12 Betz T, Neuwerth D, Steinbauer M, Uhl C, Pfister K, Töpel I. Biosynthetic vascular graft: a valuable alternative to traditional replacement materials for treatment of prosthetic aortic graft infection?. Scand J Surg 2019; 108 (04) 291-296
- 13 Töpel I, Uhl C, Ayx I, Steinbauer M. Xenografts in septic vascular surgery. Gefasschirurgie 2016; 21 (Suppl. 02) 55-58
- 14 Stather PW, Howard AQ. A novel technique for bifurcated bovine plus Omniflow aortic graft reconstruction. Eur J Vasc Endovasc Surg 2017; 53 (01) 104
- 15 Neufang A, Dorweiler B, Espinola-Klein C. et al. Outcomes of complex femorodistal sequential autologous vein and biologic prosthesis composite bypass grafts. J Vasc Surg 2014; 60 (06) 1543-1553
- 16 Dünschede F, Stabrauskaite J, Weisser G, Espinola-Klein C, Dorweiler B, Vahl CF. Crural bypass for critical lower limb ischemia with Omniflow II prosthesis. Thorac Cardiovasc Surg 2016; 64 (04) 311-315
- 17 Neufang A, Duenschede F, Espinola-Klein C. et al. Contemporary results with the biosynthetic glutaraldehyde denatured ovine collagen graft (Omniflow II) in femoropopliteal position. J Vasc Surg 2020; 71 (05) 1630-1643
- 18 Dünschede F, Youssef M, Stabrauskaite J. et al. Omniflow-II™ for critical limb ischemia: long-term results [in German]. Chirurg 2017; 88 (03) 233-238
- 19 Edwards GA, Roberts G. Development of an ovine collagen-based composite biosynthetic vascular prosthesis. Clin Mater 1992; 9 (3-4): 211-223
- 20 Omniflow® II Biosynthetic Vascular Prosthesis. Product Information. . LeMaitre Vascular. Accessed date: 1 September 2020 at: https://www.lemaitre.com/products/omniflow-ii-biosynthetic-vascular-prosthesis
- 21 Inston NG. Long-term results of biological grafts for haemodialysis vascular access. J Vasc Access 2015; 16 (09) 82-86
- 22 De Siqueira JR, Sun ZDY, Tahir W, Bhasin N, Parry D. Use of Omniflow® II in infected vascular grafts with femoral anastomotic dehiscence. Ann Vasc Surg 2020; 65: 160-165
- 23 Batt M, Feugier P, Camou F. et al; Research Group for Vascular Graft Infection. A meta-analysis of outcomes after in situ reconstructions for aortic graft infection. Angiology 2018; 69 (05) 370-379
- 24 Töpel I, Stigler T, Ayx I, Betz T, Uhl C, Steinbauer M. Biosynthetic grafts to replace infected prosthetic vascular bypasses: a single-center experience. Surg Infect (Larchmt) 2017; 18 (02) 202-205