A systematic review of preclinical data regarding Commercial Silver coated Vascular grafts.

Abstract Objective Vascular graft infection (VGI) is a serious complication with a high mortality and morbidity rate. Several measures could be taken to reduce the risk. One of them are silver containing vascular grafts. However, to date, no clinical advantages have been reported. This study reviews the outcome of preclinical studies focusing on the role of commercially available silver coated grafts in the prevention of VGI. Methods A systematic review was performed with a focus on the preclinical role of commercially available silver coated vascular grafts in the prevention and treatment of VGI. A comprehensive search was conducted in Medline, Embase and Web of Science. Results Nine in vitro and five in vivo studies were included. Two commercial grafts were used (INTERGARD SILVER™ and Silver Graft™). In vitro studies used both gram-positive and gram-negative strains. A positive antimicrobial effect was observed in seven out of nine studies (77.8%). A delayed antifungal effect against Candida species was observed in vitro but disappeared when adding serum proteins. In vivo studies witnessed a microbicidal effect in two out of five studies (40%), but only tested a single causative pathogen (i.e. Staphylococcus aureus). Conclusion Both in vitro and in vivo studies demonstrated conflicting and mixed results concerning the antimicrobial efficacy of commercially available silver containing grafts in the prevention of VGI. In general, the study set-up was heterogeneous in the different papers. Given the lack of convincing preclinical evidence and their poor performance in clinical studies, more data are needed at this time to guide the appropriate use of silver grafts in the future.