Ezüst-acetáttal bevont Dacron grafttal végzett rekonstrukciós érműtétek középtávú eredményei The midterm results of silver coated polyester graft implantation in aortic and lower extremity revascularization

Bevezetes/celkitűzes: A műerek fertőzese vagy septicus allapotban műer beultetese magas morbiditasu es mortalitasu allapot, mely az ersebeszet egyik legnagyobb kihivasa ma is. A nehany evvel ezelőtt megjelent ezust-acetattal bevont polieszter graft uj lehetőseget jelent a revascularisatiot biztosito műteti lehetősegek kozott. Vizsgalatunk celja az ezustacetattal bevont műerbeultetesek eredmenyeinek elemzese a halalozas, graftelzarodas, graftinfekcio es amputacio szempontjabol. Anyag es modszerek: Retrospektiv vizsgalatunk soran a Semmelweis Egyetem Ersebeszeti Klinikajan 2001. oktober 1. es 2006. oktober 1. kozott beultetett 42 ezust-acetattal bevont Dacron graft (InterGard Silver erprotezis) eredmenyeit ertekeltuk. Az aorto-femoropoplitealis szakaszon korabban beultetett graft infekcioja miatt 17 esetben, aortoduodenalis fistula miatt 7 esetben, septicus allapotot okozo gangraena miatt 16 esetben ultettunk be ezust-acetattal bevont graftot, ket esetben infekcio nem allt fenn. Eredmenyek: Fertőzes miatt 40 esetben kerult ezust-acetattal bevont graft beultetesre 40 betegben. Az atlageletkor 62 ev volt (35–81 ev), 70% volt ferfi. Hosszu tavu kovetesi adat 29 betegről allt rendelkezesre, az atlagos utankovetesi idő 36,76 honap volt. Korai (30 napon beluli) halalozas 3 (8%), kesői 11 (38%) esetben fordult elő. Korai graftelzarodast 8, kesőit 2 esetben eszleltunk (20, illetve 7%). Az ismetelt graftinfekciok aranya a korai es a kesői időszakban egyarant 7% volt. A korai szakban 5 major es 3 minor amputacio valt szuksegesse, az utankovetes soran a major amputacios arany 28% volt. Kovetkeztetesek: Infekciokontroll szempontjabol jo eredmenyeket ado lehetőseg az ezust-acetattal bevont Dacron graft e sajat anyagunkban is magas halalozassal es amputacios arannyal biro betegcsoportban. Kulcsszavak: graftinfekcio, in situ errekonstrukcio, ezust-acetat Background: Prosthetic graft infection or the need for reconstructive arterial surgery in septic condition is a challenging situation in vascular surgery. Recent introduction of silver coated polyester graft has meant a new therapeutic option in selecting the type of graft for revascularization. In this study we analyzed the short and midterm outcome of using silver coated grafts in aortic and lower extremity arterial reconstructions (mortality, graft occlusion, graft infection, amputation). Materials and methods: In a single center retrospective study we implanted 42 silver coated Dacron grafts (InterGard Silver Dacron prosthesis). The indication of silver graft implantation was graft infection in 17, aorto-duodenal fistula in 7, septic condition caused by gangrene in 16 cases and in 2 cases infection was not established. Results: Forty silver grafts were implanted in 40 patients with diagnosed infection. The mean age was 62 years (35–81 years), 70% were men. Long term follow-up data were available in 29 patients; the mean follow-up time was 36.76 months. Early (within 30 days of surgery) death occurred in 3 and late death in 11 cases (8 and 38%). Early graft occlusion was noticed in 8 and late occlusion in 2 cases (20 and 7%). Reinfection was diagnosed in 7% of the cases in the early and the midterm period as well. Eight amputations were indicated in the early postoperative period (5 major and 3 minor) and 28% of the patients required major amputation during the follow-up. Conclusions: Silver coated Dacron graft means a valuable therapeutic option with good rate of infection control in the treatment of graft infection and septic condition in the lack of autologous graft material in this high risk population.