Prophylactic Use of Silver-acetate-coated Polyester Dacron Graft in Aortic Disease for Prevention of Graft Infection

From January 2000 to December 2009, in the Division of Vascular Surgery of the hospitals of Pisa and Naples (Monaldi Hospital), InterGard silver (InterVascular, La Ciotat, France) grafts were implanted in 1,424 patients (93.6% male and 6.4% female) for the treatment of aorto-iliac diseases. The mean age of patients was 71.4 ± 7.4 years. Some patient characteristics were considered as increased risk factors for graft infection; these include diabetes, age >80 years, mycotic aneurysms, and ruptured aneurysms. Hyperleukocytosis, fever >38°C, and wound infections were also recorded. The primary patency at 30 days was 99.7%. At 3, 5, and 10 years it was 95.6 ± 2.2%, 94.3 ± 2.3%, and 93.8% ± 2.7%, respectively. Secondary patency at 10 years was 98.6 ± 1.7%. During hospital stay, 41 patients experienced leukocytosis and 32 had peaks of hyperpyrexia >38%C. Early postoperative complications requiring reintervention occurred in 56 (4%) patients. In the perioperative period (30 days from surgery), 49 wound infections were recorded. Among all 1,424 silver grafts, 5 (0.35%) cases of graft infection have been found: three in the first four months (early infections: 0.21 %) and two later (late infections: 0.14%). Clinical findings at onset of graft infection have been: one case of graft-enteric fistula (0.07%), treated by total graft excision, proximal aortic stump closure, and axillobifemoral bypass; two others cases (0.14%) presented with severe bleeding due to anastomotic disruption that led to patient death. These data, compared to the numbers published in the literature, seem to support the hypothesis that extensive use of silver-acetate-coated Dacron graft could reduce Dacron graft infection, impoving both the immediate and long-term outcome in patients. Nevertheless, accurate selection of patients for elective aorto-iliac surgery, accurate operative technique, and meticulous respect for any perioperative prophylactic measures, are of paramount importance for the prevention of early and late graft infection.