Alloplastische Prothesen bei Protheseninfektionen

Many cases of vascular graft infections require partial or complete removal of the colonized graft material. This necessitates formulation of a new treatment plan to further reconstruct the arterial vessels, during which selection of a suitable graft material plays an important role. Reconstructions can be performed extra-anatomically or in situ. The surgical site is usually cleansed with antiseptics before revascularization, but the most appropriate antiseptic agent for the vascular surgery setting remains to be clearly identified. Extra-anatomical reconstruction using autologous vein material is recommended by many guidelines for peripheral bypasses, but may be impracticable in the absence of suitable graft material. In other areas, such as for aortic reconstructions, in situ techniques are often favored to avoid complications associated with extra-anatomical revascularizations in the respective region. Reconstruction using deep vein material is one option to achieve good results in the aortic setting, but not without substantial morbidity at the donor site. In some cases, alloplastic material must be used for reconstruction following removal of an infected graft. For such cases, antimicrobial grafts deserve consideration. Silver-bonded and rifampin-impregnated grafts have been studied in both in vitro and in vivo settings and have shown promising antimicrobial efficacy, but are not without their limitations. These include, but are not limited to, possible reinfections for silver-bonded or the short presence of antibiotic levels with rifampin-impregnated grafts. In a relatively new graft, the positive effects and antimicrobial properties of silver and triclosan are combined, but further evaluation in a clinical setting is required.