Vascular Surgery

Prof. Dr. Bernhard Dorweiler

Biosynthetic grafts for native andprosthetic vascular graft infection

Division of Vascular Surgery

Dorweiler B, Trinh TT, Vahl CF, EL Beyrouti H

Vascular Surgery

Prof. Dr. Bernhard Dorweiler

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InteressenskonfliktIn den letzten 24 Monaten hatte ich finanzielle Interessen/Arrangements oderBeziehungen mit folgenden aufgelisteten Organisationen1. Anstellungsverhältnis oder Führungsposition

keine

2. Beratungs- bzw. Gutachtertätigkeitkeine

3. Besitz von Geschäftsanteilen, Aktien oder Fondskeine

4. Patent, Urheberrecht, Verkaufslizenzkeine

5. Honorarekeine

6. Finanzierung wissenschaftlicher Untersuchungenkeine

7. Andere finanzielle Beziehungen (Reisekosten)keine

Vascular Surgery

Prof. Dr. Bernhard Dorweiler

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Challenge

Aortoiliac reconstruction in non-sterileOR-field: Prosthetic graft infection Direct bacterial Contamination Indirect bacterial Contamination

Choice of graft material ?

Vascular Surgery

Prof. Dr. Bernhard Dorweiler

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Biosynthetic graftOmniflow II® BiograftCombination of Polyester-Endoskeletton with ovine Collagen

Diameter 5-8mm, length 20-65 cm

Bio Nova International, Australia/LeMaitre, Germany

Vascular Surgery

Prof. Dr. Bernhard Dorweiler

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Omniflow®-Bifurcation

2015 2016 2017

Vascular Surgery

Prof. Dr. Bernhard Dorweiler

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„Omniflow®-bifurcation“ – Mainz approach

Omniflow 8mm/65cm

Vascular Surgery

Prof. Dr. Bernhard Dorweiler

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„Omniflow®-bifurcation“ - implantation

Vascular Surgery

Prof. Dr. Bernhard Dorweiler

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„Omniflow®-bifurcation“ in aortoiliac-AOD

Vascular Surgery

Prof. Dr. Bernhard Dorweiler

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„Omniflow®-bifurcation“ in EVAR-Conversion

Vascular Surgery

Prof. Dr. Bernhard Dorweiler

Graft infection/AEF after EVAR/Y-graft

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Vascular Surgery

Prof. Dr. Bernhard Dorweiler

Literature Omniflow®-Bifurcation

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Bifurcated grafts 6Mortality 30d 12.5%Graft complications 12.5%Reinfection 0%Follow-up(Median, Months)

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Scand J Surg. 2018

Vascular Surgery

Prof. Dr. Bernhard Dorweiler

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Omniflow®-Bifurcations MAINZ (11/2015-01/2019)

n %Patients 16Men 10 63%Age (years) 66±6 58-80ComorbiditiesHypertension 14 88%Hyperlipoproteinemia 2 13%Diabetes mellitus 3 19%Nikotine abuse 6 38%CAD 8 50%pAOD 9 56%ASA-Class ≥ III 15 94%

n %HistoryEVAR/EVAS 1/1Prosthetic graft(Tube/Y)

1/1/3

IndicationGraft infection 7 44%pAOD IV 6 38%Contamination 2 12%mycotic AAA 1 6%

Vascular Surgery

Prof. Dr. Bernhard Dorweiler

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Results

nOR-time(median, Min.)

330 253-661

Mortality 1 6%ComplicationsHematoma 1 6%Graft revision 2 13%Amputations 0Groin infection 1 6%Colonic ischemia 1 6%

Follow-up(median, Months)

17 (1-40)

Death 1 (3 Months)Reintervention 1 (27 Months)

Vascular Surgery

Prof. Dr. Bernhard Dorweiler

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Recurrent-(fungal)-Infection followingexplant. of Y-graft + autologous reconstruction

Graft infection with AEFExplant.+ Reconstruction 2016

2-Vessel-Chimney-EVAS in prox. anastomotic rupture 2017

Vascular Surgery

Prof. Dr. Bernhard Dorweiler

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Explant of Ch-EVAS-Bridging

Vascular Surgery

Prof. Dr. Bernhard Dorweiler

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Compositgraft Pericardial tube/Omniflow-Bifurcation

Vascular Surgery

Prof. Dr. Bernhard Dorweiler

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Conclusion According to our initial results, Omniflow®-

Bifurcation can be used as an alternative graft foraortoiliac reconstruction in non-sterile operativefield.

Patient selection and education/consent must becareful against established options (autologousreconstruction, antibacterial polyester grafts).

A close follow-up protocol is mandatory and theinitial results need to be extended in patientenrollment and follow-up (multicenterregistry/study).

Vascular Surgery

Prof. Dr. Bernhard Dorweiler

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Many thanks for your attention !

Prof. Dr. Bernhard DorweilerHead, Division of Vascular Surgery

University Medical Center Mainzbernhard.dorweiler@unimedizin-mainz.de