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
2
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
3
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
4
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
5
Omniflow®-Bifurcation
2015 2016 2017
Vascular Surgery
Prof. Dr. Bernhard Dorweiler
6
„Omniflow®-bifurcation“ – Mainz approach
Omniflow 8mm/65cm
Vascular Surgery
Prof. Dr. Bernhard Dorweiler
7
„Omniflow®-bifurcation“ - implantation
Vascular Surgery
Prof. Dr. Bernhard Dorweiler
8
„Omniflow®-bifurcation“ in aortoiliac-AOD
Vascular Surgery
Prof. Dr. Bernhard Dorweiler
9
„Omniflow®-bifurcation“ in EVAR-Conversion
Vascular Surgery
Prof. Dr. Bernhard Dorweiler
Graft infection/AEF after EVAR/Y-graft
10
Vascular Surgery
Prof. Dr. Bernhard Dorweiler
Literature Omniflow®-Bifurcation
11
Bifurcated grafts 6Mortality 30d 12.5%Graft complications 12.5%Reinfection 0%Follow-up(Median, Months)
11
Scand J Surg. 2018
Vascular Surgery
Prof. Dr. Bernhard Dorweiler
12
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
13
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
14
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
15
Explant of Ch-EVAS-Bridging
Vascular Surgery
Prof. Dr. Bernhard Dorweiler
16
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
18
Many thanks for your attention !
Prof. Dr. Bernhard DorweilerHead, Division of Vascular Surgery
University Medical Center [email protected]
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