Performance of the BioIntegral Bovine Pericardial Graft in Vascular Infections:VASCular No-REact Graft Against INfection Study

Background: Vascular graft and endograft infections (VGEI) and native vessel infections (NVI) remain considerable challenges in vascular surgery, leading to high mortality and morbidity rates. Although in situ reconstruction is the preferred treatment, the material of choice is still a source of debate. Autologous veins are considered the first choice; however, xenografts may be an acceptable alternative. The performance of a biomodified bovine pericardial graft is assessed when implemented in an infected vascular area. Methods: This is a prospective multicenter cohort study. Patients who underwent reconstruction for VGEI or NVI with a biomodified bovine pericardial bifurcated or straight tube graft were included from December 2017 until June 2021. The primary outcome measure was reinfection at mid-term follow-up. Secondary outcome measures included mortality, patency, and amputation rate. Results: Thirty-four patients with vascular infections were included, of which 23 (68%) had an infected Dacron prosthesis after primary open repair and 8 (24%) had an infected endovascular graft. The remaining 3 (9%) had infected native vessels. At secondary repair, 3 (7%) patients had an in situ aortic tube reconstruction, 29 (66%) had an aortic bifurcated reconstruction, and 2 (5%) had an iliac-femoral reconstruction. At 1-year follow-up after the BioIntegral bovine pericardial graft reconstruction, the reinfection rate was 9%. The 1-year infection-related and procedure-related mortality rate was 16%. The occlusion rate was 6% and in total 3 patients underwent a lower limb amputation during the 1-year follow-up period. Conclusions: In situ reconstruction as treatment of (endo)graft and native vessel infections remains a challenge and reinfection looms as a potential consequence. In cases where time is of essence or when autologous venous repair is not feasible, a swift available solution is needed. The BioIntegral biomodified bovine pericardial graft may be an option as it shows reasonable results in terms of reinfection, in aortic tube and bifurcated grafts.</p

A systematic review and meta-analysis of F-18-fluoro-D-deoxyglucose positron emission tomography interpretation methods in vascular graft and endograft infection

OBJECTIVE: Vascular graft and endograft infection (VGEI) has high morbidity and mortality rates. Diagnosis is complicated since symptoms vary and can be non-specific. A recent meta-analysis identified the use of 18F-fluoro-D-deoxyglucose positron emission tomography-computed tomography (18F-FDG PET(/CT)) as the most valuable tool for diagnosing VGEI and favorable to computed tomography as the current standard. However, the availability and varied use of several interpretation methods, without consensus on which interpretation method is best, complicates clinical use. The aim of this study was to evaluate the diagnostic performance of different interpretation methods of 18F-FDG PET(/CT) in diagnosing VGEI. METHODS: A systematic review was performed according to the PRISMA guidelines. Data sources included PubMed/Medline, Embase, and Cochrane. A meta-analysis was conducted on the different interpretation methods for 18F-FDG PET(/CT) in diagnosing VGEI, including visual FDG uptake intensity, visual FDG uptake pattern, and quantitative SUVmax. RESULTS: Out of 613 articles, 13 were included-10 prospective and 3 retrospective articles. The FDG uptake pattern method (I2 26.2%) showed negligible heterogeneity, while the FDG uptake intensity (I2 42.2%) and SUVmax (I2 42.1%) methods both showed moderate heterogeneity. The pooled sensitivity for FDG uptake intensity was 0.90 (95% CI: 0.79-0.96), for uptake pattern 0.94 (95% CI: 0.89-0.97), and for the SUVmax method 0.95 (95% CI: 0.76-0.99). The pooled specificity for FDG uptake intensity was 0.59 (95% CI: 0.38-0.78), whereas for FDG uptake pattern it was 0.81 (95% CI: 0.71-0.88) and for SUVmax it was 0.77 (95% CI: 0.63-0.87). The uptake pattern interpretation method demonstrated the best positive and negative post-test probability-82% and 10%, respectively. CONCLUSION: This meta-analysis identified the FDG uptake pattern as the most accurate assessment method of 18F-FDG PET(/CT) for diagnosing VGEI. The optimal SUVmax cutoff, depending on the vendor, demonstrated strong sensitivity and moderate specificity

Diagnostic Imaging in Vascular Graft Infection:A Systematic Review and Meta-Analysis

Background: Vascular graft infection (VGI), a serious complication in vascular surgery, has a high morbidity and mortality rate. The diagnosis is complicated by non-specific symptoms and challenged by the variable accuracy of different imaging techniques. The objective of this study was to determine the diagnostic value of various imaging techniques to diagnose VGI. Methods: A systematic review was conducted according to the PRISMA guidelines. Data sources included PubMed/Medline, Embase, and Cochrane from January 1997 until October 2017. Observational cohort studies were included. A meta-analysis was conducted on several imaging modalities: computed tomography with or without angiography (CT(A)), F-18-fluoro-D-deoxyglucose positron emission tomography with or without low dose or contrast enhanced CT (FDG-PET(/CT)), and white blood cell scintigraphy with or without single photon emission computed tomography combined with low dose CT (WBC (SPECT/CT)). Results: Of 4259 papers, 14 articles were included, containing eight prospective and six retrospective articles. CTA (I-2 7.4%), FDG-PET (I-2 36.5%), and FDG-PET/CT (I-2 36.6%) showed negligible to moderate heterogeneity, while WBC scintigraphy +/- SPECT/CT (I-2 78.6%) showed considerable heterogeneity. Pooled sensitivity for CTA was 0.67 (95% CI 0.57-0.75), in contrast to FDG-PET of 0.94 (95% CI 0.88-0.98), FDG-PET/CT of 0.95 (95% CI 0.87-0.99), WBC scintigraphy of 0.90 (95% CI 0.85-0.94), and WBC scintigraphy with SPECT/CT of 0.99 (95% CI 0.92-1.00). The pooled specificities were for CTA 0.63 (95% CI 0.48-0.76), FDG-PET 0.70 (95% CI 0.59-0.79), FDG-PET/CT 0.80 (95% CI 0.69-0.89), WBC scintigraphy 0.88 (95% CI 0.81-1.94), and WBC scintigraphy SPECT/CT 0.82 (95% CI 0.57-0.96). Pre-and post-test results showed that WBC SPECT/CT favours FDG-PET/CT, with a positive post-test probability of 96% versus 83%. Conclusion: This meta-analysis suggests the diagnostic performance of WBC scintigraphy combined with SPECT/CT is the greatest in diagnosing VGI. However, it is a time consuming technique and not always available. Therefore FDG-PET/CT may be favourable as the initial imaging technique. The use of solitary CTA in diagnosing VGI seems to be obsolete. (C) 2018 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved