PROPHYLAXIS AND TREATMENT OF VASCULAR PRO STHETIC INFECTIONS IN THE THORACIC AORTA

Infections of vascular prostheses following replacement of the thoraci c aorta remain a rare complication, fortunately. The incidence of pros thetic infection amounts to approximately 1.6%, however, there is only limited information from single center studies, and linearized actuar ial data for more exact estimations are not available. Experience with prophylaxis and treatment of bacterial endocarditis as well as data a vailable from peripheral vascular reconstruction nevertheless allow th e development of treatment strategies concerning this complication. Ex perimentally, there is clear evidence that pretreatment of Dacron-graf ts using the fibrin sealant-antibiotic compound results in a significa nt protection from infection, created by artificial contamination,vith staphylococcus aureus. This concept could clearly be confirmed in cli nical series involving treatment of prosthetic valve endocarditis. Cur rently, the concept of implantation of cryopreserved human vascular al lografts is studied clinically. Its efficiency in infected areas and f ollowing prosthetic replacement of the thoracic aorta has not been pro ven. Some preliminary results as well as studies on treatment for bact erial endocarditis would suggest a clear advantage of this strategy, h owever statistically significant improvements have not been published. Currently available data, however appear to be sufficient to advocate potentially successful techniques as a prophylaxis in routine thoraci c aortic replacement as well as for treatment in case of a vascular pr osthetic infection following such procedures.