Bioabsorbable Beads For Vascular Graft Salvage
Andrew C. Schroeder, DO, Roan J. Glocker, MD.
University of Rochester, Rochester, NY, USA.
OBJECTIVES: Few studies have examined the use of bioabsorbable antibiotic-impregnated beads for vascular graft salvage in patients unfit for explantation. We hypothesize that calcium sulfate antibiotic beads in addition to myofascial flap coverage can aid in vascular graft salvage when explantation is not possible. METHODS: We searched Current Procedural Terminology (CPT) codes for bioabsorbable antibiotic bead placement within the vascular surgery division at our institution between 2014-2021. Graft location, bacterial species, operative bead placement, and follow-up since infection, including any suppressive antibiotics were recorded. RESULTS: We identified eight sites of bioabsorbable antibiotic bead placement in six patients unfit for graft explantation at our institution between 2014-2021. All sites were femoral-based incisions for grafts including axillary-to-femoral, femoral-to-femoral, and femoral-to-popliteal bypasses. Graft material consisted of PTFE, Dacron, and one cryo-preserved arterial graft. Pathogens isolated were gram-positive, gram-negative, and fungal species. All sites received myofascial flap coverage, and Vancomycin and Gentamicin impregnated calcium sulfate beads were used in six of the eight sites, with Vancomycin and Tobramycin beads used in the remaining two sites. While suppressive antibiotics strategies varied (see below), all sites remain infection free at mean follow-up of 997 +/- 823 days. CONCLUSIONS: Bioabsorbable antibiotic bead placement with flap coverage is an option for infection resolution and vascular graft salvage if explantation and reconstruction cannot be performed.
| Age/Sex | Graft Location (Material) | Organism(s) Isolated | Suppressive Antibiotics | Infection-free Days Post-Op |
| 78F | Bilateral groin, fem-fem (PTFE) | Peptostreptococcus | None | 2553 |
| 65F | Right groin, ax-fem (PTFE) | Strep agalactiae | 4 weeks targeted (Ceftriaxone) | 1583 |
| 68M | Left groin, fem-pop (PTFE) | Proteus mirabilis, Enterococcus faecalis, Candida parapsilosis | 4 weeks broad-spectrum (Zosyn) | 716 |
| 53M | Left groin, ABF (Dacron) | Staph aureus | Targeted indefinitely (Keflex) | 219 |
| 68M | Right groin, ax-fem (PTFE) | Enterococcus coli | None | 350 |
| 69M | Bilateral groins, fem-fem (cryo) | Candida albicans, Stenotrophomonas | Targeted indefinitely (Bactrim) | 558 |
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