Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, Research Unit of Vascular Surgery, KU Leuven, Leuven, Belgium.
Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, Research Unit of Vascular Surgery, KU Leuven, Leuven, Belgium.
Eur J Vasc Endovasc Surg. 2022 Jan;63(1):112-118. doi: 10.1016/j.ejvs.2021.09.020. Epub 2021 Nov 18.
The aim of this study was to investigate the efficacy of vascular graft coatings used in the aortic position to prevent vascular graft infection (VGI).
A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines using a pre-registered protocol (CRD42020206436). Eligible studies used a vascular graft coating in the aortic position and reported on VGI. A search was performed in MEDLINE (PubMed), Embase, Web of Science, and the Cochrane Library. Primary outcome parameters were VGI, patency, and mortality. Pooled estimates of VGI were calculated using odds ratio (OR) and 95% confidence intervals (CIs) wherever possible. Quality assessment was performed with the Newcastle-Ottawa Assessment Scale and the Revised Cochrane risk of bias tool for randomised trials.
In total, 6 873 papers were identified. Only eight studies were included. Six of eight studies (75%) reported on known antimicrobial coating strategies such as antibiotics (n = 3) and silver (n = 3). In the other two studies, polymer coated grafts were used. Only three of eight studies compared coated with uncoated grafts (two antibiotic and one silver). Two randomised controlled trials reported on the effect of rifampicin soaked (1 mg/mL) grafts and showed no significant effect in the early (2 months; OR 0.69, 95% CI 0.29 - 1.62) or late (2 years; OR 0.73, 95% CI 0.23 - 2.32) post-operative periods. A retrospective cohort study focusing on the effect of silver coated grafts did not reveal any advantage (OR 0.19, 95% CI 0.02 - 1.64). Two polymer coated grafts were not considered to have a potential benefit in the prevention of VGIs.
Clinical studies reporting on the antibacterial effect of vascular graft coatings in the aortic position to prevent VGI are scarce. For silver and antibiotic coatings, no significant protection for VGI was observed. New types of grafts or long acting coating strategies are mandatory to prevent this complication in the future.
本研究旨在探讨用于主动脉位置的血管移植物涂层在预防血管移植物感染（VGI）方面的疗效。
按照预先注册的方案（CRD42020206436），根据系统评价和荟萃分析的首选报告项目（PRISMA）指南进行系统评价。合格的研究使用了主动脉位置的血管移植物涂层，并报告了 VGI。在 MEDLINE（PubMed）、Embase、Web of Science 和 Cochrane 图书馆中进行了检索。主要结局参数是 VGI、通畅率和死亡率。只要有可能，就使用比值比（OR）和 95%置信区间（CI）计算 VGI 的汇总估计值。使用纽卡斯尔-渥太华评估量表和修订后的 Cochrane 随机试验偏倚风险工具对质量进行评估。
共确定了 6873 篇论文。仅纳入了 8 项研究。8 项研究中有 6 项（75%）报告了已知的抗菌涂层策略，如抗生素（n=3）和银（n=3）。在另外两项研究中，使用了聚合物涂层移植物。8 项研究中只有 3 项比较了涂层与未涂层移植物（2 项抗生素和 1 项银）。两项随机对照试验报告了利福平浸泡（1mg/ml）移植物的效果，结果显示在早期（2 个月；OR 0.69，95%CI 0.29-1.62）或晚期（2 年；OR 0.73，95%CI 0.23-2.32）术后期间没有显著效果。一项关注银涂层移植物效果的回顾性队列研究也没有发现任何优势（OR 0.19，95%CI 0.02-1.64）。两种聚合物涂层移植物被认为对预防 VGI 没有潜在益处。
报告主动脉位置血管移植物涂层在预防 VGI 方面的抗菌效果的临床研究很少。对于银和抗生素涂层，没有观察到对 VGI 的显著保护作用。未来需要新型移植物或长效涂层策略来预防这种并发症。
