fibrin and Leriche-Syndrome

The incidence of infection following arterial reconstruction using synthetic graft materials varies from less than 1 to 5%. One of three mechanisms is thought to be responsible: 1. intraoperative contamination, 2. extension from adjacent infected or colonized tissue, or 3. hematogenous or lymphogenous seeding. We present ultrastructural data of a patient with a polymicrobial graft infection due to a prostheto-enteric fistula 16 years after reconstruction of an aortobifemoral graft. The polymer surface showed signs of biodegradation and was completely covered with a layer of plasma proteins. Disrupted fibroblasts on the intersegmental graft surface were surrounded by bundles of collagen. Gram-negative rods and grampositive cocci were embedded in an extracellular EPS matrix. Bacterial culture confirmed growth of Eikenella corrodens, Fusobacterium nucleatum and Peptostreptococcus species. Fibrin and granulation tissue from the neoadventitia started to mark off the inflammatory process. Transmission electron microscopy is a valuable tool for the investigation of alloplastic arterial devices. After 16 years of implantation the graft shows different signs of biodegradation.

Topics: Aorta, Abdominal; Aortic Diseases; Bacteriological Techniques; Biofilms; Blood Vessel Prosthesis; Coated Materials, Biocompatible; Collagen; Fibrin; Gram-Positive Cocci; Gram-Positive Rods; Granulation Tissue; Humans; Intestinal Fistula; Ischemia; Leg; Leriche Syndrome; Male; Microscopy, Electron; Middle Aged; Polyesters; Postoperative Complications; Prosthesis-Related Infections