A pilot study of a triple antimicrobial-bonded Dacron graft for the prevention of aortic graft infection

J Vasc Surg. 2012 Sep;56(3):794-801. doi: 10.1016/j.jvs.2012.02.008. Epub 2012 May 10.


Objective: Perioperative infection of an aortic graft is one of the most devastating complications of vascular surgery, with a mortality rate of 10% to 30%. The rate of amputation of the lower limbs is generally >25%, depending on the graft material, the location of the graft and infection, and the bacterial virulence. In vitro studies suggest that an antibiotic-impregnated graft may help prevent perioperative graft infection. In a pilot animal study, we tested a locally developed technique of bonding Dacron aortic grafts with three antimicrobial agents to evaluate the ensuing synergistic preventive effect on direct perioperative bacterial contamination.

Methods: We surgically implanted a 6-mm vascular knitted Dacron graft in the infrarenal abdominal aorta of six Sinclair miniature pigs. Two pigs received unbonded, uninoculated grafts; two received unbonded, inoculated grafts; and two received inoculated grafts that were bonded with chlorhexidine, rifampin, and minocycline. Before implantation, the two bonded grafts and the two unbonded grafts were immersed for 15 minutes in a 2-mL bacterial solution containing 1 to 2 × 10(7) colony-forming units (CFU)/mL of Staphylococcus aureus (ATCC 29213). Two weeks after graft implantation, the pigs were euthanized, and the grafts were surgically excised for clinical, microbiologic, and histopathologic study.

Results: The two bonded grafts treated with S aureus showed no bacterial growth upon explant, whereas the two unbonded grafts treated with S aureus had high bacterial counts (6.25 × 10(6) and 1.38 × 10(7) CFU/graft). The two control grafts (unbonded and untreated) showed bacterial growth (1.8 × 10(3) and 7.27 × 10(3) CFU/graft) that presumably reflected direct, accidental perioperative bacterial contamination; S cohnii ssp urealyticus and S chromogenes, but not S aureus, were isolated. The histopathologic and clinical data confirmed the microbiologic findings. Only pigs that received unbonded grafts showed histopathologic evidence of a perigraft abscess.

Conclusions: Our results suggest that bonding aortic grafts with this triple antimicrobial combination is a promising method of reducing graft infection resulting from direct postoperative bacterial contamination for at least 2 weeks. Further studies are needed to explore the ability of this novel graft to combat one of the most feared complications in vascular surgery.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Animals
  • Anti-Infective Agents / administration & dosage*
  • Aorta, Abdominal / microbiology
  • Aorta, Abdominal / pathology
  • Aorta, Abdominal / surgery*
  • Blood Vessel Prosthesis Implantation / adverse effects
  • Blood Vessel Prosthesis Implantation / instrumentation*
  • Blood Vessel Prosthesis*
  • Chlorhexidine / administration & dosage
  • Coated Materials, Biocompatible*
  • Disease Models, Animal
  • Drug Therapy, Combination
  • Minocycline / administration & dosage
  • Pilot Projects
  • Polyethylene Terephthalates*
  • Prosthesis Design
  • Prosthesis-Related Infections / microbiology
  • Prosthesis-Related Infections / pathology
  • Prosthesis-Related Infections / prevention & control*
  • Rifampin / administration & dosage
  • Staphylococcal Infections / microbiology
  • Staphylococcal Infections / pathology
  • Staphylococcal Infections / prevention & control*
  • Swine
  • Swine, Miniature
  • Time Factors


  • Anti-Infective Agents
  • Coated Materials, Biocompatible
  • Polyethylene Terephthalates
  • Minocycline
  • Chlorhexidine
  • Rifampin