Comparison of Open Arterial Revascularization Using Expandable PTFE Stent Grafts vs Sewn PTFE Interposition Bypass in an Infected Field Porcine (Sus scrofa) Model

Objectives Autologous reconstruction for vascular injuries in a contaminated field requires time, technique, and appropriately sized conduit. Expandable polytetrafluoroethylene ePTFE grafts are often used. Direct-site endovascular repair DSER with ePTFE stent grafts may offer an expeditious alternative to sewn graft in this setting. We hypothesized that DSER would demonstrate less device failure and less morbidity when compared to ePTFE interposition bypass. Methods Bilateral iliac arteries were transected in Fourteen Yorkshire-cross swine One randomly assigned artery received sewn ePTFE bypass while the other was treated with DSER followed by contamination with Methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa. Device failure was assessed with ultrasound and angiography on day 7 and 21 respectively. Physiologic measurements and arterial samples were obtained at the terminal procedure. Results No devices failed at day 7. DSER had less failure at day 21 014 vs. 914, p0.001. DSER was faster 246 min vs. 6217 min, p0.001. No difference was seen in gross infection 1014 vs. 714, p0.440 and flow rates at baseline, placement, or harvest p0.921, 0.252, 0.321. Conclusion DSER demonstrated superior efficacy, faster placement, and similar infection rates when compared to ePTFE bypass for open arterial revascularization in an infected field. DSER may improve outcomes as a bridge to definitive repair. Grant Dr. Davidson received support for this project from the National Center for Advancing Translational Sciences, National Institutes of Health, through grant number UL1 TR001860.