Perigraft vascularization and incorporation of implanted Dacron prostheses are affected by rifampicin coating

• Published in: Journal of vascular surgery 2016-12, Vol.64 (6), p.1815-1824
• Main Authors: Moussavian, Mohammed R., MD, Laschke, Matthias W., MD, Schlachtenberger, Georg, von Heesen, Maximilian, MD, Wagner, Matthias, MD, Glanemann, Matthias, MD, Menger, Michael D., MD
• Format: Article
• Language: English
• Subjects: Animals; Anti-Bacterial Agents - administration & dosage; Anti-Bacterial Agents - toxicity; Apoptosis - drug effects; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation - adverse effects; Blood Vessel Prosthesis Implantation - instrumentation; Cell Proliferation - drug effects; Chemotaxis, Leukocyte - drug effects; Coated Materials, Biocompatible; Granuloma, Foreign-Body - chemically induced; Granuloma, Foreign-Body - pathology; Lymphocytes - drug effects; Macrophages - drug effects; Mice, Inbred C57BL; Models, Animal; Neovascularization, Physiologic - drug effects; Neutrophil Infiltration - drug effects; Polyethylene Terephthalates; Prosthesis Design; Prosthesis-Related Infections - diagnosis; Prosthesis-Related Infections - microbiology; Prosthesis-Related Infections - prevention & control; Rifampin - administration & dosage; Rifampin - toxicity; Skin - blood supply; Surgery; Time Factors; Wound Healing - drug effects
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2015.07.104

Background Prosthetic vascular grafts are increasingly implanted to replace damaged arteries. However, their microbial contamination is highly problematic and often results in devastating clinical complications. To reduce the risk of infection, Dacron grafts may be coated with rifampicin. In this experimental study we analyzed whether this coating affects the early tissue incorporation of the grafts. Methods Saline- and rifampicin-coated Dacron (Dacron-Rifamp) grafts were implanted into dorsal skinfold chambers of C57BL/6 mice (n = 8 per group) to study vascularization, inflammation, cell proliferation, and apoptosis at the implantation site using repetitive intravital fluorescence microscopy and immunohistochemistry over an observation period of 14 days. Results Implanted Dacron-Rifamp grafts exhibited a impaired vascularization, indicated by a significantly lower functional capillary density (85 ± 1 cm/cm2 ) compared with controls (113 ± 1 cm/cm2 ; P  < .05). This was associated with a reduced number of Ki-67-positive proliferating cells (9.4% ± 1.1% vs 13.5 ± 0.4%; P  < .05) and an increased number of cleaved caspase-3-positive apoptotic cells (2.7% ± 0.3% vs 1.3% ± 0.3%; P  < .05) in the newly developing granulation tissue surrounding the implants. In addition, the neutrophilic (652 ± 84 mm2 vs 934 ± 117 mm2 ; P  = .06), lymphatic (26 ± 6 mm2 vs 39 ± 9 mm2 ; P  = .24) and macrophage response (177 ± 42 mm2 vs 233 ± 86 mm2 ; P  = .57) was decreased by trend in the group with Dacron-Rifamp grafts. Conclusions Our novel findings show that early perigraft vascularization and incorporation of implanted Dacron prostheses are affected by the rifampicin coating. Because rapid graft vascularization and incorporation are thought to reduce the risk of infection, the use of Dacron-Rifamp Dacron grafts for antibacterial prophylaxis should be reconsidered particularly in cases of elective arterial reconstruction in a noninfected environment.