Antibiotic-coated ePTFE decreases graft colonization and neointimal hyperplasia.

BACKGROUND: Synthetic vascular conduits used in traumatic or infected fields have a high failure rate leading to catastrophic consequences including amputation and death. Although efforts to coat vascular grafts with antibiotics have had varying results, we developed a novel coating technique for expanded-polytetrafluoroethylene (ePTFE), which has proven to be effective in vitro. Thus, we hypothesized that the coated grafts would resist infection and have decreased neointimal hyperplasia when used in vivo in a large animal model. METHODS: Minocycline and rifampin suspended in a mixture of methacrylates were coated onto a 3cm segment of 6mm ePTFE (Bard, Tempe, AZ). An antibiotic-coated (ABX), adhesive-coated (AC), or control (C) ePTFE graft was then placed as an end-to-side graft into the left iliac artery of a male mongrel pig. Sterile saline or innoculum containing 3x10(8)Staphylococcus aureus (SA) or Staphylococcus epidermidis (SE) was then placed directly on the graft and the reflected peritoneum re-approximated to confine the bacteria. After 6 wk, the graft was harvested, cultured, and morphometric analyses of neointimal hyperplasia were performed. RESULTS: Twenty-seven pigs had grafts placed (9 ABX, 9 AC, 9 C) and harvested. Of the nine grafts exposed to SA, the uncoated and adhesive-coated grafts averaged greater than 50,000 colonies of SA while the antibiotic-coated grafts averaged less than 50 colonies. Although not statistically significant, neointimal hyperplasia was decreased by 15% to 20% when using an ABX graft in an infected field. CONCLUSIONS: The coated grafts appeared to decrease NIH formation although not significantly in this small pilot study. The methacrylate antibiotic-coated ePTFE graft did provide resistance to infection when used in infected fields.

Prosthetic vascular conduit in contaminated fields: a new technology to decrease ePTFE infections.

Vascular reconstruction using prosthetic materials in contaminated fields can lead to infection, graft loss, and subsequent amputation. We hypothesized that minocycline and rifampin bound to an ePTFE graft using a unique methacrylate technology would provide for resistance from infection and controlled antibiotic elution. Kirby Bauer susceptibility testing was performed on plates overlaid with Staph aureus (SA) and Staph epidermidis (SE) using 6 mm diameter discs of uncoated graft or antibiotic coated graft (ABX). Zones of inhibition (ZIH) were determined after 24 hours. ABX grafts were then placed in a continuous water bath and a recirculating, pulsatile flow device. Susceptibility testing and high performance liquid chromatography with mass spectroscopy was performed to determine graft performance and antibiotic elution rate. ABX grafts had an average ZIH of 35 mm for SA and 44 mm for SE (each P < 0.0001). After the 1 week water bath, the ZIH of the ABX grafts was 23 mm on both the SA and SE plates. The high performance liquid chromatography with mass spectroscopy revealed that after 24 hours, 50 per cent of the antibiotics remained on the graft, and there was a sustained elution for 7 days. Minocycline and rifampin can be bound to ePTFE vascular grafts using a unique methacrylate method. In vitro, the grafts provide a slow elution of antibiotics that provide resistance from infection by SA and SE for up to 2 weeks after graft insertion.

Variations of L*a*b* values among Vitapan Classical Shade Guides.

PURPOSE: To measure the variations in L*a*b* values of a group of 25 guides and to assess whether shade guides are indeed interchangeable. MATERIALS AND METHODS: The L*a*b* values of individual shade tabs were measured with a LabScan(tm) XE scanning spectrocolorimeter (SSC) with a special attachment for reproducibly positioning shade tabs. Each shade guide (Vitapan Classical, Vident) contained 16 shade tabs. Absolute calibration of the SSC was performed with color tiles traceable to NIST. One shade guide was used to determine the reproducibility of the experimental method by measuring and then removing each shade tab of the standard 10 times. This assessed the variations in observed values induced by the measurement method and the geometry of the specimens. The entire sample consisted of 25 shade guides. The tabs of each of the 25 shade guides were read five times in the SSC, without moving the specimen. Measurements and calculations of E, L*, a*, and b* were performed using Universal Software V4.10 (Hunter Associates Laboratory). The mean, standard deviation, and range were determined of the E, L*, a*, and b* values for each one of the 16 shades in the shade guides. Differences in color are expressed as DeltaE in color science. The standard deviation of E (E(sd)) and the range of E (E(r)) for each of the shades were used as a DeltaE value to assess color differences. RESULTS: For the reproducibility measurements, the shades had values for E(r) varying from 0.08 to 0.69, and E(sd) between 0.02 and 0.22. This established the detection limit for our method for each of the shades. For the group of 25 shade guides, E(r) varied from 0.75 to 3.05, and E(sd) from 0.22 to 0.54. The difference in value of E(r) obtained from the reproducibility test and the E(r) of the group of 25 guides is significant at p < 0.05. The same was found for E(sd). The largest reproducible E(r) observed was 3.05 for shade C1. CONCLUSIONS: The differences observed between shade guides are larger than the variations induced by the experimental method. The difference in E values for the shades C1 and C2 is 2.19; hence the observed E(r) of 3.05 between shade tabs of the same shade (C1) is larger than the changes in color between shades. This large a variation in what are claimed as identical shade tabs is deemed of clinical importance, and therefore, the shade guides should not be considered interchangeable.