Vascular Graft Infections (VASGRA)

May 5, 2015 updated by: University of Zurich

Vascular Graft Infections - Epidemiology, Best Treatment Options, Imaging Modalities and Impact of Negative Pressure Wound Therapy

Background: Vascular grafts are increasingly implanted due to an increasing prevalence of atherosclerosis and diabetes, and about 1-6% of vascular procedures are complicated by infection. Mortality attributable to prosthetic vascular graft infections (PVGI) is high. However, there are almost no data regarding best treatment options of such complicated infections. Most recommendations are based on expert opinion and not on clinical trials or cohort observational data analyses. Evaluating infectious and other complications after vascular surgery procedures are important, and additionally, such studies may offer insights for quality improvement and improved patient outcomes. With the first aim investigators will establish an infrastructure for studying PVGI in Zurich. Investigators will take advantage of the Swissvasc registry, a central registry which collects preoperative, operative and discharge data regarding the index vascular surgical interventions. They will create a prospective observational cohort database of all patients who receive a vascular graft (peripheral, aortic, vein) at the University hospital of Zurich (VASGRA Cohort A). Patients with a PVGI will be included in VASGRA Cohort B and followed up using a flow chart with a focus on the course of this infectious complication. Additionally, investigators will establish a biobank with the collection of tissue- and blood samples of patients with PVGI. With the second aim researchers will investigate different diagnostic, clinical and therapeutic research questions nested in the VASGRA Cohort. Firstly, they will address epidemiological questions, such as: determine the incidence and outcome of complications after vascular graft placement; determine risk factors, best treatment strategies and outcome of PVGI, and determine the influence of different antibiotic regimens on the outcome of PVGI due to different bacterial pathogens. Secondly, investigators will determine the accuracy of different imaging techniques (PET/CT and MRI) for the diagnosis of PVGI, and their individual role for the assessment of treatment response. Thirdly, investigators will evaluate the bacterial diversity of vascular wound infections using 16s r-Ribonucleic acid (RNA)amplification, and investigators will explore whether this bacterial diversity does predict disease progression. Here, investigators will also study the impact of negative pressure wound therapy (NPWT) on bacterial diversity in the treatment course of PVGI. Fourthly, investigators will look for cut-off levels of relevant blood leucocytes count, C-reactive protein and procalcitonin raising suspicion of a PVGI. Lastly, investigators will look at histopathological features of excised vascular grafts. Expected value of the project: Results from the proposed study are an important contribution to the field, based on the large sample size, longitudinal design and by unifying clinical and epidemiological science. The very well characterized patient groups and the close connection between vascular surgeons, infectious disease specialists, specialists in nuclear medicine and microbiologist will help to investigate PVGI in depths. Investigators hope to be able to develop guidelines regarding best diagnostic modalities and treatment options in case of vascular graft infections. In the future we plan to examine bacteria retrieved from the PVGI in the laboratory in detail. The recovered bacteria will be examined for antimicrobial susceptibility and their capability to form biofilms. Furthermore investigators will examine how bacterial recovery form explanted grafts could be optimized.

Study Overview

Status

Recruiting

Conditions

Intervention / Treatment

Study Type

Observational

Enrollment (Anticipated)

1800

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Locations

  • Switzerland
    • ZH
      • Zurich, ZH, Switzerland, 8091
        • Recruiting
        • University Hospital Zurich, Div of Infectious Diseases and Hospital Epidemiology

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Sampling Method

Non-Probability Sample

Study Population

All patients with a vascular surgery at the University hospital will be included in the study.

Description

Inclusion criteria:

Control patients:

- Vascular graft surgery (peripheral, aortic, vein)

Case patients:

  • Patients with previous primary implantation of an aortic or peripheral vascular implant and suspicion of PVGI
  • Age >18 years
  • Written informed consent

Exclusion criteria:

  • Drug or alcohol abuse
  • Involvement in a conflicting clinical trial (investigational drug)
  • Inability to follow the procedures of the cohort, e.g. due to language problems, psychological disorders or dementia of the subject
  • Known or suspected non-compliance

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Observational Models: Cohort
  • Time Perspectives: Prospective

Cohorts and Interventions

Group / Cohort
Intervention / Treatment
Prosthetic vascular graft implantation, follow up
Device: Prosthetic vascular graft
Implantation of a prosthetic vascular graft
Other Names:
  • Valsalva Graft, Gelwave TM
  • Subclavia Graft, Gelwave TM
  • Longer Ante-Flo Offset branch, Gelwave TM
  • Lupiae Branched Graft, Gelwave TM
  • 4 Branched Plexus, Gelwave TM
  • Bifurcate, Gelwave TM soft
  • Subclavia Graft straight, Gelwave TM soft
  • Intergard woven straight, Intervascular "Maquet Getinge Group"
  • Intergard woven hemabridge, Intervascular "Maquet Getinge Group"
  • Intergard woven Aortic Arch, Intervascular "Maquet Getinge Group"
  • Intergard Silver Knitted Bifurcation, Intervascular "Maquet Getinge Group"
  • Intergard Silver Knitted Straight, Intervascular "Maquet Getinge Group"
  • InterGard TM knitted Bifurcation, Intervascular "Maquet Getinge Group"
  • FlowLine Bipore r Heparin ePTFE Vascular Graft, Jotec r GmbH
  • ePTFE Vascular Graft Regular Wall flex, IMPRA r
  • ePTFE Vascular Graft Thin Wall flex, IMPRA r
  • ePTFE Vascular Graft Regular Wall straight, IMPRA r
  • Gore-Tex Stretch Vascular Graft standard Wall Eptfe, W.L. Gore & Associates, Inl

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Vascular graft infection
Time Frame: within 10 years
Persons are followed up after vascular graft surgery.
within 10 years

Secondary Outcome Measures

Outcome Measure
Time Frame
Bleeding
Time Frame: 10 years
10 years
Foreign body reaction
Time Frame: 10 years
10 years
All cause- mortality
Time Frame: 10 years
10 years

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

University of Zurich

Collaborators

Schweizerischer Nationalfonds

Investigators

  • Principal Investigator: Barbara Hasse, MD, University Hospital Zurich, Div of Infectious Diseases and Hospital Epidemiology

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start

May 1, 2013

Primary Completion (Anticipated)

March 1, 2023

Study Completion (Anticipated)

March 1, 2023

Study Registration Dates

First Submitted

March 7, 2013

First Submitted That Met QC Criteria

March 26, 2013

First Posted (Estimate)

April 1, 2013

Study Record Updates

Last Update Posted (Estimate)

May 6, 2015

Last Update Submitted That Met QC Criteria

May 5, 2015

Last Verified

May 1, 2015

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • KEK-ZH-Nr. 2012-0583

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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