1
|
Li WD, Wu GY, Song B, Zhao J, Li XQ, Zhou M. Case report: Remedial surgical treatment of aorto-duodenal fistula with infected aneurysm after endovascular aortic repair. Front Cardiovasc Med 2022; 9:975871. [PMID: 36304548 PMCID: PMC9592967 DOI: 10.3389/fcvm.2022.975871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 09/20/2022] [Indexed: 12/03/2022] Open
Abstract
Aorto-duodenal fistula (ADF) is a rare cause of upper gastrointestinal bleeding, but it is associated with high mortality. It usually occurs in patients with prior aortic surgery or who have undergone aortic graft placement. Abdominal aortic aneurysm (AAA) might be a cause of primary ADF, which could develop into sudden shock. Because ADF is difficult to diagnose, surgery to correct it has a poor outcome. We here report the successful treatment of an ADF complicated with infected AAA after endovascular repair of a ruptured aneurysm of the iliac artery.
Collapse
|
2
|
Eilenberg W, Klopf J, Domenig CM, Klinger M, Wolf F, Gollackner B, Nanobachvili J, Neumayer C. The Femoral Vein as a Long-Term Aorto-Iliac Graft for Aortic Infection and Aortitis. World J Surg 2022; 46:1235-1242. [PMID: 35118519 PMCID: PMC8971159 DOI: 10.1007/s00268-022-06460-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2022] [Indexed: 11/30/2022]
Abstract
Background Reconstruction of the aorto-iliac segment with femoral vein (FV) as substitute for infected synthetic grafts or mycotic aneurysms constitutes the most sustainably convenient alternative. The aim of this study was to evaluate the long-term outcome of up to 16 years of follow-up, analysing the morphologic adaption of the FV with special emphasis on the distal and proximal anastomoses. Methods We conducted a retrospective study of 22 patients with 109 computed tomography angiograms (CTAs) treated between August 2001 and January 2020 in case of aortic infection/aortitis. Morphologic changes like anastomotic dilatation/stenosis as well as changes of FV wall thickness were retrospectively analysed in pre- and postoperative CTAs. Results Elective procedure was done in 17/22 (77%) cases, and 5/22 (23%) patients required emergent surgery. The median follow-up was 91.5 months (P25;P75 = 21;117). Cross-sectional diameter of proximal (20.38 ± 3.77 vs 22.04 ± 3.97 mm, p = 0.007) and distal anastomoses (13.05 ± 4.23 vs 14.61 ± 5.19 mm, p = 0.05) increased significantly, as well as the proximal and distal anastomotic areas (3.36 ± 1.29 vs 4.32 ± 1.63 mm2, p = 0.04 and 0.99 ± 0.48 vs 1.25 ± 0.72 mm2, p = 0.023, respectively). Venous wall thickness was significantly reduced at the anastomotic site (1.74 ± 0.46 vs 1.24 ± 0.31 mm, p = 0.001). The upper thigh diameter did not differ before and after harvesting of the FV (161.6 ± 29.1 vs. 178.2 ± 23.3 mm, p = 0.326, respectively). Conclusion This long-term CTA follow-up study showed that the FV wall becomes thinner at the anastomotic site, and the anastomoses dilate with time without rupture. The FV is a durable conductor after replacement of the aorto-iliac segment due to aortic infection. Further CTA studies from more centres are warranted to evaluate the risk of vein rupture.
Collapse
Affiliation(s)
- W Eilenberg
- Department of General Surgery, Division of Vascular Surgery, Medical University of Vienna, General Hospital of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - J Klopf
- Department of General Surgery, Division of Vascular Surgery, Medical University of Vienna, General Hospital of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - C M Domenig
- Department of General Surgery, Division of Vascular Surgery, Medical University of Vienna, General Hospital of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - M Klinger
- Department of General Surgery, Division of Vascular Surgery, Medical University of Vienna, General Hospital of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - F Wolf
- Department of Biomedical Imaging and Image Guided Therapy, Division of Cardiovascular and Interventional Radiology, Medical University of Vienna, General Hospital of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - B Gollackner
- Department of General Surgery, Division of Vascular Surgery, Medical University of Vienna, General Hospital of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - J Nanobachvili
- Department of General Surgery, Division of Vascular Surgery, Medical University of Vienna, General Hospital of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - C Neumayer
- Department of General Surgery, Division of Vascular Surgery, Medical University of Vienna, General Hospital of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| |
Collapse
|
3
|
Le PT, Nguyen TH, Nguyen KT, Lam NV. Left renal vein as a graft for aortic reconstruction in a patient with primary aortoenteric fistula secondary to a mycotic aneurysm. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2020; 7:176-179. [PMID: 33748557 PMCID: PMC7966847 DOI: 10.1016/j.jvscit.2020.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 11/12/2020] [Indexed: 11/25/2022]
Abstract
Description of the use of the left renal vein for aortic reconstruction in primary aortoenteric fistula secondary to a mycotic aneurysm has not been found in the literature. We report here a case of primary aortoenteric fistula secondary to a mycotic aneurysm with gross retroperitoneal contamination that was successfully treated by using a left renal vein graft for aortic reconstruction.
Collapse
Affiliation(s)
- Phong T Le
- Vascular Surgery Department, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | - Thao H Nguyen
- Vascular Surgery Department, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | - Kien T Nguyen
- Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
| | - Nut V Lam
- Vascular Surgery Department, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| |
Collapse
|
4
|
Abstract
The management of infected prosthetic grafts is one of the most challenging problems facing vascular surgeons. High mortality and morbidity rates with traditional treatment have led many surgeons to consider different and novel strategies. Diagnosis is usually straightforward, but occasionally is unclear even after extensive clinical and radiologic investigations. Although routine total graft excision for all infected aortic grafts is still favored by some vascular surgeons, most favor only partial graft excision if only the distal limb of the graft is involved. Placement of in situ autologous vein or cryopreserved grafts have gained popularity, and investigations are continuing regarding the use of in situ antibiotic and silver-coated prosthetic grafts. In this article the authors review the incidence and etiology of aortic graft infections, methods to prevent these complications, the diagnosis of infected aortic grafts, and lastly the management of these complicated cases, including total graft excision and partial and complete graft preservation.
Collapse
|
5
|
Use and durability of femoral vein for autologous reconstruction with infection of the aortoiliofemoral axis. J Vasc Surg 2014; 59:675-83. [DOI: 10.1016/j.jvs.2013.09.029] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 09/16/2013] [Accepted: 09/16/2013] [Indexed: 11/23/2022]
|
6
|
Mussa FF, Hedayati N, Zhou W, El-Sayed HF, Kougias P, Darouiche RO, Lin PH. Prevention and treatment of aortic graft infection. Expert Rev Anti Infect Ther 2014; 5:305-15. [PMID: 17402845 DOI: 10.1586/14787210.5.2.305] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Prosthetic vascular graft infection remains one of the most challenging surgical problems for vascular surgeons. This condition is classically associated with high morbidity and mortality rates. Accurate diagnosis of a vascular graft infection can typically be made based on a thorough history and physical examination; although, infrequently, an extensive radiological evaluation is necessary to establish the clinical finding. Complete graft excision and extra-anatomic bypass grafting remains a commonly accepted surgical treatment strategy. Recent clinical data have supported other treatment modalities, including the use of in situ antibiotic-impregnated graft replacement, in situ allograft replacement and in situ autologous graft replacement. This article will review the pathobiology of aortic graft infection, as well as methods to prevent a prosthetic graft infection. Furthermore, various surgical treatment modalities of aortic graft infection will be discussed.
Collapse
Affiliation(s)
- Firas F Mussa
- The Michael E DeBakey VA Medical Center, Division of Vascular Surgery & Endovascular Therapy, Michael E DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
| | | | | | | | | | | | | |
Collapse
|
7
|
What is the Best Treatment for Primary Infected Aortic Aneurysms? Eur J Vasc Endovasc Surg 2011; 42:625-6. [DOI: 10.1016/j.ejvs.2011.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2011] [Accepted: 08/01/2011] [Indexed: 11/23/2022]
|
8
|
Sugimoto M, Banno H, Idetsu A, Matsushita M, Ikezawa T, Komori K. Surgical experience of 13 infected infrarenal aortoiliac aneurysms: Preoperative control of septic condition determines early outcome. Surgery 2011; 149:699-704. [DOI: 10.1016/j.surg.2010.12.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2010] [Accepted: 12/24/2010] [Indexed: 01/16/2023]
|
9
|
van Zitteren M, van der Steenhoven T, Burger D, van Berge Henegouwen D, Heyligers J, Vriens P. Spiral Vein Reconstruction of the Infected Abdominal Aorta Using the Greater Saphenous Vein: Preliminary Results of the Tilburg Experience. Eur J Vasc Endovasc Surg 2011; 41:637-46. [DOI: 10.1016/j.ejvs.2011.01.020] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2010] [Accepted: 01/25/2011] [Indexed: 11/28/2022]
|
10
|
Dubois M, Daenens K, Houthoofd S, Peetermans W, Fourneau I. Treatment of Mycotic Aneurysms with Involvement of the Abdominal Aorta: Single-centre Experience in 44 Consecutive Cases. Eur J Vasc Endovasc Surg 2010; 40:450-6. [DOI: 10.1016/j.ejvs.2010.07.017] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Accepted: 07/24/2010] [Indexed: 02/06/2023]
|
11
|
Kuizenga K, Reijnen MM, Tielliu IF, Verhoeven EL, van den Dungen JJ, Zeebregts CJ. Conventional or Endovascular Treatment of Ongoing Mycotic Aortic Aneurysmal Disease? Vascular 2009; 17:103-7. [DOI: 10.2310/6670.2008.00063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We report a case in which conventional and endovascular exclusion techniques were used to treat ongoing mycotic aortic aneurysmal disease. A 51-year-old man presented with an infrarenal mycotic aortic aneurysm that was excluded and reconstructed with a superficial femoral vein. Two years later, he developed a symptomatic mycotic aneurysm of the descending thoracic aorta, which required emergent treatment with a stent graft. The patient died 5 months later of massive bleeding owing to an aortobronchial fistula deriving from a new thoracic aneurysm proximal to the stent graft. Choices and different modes of treatment are discussed. Endovascular treatment of symptomatic mycotic aortic aneurysm might provide a valid alternative to open repair but may be unsuccessful owing to ongoing infection. In situ replacement using autologous material seems appealing whenever feasible.
Collapse
Affiliation(s)
- Kirsten Kuizenga
- *Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, Groningen, the Netherlands; and †Department of Surgery, Division of Vascular Surgery, Alysis Zorggroep, Location Rijnstate, Arnhem, the Netherlands
| | - Michel M.P.J. Reijnen
- *Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, Groningen, the Netherlands; and †Department of Surgery, Division of Vascular Surgery, Alysis Zorggroep, Location Rijnstate, Arnhem, the Netherlands
| | - Ignace F.J. Tielliu
- *Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, Groningen, the Netherlands; and †Department of Surgery, Division of Vascular Surgery, Alysis Zorggroep, Location Rijnstate, Arnhem, the Netherlands
| | - Eric L.G. Verhoeven
- *Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, Groningen, the Netherlands; and †Department of Surgery, Division of Vascular Surgery, Alysis Zorggroep, Location Rijnstate, Arnhem, the Netherlands
| | - Jan J.A.M. van den Dungen
- *Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, Groningen, the Netherlands; and †Department of Surgery, Division of Vascular Surgery, Alysis Zorggroep, Location Rijnstate, Arnhem, the Netherlands
| | - Clark J. Zeebregts
- *Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, Groningen, the Netherlands; and †Department of Surgery, Division of Vascular Surgery, Alysis Zorggroep, Location Rijnstate, Arnhem, the Netherlands
| |
Collapse
|
12
|
In situ replacement with equine pericardial roll grafts for ruptured infected aneurysms of the abdominal aorta. J Vasc Surg 2009; 49:1041-5. [DOI: 10.1016/j.jvs.2008.11.053] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2008] [Revised: 11/13/2008] [Accepted: 11/13/2008] [Indexed: 11/24/2022]
|
13
|
Phade SV, deFreitas D, Powell CS, Stoner M. Evolution of bacterial arteritis into a mycotic aortic aneurysm. Vasc Endovascular Surg 2007; 41:158-60. [PMID: 17463210 DOI: 10.1177/1538574406298516] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Arteritis and mycotic aneurysms have been well described for more than 100 years. The authors report a case of bacterial arteritis that presented with pneumatosis of the aortic wall and that evolved over 1 week into an infected abdominal aortic aneurysm. This case documents the rapid progression from arteritis to mycotic aneurysm, highlighting the need for close radiologic follow-up and aggressive medical and surgical management.
Collapse
Affiliation(s)
- Sachin V Phade
- Section of Vascular and Endovascular Surgery, East Carolina University, Greenville, North Carolina 27834, USA
| | | | | | | |
Collapse
|
14
|
Wolford HY, Cothren CC, Moore EE. Postinjury abdominal aortic graft infection: documentation and successful management. ACTA ACUST UNITED AC 2006; 61:1274-6. [PMID: 17099544 DOI: 10.1097/01.ta.0000224904.46599.e0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This case report illustrates that postinjury aortic grafts may become infected. A high index of suspicion should be maintained in the postoperative period to detect these infections as early as possible. Prevention and treatment strategies will continue to evolve.
Collapse
Affiliation(s)
- Heather Y Wolford
- Department of Surgery, Denver Health Medical Center, Denver, Colorado 80204, USA
| | | | | |
Collapse
|
15
|
Bell CL, Ali AT, Brawley JG, D'Addio VJ, Modrall JG, Valentine RJ, Clagett GP. Arterial Reconstruction of Infected Femoral Artery Pseudoaneurysms Using Superficial Femoral-Popliteal Vein. J Am Coll Surg 2005; 200:831-6. [PMID: 15922192 DOI: 10.1016/j.jamcollsurg.2005.02.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2004] [Revised: 12/09/2004] [Accepted: 02/02/2005] [Indexed: 01/29/2023]
Abstract
BACKGROUND Infected femoral artery pseudoaneurysms (IFAPs) secondary to percutaneous arterial access, injection of illegal substances, and from infected synthetic grafts, appear to be increasing in incidence. Ligation of IFAPs without revascularization offers control of infection but may risk limb ischemia. Revascularization with extraanatomic synthetic grafts may risk reinfection and abrupt thrombosis. Excision of IFAPs with revascularization using superficial femoral popliteal vein (SFPV) provides both control of infection and excellent limb perfusion. STUDY DESIGN A retrospective review was conducted of patients diagnosed with IFAP who underwent resection and revascularization with SFPV at a single medical center. Outcomes measured included reinfection and amputation rate. These were compared with other series using various methods to treat IFAPs. RESULTS Eleven patients with IFAP were encountered from 1992 to 2004. Mean age was 64 years (+/-10 SD). Five patients developed IFAP secondary to percutaneous arterial access procedures. Four patients developed infected femoral artery pseudoaneurysms secondary to synthetic graft infection. Two patients developed IFAP secondary to injection of illegal substances in the femoral region. All patients had positive wound cultures initially. Staphylococcus was the most common organism found in wound cultures. All patients underwent resection of IFAP with lower extremity revascularization using SFPV. There was no incidence of limb ischemia and no perioperative deaths in this series. CONCLUSIONS Excision of IFAP with revascularization can be successfully achieved using SFPV. This method may prove to be superior to other methods with apparent higher patency rates and resistance to reinfection.
Collapse
Affiliation(s)
- Christopher L Bell
- Department of Surgery, The University of Texas Southwestern Medical Center at Dallas, Dallas, TX 75235, USA
| | | | | | | | | | | | | |
Collapse
|
16
|
Nevelsteen A, Baeyens I, Daenens K, Fourneau I. Regarding “deep vein harvest: predicting need for fasciotomy”. J Vasc Surg 2004; 40:403; author reply 403-4. [PMID: 15303273 DOI: 10.1016/j.jvs.2004.04.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
17
|
Kyriakides C, Kan Y, Kerle M, Cheshire NJ, Mansfield AO, Wolfe JHN. 11-year experience with anatomical and extra-anatomical repair of mycotic aortic aneurysms. Eur J Vasc Endovasc Surg 2004; 27:585-9. [PMID: 15121107 DOI: 10.1016/j.ejvs.2004.02.024] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2004] [Indexed: 11/20/2022]
Abstract
BACKGROUND We have reviewed our management, of both ruptured and non-ruptured, abdominal and thoraco-abdominal mycotic aneurysms in order to determine the safety and efficacy of in situ and extra-anatomical prosthetic repairs. METHODS Data regarding presenting symptoms, investigations, operative techniques and outcome, were collected on patients treated at a singe centre over 11 years. RESULTS There were 11 men and four women, with a median age of 70 years (range, 24-79). All but one patient were symptomatic and six had a contained leak on admission. In six patients no organisms were identified in either blood or tissue cultures. Pre-operative CT identified; four infra-renal, four juxta-renal, three (Crawford thoraco-abdominal) type IV, three type III and one type II, aortic aneurysms. Thirteen were repaired with in situ prostheses and two required axillo-femoral prosthetic grafts. There were four early deaths. All surviving patients have been followed-up for a median duration of 38 months (range 1/2-112 months). There were two late deaths at 3 months (juxta-renal) and at 2 years (type III), the latter relating to graft infection. CONCLUSIONS In the absence of uncontrolled sepsis, repair of mycotic aortic aneurysms using prosthetic grafts can achieve durable results.
Collapse
Affiliation(s)
- C Kyriakides
- Regional Vascular Unit, St Mary's Hospital, London, UK
| | | | | | | | | | | |
Collapse
|
18
|
Gibbons CP, Ferguson CJ, Fligelstone LJ, Edwards K. Experience with femoro-popliteal vein as a conduit for vascular reconstruction in infected fields. Eur J Vasc Endovasc Surg 2003; 25:424-31. [PMID: 12713781 DOI: 10.1053/ejvs.2002.1853] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE to review the outcome of femoro-popliteal vein grafts for arterial reconstruction in the presence of sepsis. PATIENTS AND METHODS twenty-six patients underwent 27 arterial reconstructions with femoro-popliteal vein in the presence of infection. Five had mycotic aneurysms (3 aortic, 1 iliac and 1 femoral), 21 had prosthetic graft infections (9 aortic, 8 femoro-femoral, 2 axillo-femoral, 1 ilio-femoral and 1 femoral dacron patch) and one underwent superior mesenteric artery reconstruction following ischaemic small bowel perforation.Arterial reconstruction followed debridement of infected tissue, removing any infected graft, povidone iodine washout and appropriate antibiotic cover. Where possible, new grafts were placed in a clean field or wrapped in omentum. Four femoral anastomoses were covered by rectus femoris flaps. RESULTS there was one early postoperative death (4%) and no limb loss. All others remained free from infection with patent grafts at 1 month to 5 years (median 22 months). Three major wound infections healed without exposing the graft. One infarcted rectus femoris flap required removal. Donor limb swelling was transient. Five required percutaneous angioplasty and one underwent open profundaplasty within 3 months. CONCLUSION femoro-popliteal vein reconstruction with debridement and appropriate antibiotic therapy is recommended for the treatment of arterial or graft infections.
Collapse
Affiliation(s)
- C P Gibbons
- Department of Vascular Surgery, Morriston Hospital, Swansea SA6 6NL, UK
| | | | | | | |
Collapse
|
19
|
Wilson SE. New alternatives in management of the infected vascular prosthesis. Surg Infect (Larchmt) 2003; 2:171-5; discussion 175-7. [PMID: 12594872 DOI: 10.1089/109629601750469492] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Infection of vascular prosthetics implanted for arterial occlusive disease occurs in approximately 1-5% of patients, including early and late clinical presentation. The incidence of infection depends on the anatomical site, with the highest rate occurring in vascular access grafts placed for hemodialysis and in inguinal and lower extremity incisions in patients undergoing bypass procedures for femoropopliteal tibial occlusion. Treatment of prosthetic graft infection has traditionally included antimicrobials, excision of the infected prosthesis, and extraanatomical bypass. With the recognition that prosthetic infection secondary to Staphylococcus epidermidis can be managed with less extensive procedures, clinical data have been reported on in situ replacement with antibiotic-bonded prostheses. Patients who have S. aureus isolated, including methicillin-resistant S. aureus, or gram-negative pathogens, still require conventional graft excision and extraanatomical bypass. METHODS Selective review of the English-language literature. RESULTS Recent clinical series show that management by graft excision of infected infrarenal aortic prosthetics and axillofemoral bypass results in 2- and 5-year survival rates of 67% and 47%, and limb salvage rates in survivors of 93% and 82% at 2 and 5 years. In situ replacement with a rifampicin-bonded prosthesis has been accomplished successfully in smaller numbers of patients and shows promising early results. Other methods under study include cryopreserved arterial and femoral vein allografts and autogenous femoral vein grafts, but data are limited when used as replacement for infected prosthetics. CONCLUSION Advances in the management of infected vascular prostheses over the last decade have led to improved mortality and decreased amputation rates with conventional excision and extraanatomical bypass. Newer methods including in situ graft replacement with antibiotic-impregnated prosthetics appear suitable for low-virulence S. epidermidis infection. Early results are promising for cryopreserved allografts and autogenous femoral vein in situ grafts; however, more clinical experience and longer follow-up will be needed to confirm their durability in a contaminated field.
Collapse
Affiliation(s)
- S E Wilson
- Department of Surgery, University of California, Irvine, California 92868, USA.
| |
Collapse
|
20
|
Daenens K, Fourneau I, Nevelsteen A. Ten-year experience in autogenous reconstruction with the femoral vein in the treatment of aortofemoral prosthetic infection. Eur J Vasc Endovasc Surg 2003; 25:240-5. [PMID: 12623336 DOI: 10.1053/ejvs.2002.1835] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE to study the short and long term effectiveness of in situ replacement of infected aortic grafts with the lower extremity deep veins. METHODS forty-nine patients operated on for infrarenal aortic graft infection since 1990 were studied. Diagnosis of infection was based on clinical signs, bacteriological tests and typical findings on CT scan and leukocyte scan. The surgical treatment consisted in harvesting the femoral vein, total graft excision, thorough debridement and in situ reconstruction with the femoral veins. After discharge, the patients were followed at 6 monthly intervals with clinical examination, duplex and/or CT scan. RESULTS there were four in-hospital deaths (8%). One patient required above-knee amputation (2%) and there were two graft limb occlusions (4%). With a mean follow-up 41 months, another 13 patients died, unrelated to the operation (29%). There were no late amputations and only two late graft limb stenoses (4%). We have a 5 year survival rate of 60%, a 5 year limb salvage rate of 98%, and a 5 year primary patency rate of 91%. There were no cases of aneurysmal dilatation of vein grafts and no incidence of reinfection. CONCLUSION in situ reconstruction with the lower extremity deep veins is in the long term a safe and attractive alternative in the treatment of infrarenal aortic graft infection.
Collapse
Affiliation(s)
- K Daenens
- Center for Vascular Diseases, University Hospital Gasthuisberg, Leuven, Belgium
| | | | | |
Collapse
|
21
|
Sin YK, Chua YL. Ruptured mycotic thoracic aortic aneurysm: lobectomy and dacron graft repair. Asian Cardiovasc Thorac Ann 2003; 11:77-9. [PMID: 12692031 DOI: 10.1177/021849230301100120] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A 57-year-old man presenting with hemoptysis and chest pain was diagnosed to have a Staphylococcus aureus mycotic aneurysm of the descending thoracic aorta, which subsequently ruptured into the left lower lobe of the lungs. He underwent successful repair with lung resection and Dacron graft replacement under hypothermic circulatory arrest, followed by long-term antibiotic therapy.
Collapse
Affiliation(s)
- Yoong Kong Sin
- Department of Cardiothoracic Surgery, National Heart Centre, Singapore, Republic of Singapore
| | | |
Collapse
|
22
|
Meneghetti AT, MacDonald PS, Reid JDS, Sladen JG, Turnbull RG. Patency of superficial femoral vein employed as a crossover femoral artery bypass conduit. Ann Vasc Surg 2002; 16:746-50. [PMID: 12404044 DOI: 10.1007/s10016-001-0245-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
This study assesses the patency of superficial femoral vein used as a crossover femoral artery bypass conduit in patients presenting either with localized groin sepsis, generalized sepsis or in patients with occluded or heavily diseased superficial femoral artery outflow. Twenty patients were followed prospectively with femoral crossover grafts constructed of superficial femoral vein. Twelve patients presented with sepsis and 8 with chronic ischemia from iliac artery occlusion and severely diseased superficial femoral artery outflow. Graft patency was assessed with regular duplex ultrasound examination. There was one perioperative death. Six patients died during the follow-up period. Mean follow-up time was 24.3 months. No graft occluded or required revision. There was no limb loss, graft infection, or graft hemorrhage. Superficial femoral vein offers an effective femoral crossover bypass graft in patients with either localized/generalized sepsis or disadvantaged outflow tracts.
Collapse
Affiliation(s)
- Adam T Meneghetti
- Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | |
Collapse
|
23
|
Thrush S, Watts A, Fraser SC, Edmondson RA. Primary autologous superficial femoral vein reconstruction of an emergency, infected, ruptured aortic aneurysm. Eur J Vasc Endovasc Surg 2001; 22:557-8. [PMID: 11735207 DOI: 10.1053/ejvs.2001.1518] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- S Thrush
- Department of Vascular Surgery, Kings College Hospital, London, UK
| | | | | | | |
Collapse
|
24
|
Affiliation(s)
- T J Bunt
- Department of Surgery, Maricopa Medical Center, 2601 East Roosevelt, Phoenix, AZ 85008, USA
| |
Collapse
|
25
|
Toursarkissian B, Smilanich RP, Sykes MT. Autologous superficial femoral vein for the repair of suprarenal mycotic aneurysms: a preferred conduit?--a case report. VASCULAR SURGERY 2001; 35:157-61. [PMID: 11668386 DOI: 10.1177/153857440103500213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The authors report a patient who presented with a ruptured mycotic aneurysm that destroyed the posterior segment of the suprarenal perimesenteric aorta. Initial in-line repair with a rifampin-soaked Dacron prosthetic patch failed 14 days postoperatively with recurrent hemorrhage. At reoperation, the aorta was repaired with a superficial femoral/popliteal vein interposition graft; a segment of superficial femoral/popliteal vein was also used in-line to revascularize the superior mesenteric and celiac arteries. The patient survived with no evidence of recurrence at 8 months postoperatively.
Collapse
Affiliation(s)
- B Toursarkissian
- Vascular Surgery Section, 219-E, University of Texas Health Science Center, 7703 Floyd Curl Drive, San Antonio, TX 78284, USA.
| | | | | |
Collapse
|
26
|
Gibbons CP, Ferguson CJ, Edwards K, Roberts DE, Osman H. Use of superficial femoropopliteal vein for suprainguinal arterial reconstruction in the presence of infection. Br J Surg 2000; 87:771-6. [PMID: 10848857 DOI: 10.1046/j.1365-2168.2000.01468.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Conventional treatment of mycotic aneurysms or graft infections of the aortoiliac segment by in situ or extra-anatomic prosthetic reconstruction has a high mortality and morbidity rate, with a substantial risk of persistent graft infection. The use of autologous vein may reduce this. METHODS Eleven patients with suprainguinal arterial infections including two with mycotic aortic aneurysms, four with aortic graft infections, four infected femorofemoral grafts and an infected axillofemoral graft were treated by debridement and in situ reconstruction with autologous superficial femoropopliteal vein. All patients received appropriate antibiotic therapy and were followed by regular postoperative duplex imaging. Preoperative femoral vein duplex imaging was performed in eight of the 11 patients. RESULTS Ten of the 11 patients survived with a functioning graft and without limb loss or evidence of infection at 4-33 months. One patient died from myocardial infarction after operation. Three patients had minor swelling of one leg. Four patients required subsequent angioplasty of anastomotic stenoses detected by duplex surveillance. CONCLUSION Superficial femoropopliteal vein is an excellent conduit for suprainguinal reconstruction in the presence of infection. Duplex imaging is useful for confirming the suitability of deep veins for use as a graft and for postoperative surveillance.
Collapse
Affiliation(s)
- C P Gibbons
- Department of Vascular Surgery, Morriston Hospital, Swansea, UK
| | | | | | | | | |
Collapse
|
27
|
Sheiner PA, Nurzia MJ, Cooper J, Miller CM. In situ prosthetic graft repair of a mycotic aneurysm of the aorta after orthotopic liver transplantation. Transplantation 2000; 69:999-1001. [PMID: 10755566 DOI: 10.1097/00007890-200003150-00058] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Vascular complications after liver transplant are associated with a high incidence of graft failure and mortality. Mycotic aneurysms, although uncommon, carry the additional risk of infection and rupture. METHODS We report a case of a 51-year-old woman who developed a mycotic aneurysm of the aorta secondary to construction of an infrarenal donor iliac artery graft during a retransplant. We evaluated risk factors for the aneurysm, appropriate diagnosis, and potential treatments. RESULTS The aneurysm was repaired with an in situ prosthetic graft. The patient is alive with good liver function 31 months posttreatment. CONCLUSIONS The use of in situ prosthetic grafts for repair of mycotic aneurysms is appropriate in certain situations and may be life-saving.
Collapse
Affiliation(s)
- P A Sheiner
- The Recanati/Miller Transplantation Institute, The Mount Sinai Medical Center, New York, New York 10029, USA
| | | | | | | |
Collapse
|
28
|
|