1
|
Manunga J, Pedersen C, Selle B, Stephenson E, Skeik N. Feasibility and outcome of partial open surgical fenestrated stent graft explantation, radical debridement, and in situ reconstruction for late graft infection. J Vasc Surg Cases Innov Tech 2023; 9:101175. [PMID: 37333865 PMCID: PMC10273282 DOI: 10.1016/j.jvscit.2023.101175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 03/15/2023] [Indexed: 06/20/2023] Open
Abstract
Aortic stent graft infection is a rare, but potentially lethal, complication of endovascular aortic aneurysm repair. Definitive treatment is complete stent graft explanation with in-line or extra-anatomical reconstruction. However, several factors can render such an operation unsafe, including the patient's overall fitness for surgery and partial incorporation of graft with a resulting robust inflammatory process, especially around the visceral vessels. We present the case of a 74-year-old man with a history of an infected fenestrated stent graft that was managed with partial explantation, wide debridement, and in situ reconstruction using a rifampin-soaked graft and a 360° omental wrap with good results.
Collapse
Affiliation(s)
- Jesse Manunga
- Section of Vascular and Endovascular Surgery, Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, MN
- Minneapolis Heart Institute Foundation, Minneapolis, MN
| | - Christopher Pedersen
- Section of Vascular and Endovascular Surgery, Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, MN
| | - Benjamin Selle
- Section of Vascular and Endovascular Surgery, Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, MN
| | - Elliot Stephenson
- Section of Vascular and Endovascular Surgery, Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, MN
- Minneapolis Heart Institute Foundation, Minneapolis, MN
| | - Nedaa Skeik
- Section of Vascular and Endovascular Surgery, Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, MN
- Minneapolis Heart Institute Foundation, Minneapolis, MN
| |
Collapse
|
2
|
Ljungquist O, Haidl S, Dias N, Sonesson B, Sörelius K, Trägårdh E, Ahl J. Conservative Management First Strategy in Aortic Vascular Graft and Endograft Infections. Eur J Vasc Endovasc Surg 2023; 65:896-904. [PMID: 36921753 DOI: 10.1016/j.ejvs.2023.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 01/08/2023] [Accepted: 03/07/2023] [Indexed: 03/16/2023]
Abstract
OBJECTIVE The aim of this study was to describe and present the outcomes of a specific treatment protocol for aortic vascular graft and endograft infections (VGEIs) without explantation of the infected graft. METHODS This was a retrospective, observational single centre cohort study carried out between 2012 and 2022 at a tertiary hospital. An aortic VGEI was defined according to the Management of Aortic Graft Infection Collaboration (MAGIC) criteria. Fitness for graft excision was assessed by a multidisciplinary team and included an evaluation of the patient's general condition, septic status, and anatomical complexity. Antimicrobial treatments were individualised. The primary outcome was survival at the last available follow up; secondary outcomes were antimicrobial treatment duration, infection eradication, treatment failure despite antimicrobial treatment, and the development of aortic fistulation. RESULTS Fifty patients were included in the study, of whom 42 (84%) had had previous endovascular repair. The median patient age was 72 years (range 51 - 82 years) and median duration of treatment with antimicrobials was 18 months (range 1 - 164 months). Kaplan-Meier analysis estimated the 30 day survival to be 98% (95% confidence interval [CI] 96 - 100), the one year survival rate to be 88% (95% CI 83.4 - 92.6), and the three year survival rate to be 79% (95% CI 72.7 - 84.7). Twenty-four (48%) patients were able to discontinue antibiotic treatment after a median of 16 months (range 4 - 81 months). When categorised according to infected graft location, deaths occurred in four (40%) patients with thoracic, two (40%) with paravisceral, seven (30%) with infrarenal VGEIs, and in one (25%) patient with an aorto-iliac VGEI; no (0%) patient with a thoraco-abdominal VGEI died. CONCLUSION Identifying the microbiological aetiology in patients with aortic VGEI enables individualised, specific antibiotic treatment, which may be useful in patients with a VGEI excluded from surgery. This single centre retrospective analysis of patients with VGEIs without fistula selected for conservative treatment suggests that conservative management of aortic VGEIs with targeted antibiotic therapy without graft excision is potentially effective, and that antimicrobial treatment will not necessarily be needed indefinitely.
Collapse
Affiliation(s)
- Oskar Ljungquist
- Clinical Infection Medicine, Department of Translational Medicine, Faculty of Medicine, Lund University, Malmö, Sweden.
| | - Sven Haidl
- Clinical Infection Medicine, Department of Translational Medicine, Faculty of Medicine, Lund University, Malmö, Sweden; Department of Infectious Diseases, Skåne University Hospital, Malmö, Sweden
| | - Nuno Dias
- Vascular Centre Malmö-Lund, Skåne University Hospital, Malmö, Sweden
| | - Björn Sonesson
- Vascular Centre Malmö-Lund, Skåne University Hospital, Malmö, Sweden
| | - Karl Sörelius
- Clinical Infection Medicine, Department of Translational Medicine, Faculty of Medicine, Lund University, Malmö, Sweden
| | - Elin Trägårdh
- Department of Medical Imaging and Physiology, Skåne University Hospital, Malmö, Sweden
| | - Jonas Ahl
- Clinical Infection Medicine, Department of Translational Medicine, Faculty of Medicine, Lund University, Malmö, Sweden; Department of Infectious Diseases, Skåne University Hospital, Malmö, Sweden
| |
Collapse
|
3
|
Destructive per continuitatem spondylodiscitis after endovascular abdominal or thoracic aneurysm repair (EVAR/TEVAR): rare and untreatable? Arch Orthop Trauma Surg 2022; 142:591-598. [PMID: 33206206 PMCID: PMC8924104 DOI: 10.1007/s00402-020-03672-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 10/27/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Very few publications have previously described spondylodiscitis as a potential complication of endovascular aortic procedures (EVAR/TEVAR). We present to our knowledge the first case series of spondylodiscitis following EVAR/TEVAR based on our data base. Particular focus was laid on the complexity of disease treatment and grave outcome perspectives from a spine surgeon's point of view in this seriously affected patient group. MATERIALS AND METHODS A retrospective analysis and chart review was performed for 11 out of 284 consecutive spondylodiscitis patients who underwent EVAR/TEVAR procedure and developed destructive per continuitatem spondylodiscitis. RESULTS All 11 patients had single or more level destructive spondylodiscitis adjacent to the thoracic/lumbar stent graft. In mean, four surgeries were performed per patient to treat this rare complication. Six out of eleven patients (55%) died within 6 months of first identification of per continuitatem spondylodiscitis. In four patients due to persisting infection of the graft and recurrence of the abscess formation, a persisting fistula from anterior approach to the skin was applied. CONCLUSIONS Destructive per continuitatem spondylodiscitis is a rare and severe complication post-EVAR/TEVAR. Clinical and imaging features of anterior paravertebral disease and anterior vertebral body involvement suggest direct continuous spread of the graft infection to the adjacent vertebral column. The mortality rate of these severe infections is extremely high and treatment with a permanent fistula may be one salvage procedure.
Collapse
|
4
|
von der Höh NH, Pieroh P, Henkelmann J, Branzan D, Völker A, Wiersbicki D, Heyde CE. Spondylodiscitis due to transmitted mycotic aortic aneurysm or infected grafts after endovascular aortic aneurysm repair (EVAR): A retrospective single-centre experience with short-term outcomes. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 30:1744-1755. [PMID: 32895774 DOI: 10.1007/s00586-020-06586-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 08/25/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE To report the challenging therapeutic approach and the clinical outcome of patients with pyogenic spondylodiscitis transmitted due to infected retroperitoneal regions of primary infected mycotic aortic aneurysms (MAAs) or secondary infected aortic stent grafts after endovascular aneurysm repair (EVAR). METHODS Between 2012 and 2019, all patients suffering from spondylodiscitis based on a transmitted infection after the EVAR procedure were retrospectively identified. Patient data were analysed regarding the time between primary and secondary EVAR infection and spondylodiscitis detection, potential source of infection, pathogens, antibiotic treatment, complications, recovery from infection, mortality, numeric rating scale (NRS), COBB angle and cage subsidence. RESULTS Fifteen patients with spondylodiscitis transmitted from primary or secondary infected aortic aneurysms after EVAR were included. The median follow-up time was 8 months (range 1-47). Surgery for spondylodiscitis was performed in 12 patients. In 9 patients, the infected graft was treated conservatively. MAAs were treated in 4 patients first with percutaneous aortic stent graft implantation followed by posterior surgery of the infected spinal region in a two-step procedure. Infection recovery was recorded in 11 patients during follow-up. The overall mortality rate was 27% (n = 4). The mean pain intensity improved from an NRS score of 8.4 (3.2-8.3) to 3.1 (1.3-6.7) at the last follow-up. CONCLUSION EVAR was used predominantly to treat primary infected MAAs. Secondary infected grafts were treated conservatively. Independent of vascular therapy, surgery of the spine led to recovery in most cases. Thus, surgery should be considered for the treatment of EVAR- and MAA-related spondylodiscitis.
Collapse
Affiliation(s)
- Nicolas Heinz von der Höh
- Department of Orthopaedic, Trauma and Plastic Surgery, University Hospital Leipzig, Liebigstr. 18, 04103, Leipzig, Germany.
| | - Philipp Pieroh
- Department of Orthopaedic, Trauma and Plastic Surgery, University Hospital Leipzig, Liebigstr. 18, 04103, Leipzig, Germany
| | - Jeanette Henkelmann
- Department for Diagnostic and Interventional Radiology, University Hospital Leipzig, Liebigstr. 18, 04103, Leipzig, Germany
| | - Daniela Branzan
- Department of Visceral, Transplant, Thorax and Vascular Surgery, University Hospital Leipzig, Liebigstr. 18, 04103, Leipzig, Germany
| | - Anna Völker
- Department of Orthopaedic, Trauma and Plastic Surgery, University Hospital Leipzig, Liebigstr. 18, 04103, Leipzig, Germany
| | - Dina Wiersbicki
- Department of Orthopaedic, Trauma and Plastic Surgery, University Hospital Leipzig, Liebigstr. 18, 04103, Leipzig, Germany
| | - Christoph-Eckhard Heyde
- Department of Orthopaedic, Trauma and Plastic Surgery, University Hospital Leipzig, Liebigstr. 18, 04103, Leipzig, Germany
| |
Collapse
|
5
|
Perrenoud AL, Heiberger G, Shriver J, Yim D. Endoleak and Pseudoaneurysm Formation in the Setting of Stent Graft Infection Following Endovascular Uretero-Arterial Fistula Repair: The Dreaded Complication. Cureus 2020; 12:e8830. [PMID: 32742842 PMCID: PMC7384727 DOI: 10.7759/cureus.8830] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The complication of uretero-arterial fistula after prolong ureteral stenting is well recognized. The treatment is primarily endovascular stenting across the fistulous communication accepting the potential risk of stent graft infection. Herein we present a case of a 71-year-old female who developed an uretero-arterial fistula after prolong ureteral stenting and exchanges following ileal conduit obstruction. Initial treatment with left common iliac stenting controlled the hematuria, but only temporarily. Repeat angiography revealed a type 1b endoleak requiring stent extension. Unfortunately, persistent hematuria necessitating further angiography showed the development of a saccular pseudoaneurysm around the stent graft requiring proximal stent extension. A nuclear medicine indium 111-tagged white blood cell scan with single-photon emission CT (SPECT)/CT confirmed stent graft infection. Conservative therapy with antibiotics failed, causing graft failure that ultimately required bypass surgery.
Collapse
Affiliation(s)
- Abby L Perrenoud
- Interventional Radiology, University of South Dakota Sanford School of Medicine, Sioux Falls, USA
| | - Garret Heiberger
- Interventional Radiology, University of South Dakota Sanford School of Medicine, Sioux Falls, USA
| | - Jackson Shriver
- Interventional Radiology, University of South Dakota Sanford School of Medicine, Sioux Falls, USA
| | - Douglas Yim
- Interventional Radiology, Avera McKennan Hospital and University Health Center, Sioux Falls, USA.,Medicine/Radiology, University of South Dakota Sanford School of Medicine, Sioux Falls, USA
| |
Collapse
|
6
|
Tang Y, Han L, Fan X, Zhang B, Zhang J, Xue Q, Xu Z. Extra-anatomical bypass to treat aortic endograft infection after thoracic endovascular aortic repair. Interact Cardiovasc Thorac Surg 2020; 30:620-622. [PMID: 32025739 DOI: 10.1093/icvts/ivz318] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 12/19/2019] [Accepted: 12/19/2019] [Indexed: 11/14/2022] Open
Abstract
This study aimed to report the case of 7 consecutive patients who underwent surgical treatment for aortic endograft infection after thoracic endovascular aortic repair (TEVAR). The management included the reconstruction of aorta using extra-anatomic prosthetic graft bypass (between the ascending aorta and the abdominal aorta), removal of the infected endograft with debridement of the infected tissue and sac drainage, followed by prolonged antibiotic therapy. This brief communication highlights that the reconstruction of aorta using extra-anatomic prosthetic graft bypass during surgical treatment for aortic endograft infection after TEVAR was reliable and effective.
Collapse
Affiliation(s)
- Yangfeng Tang
- Department of Cardiothoracic Surgery, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Lin Han
- Department of Cardiothoracic Surgery, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Xinli Fan
- Department of Cardiothoracic Surgery, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Boyao Zhang
- Department of Cardiothoracic Surgery, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Jiajun Zhang
- Department of Cardiothoracic Surgery, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Qin Xue
- Department of Cardiothoracic Surgery, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Zhiyun Xu
- Department of Cardiothoracic Surgery, Changhai Hospital, The Second Military Medical University, Shanghai, China
| |
Collapse
|
7
|
Periaortic Abscess following DeBakey Type-1 Aortic Dissection Repair with Dacron Graft-Early Diagnosis and Management. Case Rep Cardiol 2019; 2019:6915356. [PMID: 31205789 PMCID: PMC6530244 DOI: 10.1155/2019/6915356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 05/02/2019] [Indexed: 11/17/2022] Open
Abstract
A 71-year-old male with history of DeBakey type-1 aortic dissection and repair with dacron graft three months prior to presentation was brought to the emergency room with complaints of high-grade fevers, chills, and shortness of breath. Chest X-ray revealed right lower lobe infiltrates and widened superior mediastinum. A follow-up CT chest with contrast showed fluid collection around the aortic graft. He was started on intravenous broad-spectrum antibiotics, and a TEE was done for further evaluation of periaortic fluid collection which showed findings to suggest periaortic abscess. The patient underwent surgical drainage of the abscess and was found to have an abscess around the surgical aortic graft which was drained followed by two weeks of antibiotic treatment. The patient was discharged to a rehabilitation facility and remained asymptomatic at three-month follow-up appointment. Type-1 aortic dissection is a medical emergency requiring acute surgical intervention, and despite significant advancements in diagnosis and management, the immediate and long-term complications remain high leading to increased risk of mortality. Our patient developed spontaneous periaortic abscess three months postoperatively requiring intensive antibiotic therapy along with surgical drainage. Our case emphasizes the importance of early diagnosis and management of late complications of periaortic abscess in patients with aortic dissection repair.
Collapse
|
8
|
|
9
|
Mandegaran R, Tang CSW, Pereira EAC, Zavareh A. Spondylodiscitis following endovascular abdominal aortic aneurysm repair: imaging perspectives from a single centre's experience. Skeletal Radiol 2018; 47:1357-1369. [PMID: 29656303 PMCID: PMC6105147 DOI: 10.1007/s00256-018-2939-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 03/19/2018] [Accepted: 03/22/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Very few reports have previously described spondylodiscitis as a potential complication of endovascular aortic aneurysm repair (EVAR). We present to our knowledge the first case series of spondylodiscitis following EVAR based on our institution's experience over an 11-year period. Particular attention is paid to the key imaging features and challenges encountered when performing spinal imaging in this complex patient group. MATERIALS AND METHODS Of 1,847 patients who underwent EVAR at our institution between January 2006 and January 2017, a total of 9 patients were identified with imaging features of spondylodiscitis (0.5%). All cross-sectional studies before and after EVAR were assessed by a Consultant Musculoskeletal Radiologist and a Musculoskeletal Radiology Fellow to evaluate for features of spondylodiscitis. RESULTS All 9 patients had single-level spondylodiscitis involving lumbosacral levels adjacent to the aortic/iliac stent graft. Eight out of nine patients had an extensive anterior paravertebral phlegmon/abscess that was contiguous with the infected stent graft and native aneurysm sac ± anterior vertebral body erosion. Epidural disease was present in only 3 out of 9 patients and was a minor feature. MRI was non-diagnostic in 3 out of 9 patients owing to susceptibility artefact. 18F-FDG PET/CT accurately depicted the spinal level involved and adjacent paravertebral disease in patients with non-diagnostic MRI and was adopted as the follow-up modality in 3 out of 5 surviving patients. CONCLUSION Spondylodiscitis is a rare complication post-EVAR. Imaging features of disproportionate anterior paravertebral disease and anterior vertebral body bony involvement suggest direct spread of infection posteriorly to the adjacent vertebral column. Use of MRI versus 18F-FDG PET/CT as the optimal imaging modality should be directed by the type of stent graft deployed.
Collapse
Affiliation(s)
- Ramin Mandegaran
- Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, 2nd Floor Tower Wing, Great Maze Pond, London, SE1 9RT, UK.
| | - Christopher S W Tang
- Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, 2nd Floor Tower Wing, Great Maze Pond, London, SE1 9RT, UK
| | - Erlick A C Pereira
- Academic Neurosurgery Unit St George's, University of London, London, SW17 0QT, UK
| | - Ali Zavareh
- Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, 2nd Floor Tower Wing, Great Maze Pond, London, SE1 9RT, UK
| |
Collapse
|
10
|
Argyriou C, Georgiadis GS, Lazarides MK, Georgakarakos E, Antoniou GA. Endograft Infection After Endovascular Abdominal Aortic Aneurysm Repair: A Systematic Review and Meta-analysis. J Endovasc Ther 2017; 24:688-697. [DOI: 10.1177/1526602817722018] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Purpose: To report a meta-analysis of the published evidence on the outcomes of aortic endograft infection after endovascular aneurysm repair (EVAR). Methods: A search of electronic information sources (PubMed/MEDLINE, SCOPUS, CENTRAL) and bibliographic reference lists identified 12 studies reporting on 362 patients (mean age 72 years; 279 men). The methodological quality of the selected studies was assessed using the Newcastle-Ottawa scale. Endpoints were 30-day/in-hospital mortality and follow-up mortality. Pooled estimates are reported with the 95% confidence interval (CI). The review was registered at the International Prospective Register of Systematic Reviews in Health and Social Care (CRD42016034166). Results: The incidence of graft infection after EVAR was 0.6% (95% CI 0.4% to 0.8%). The time from implantation to diagnosis ranged from 1 to 128 months (mean 25). The majority of patients (293, 81%) underwent surgical treatment (95% CI 77% to 83%); 9 (2.5%) patients (95% CI 21% to 43%) received conservative treatment. Aortic replacement with a prosthetic graft was performed in 58% (95% CI 52% to 62%), whereas cryopreserved allografts and autologous grafts were used in 31% (95% CI 28% to 33%) and 11% (95% CI% 8 to 14%), respectively. Less than half of the patients (40%) had emergency surgery. The pooled estimate of 30-day/in-hospital mortality was 26.6% (95% CI 16.9% to 39.2%). The pooled 30-day/in-hospital mortality for 9 patients treated conservatively was 63.3% (95% CI 30.7% to 87.0%). The pooled overall follow-up mortality was 45.7% (95% CI 36.4% to 55.4%) vs 58.6% (95% CI 28.8% to 83.3%) for the 9 patients receiving conservative treatment. Conclusion: Aortic endograft infection is a rare complication after EVAR. Surgical treatment with complete explantation of the infected endograft seems to be the optimal management in selected patients. Supportive medical treatment without surgical intervention has a significant associated mortality.
Collapse
Affiliation(s)
- Christos Argyriou
- Department of Vascular and Endovascular Surgery, University General Hospital of Alexandroupolis, “Democritus” University of Thrace, Alexandroupolis, Greece
| | - George S. Georgiadis
- Department of Vascular and Endovascular Surgery, University General Hospital of Alexandroupolis, “Democritus” University of Thrace, Alexandroupolis, Greece
| | - Miltos K. Lazarides
- Department of Vascular and Endovascular Surgery, University General Hospital of Alexandroupolis, “Democritus” University of Thrace, Alexandroupolis, Greece
| | - Efstratios Georgakarakos
- Department of Vascular and Endovascular Surgery, University General Hospital of Alexandroupolis, “Democritus” University of Thrace, Alexandroupolis, Greece
| | - George A. Antoniou
- Department of Vascular and Endovascular Surgery, The Royal Oldham Hospital, Pennine Acute Hospitals NHS Trust, Manchester, UK
| |
Collapse
|
11
|
Laohapensang K, Arworn S, Orrapin S, Reanpang T, Orrapin S. Management of the infected aortic endograft. Semin Vasc Surg 2017; 30:91-94. [DOI: 10.1053/j.semvascsurg.2017.11.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
12
|
Han K, Lee DY, Kim MD, Lee S, Won JY, Kwon JH, Choi D, Ko YG. Hybrid Treatment: Expanding the Armamentarium for Infected Infrarenal Abdominal Aortic and Iliac Aneurysms. J Vasc Interv Radiol 2017; 28:564-569. [DOI: 10.1016/j.jvir.2016.10.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 10/26/2016] [Accepted: 10/26/2016] [Indexed: 11/24/2022] Open
|
13
|
Megaloikonomos PD, Antoniadou T, Dimopoulos L, Liontos M, Igoumenou V, Panagopoulos GN, Giannitsioti E, Lazaris A, Mavrogenis AF. Spondylitis transmitted from infected aortic grafts: a review. J Bone Jt Infect 2017; 2:96-103. [PMID: 28540144 PMCID: PMC5441139 DOI: 10.7150/jbji.17703] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Graft infection following aortic aneurysms repair is an uncommon but devastating complication; its incidence ranges from <1% to 6% (mean 4%), with an associated perioperative and overall mortality of 12% and 17.5-20%, respectively. The most common causative organisms are Staphylococcus aureus and Escherichia coli; causative bacteria typically arise from the skin or gastrointestinal tract. The pathogenetic mechanisms of aortic graft infections are mainly breaks in sterile technique during its implantation, superinfection during bacteremia from a variety of sources, severe intraperitoneal or retroperitoneal inflammation, inoculation of bacteria during postoperative percutaneous interventions to manage various types of endoleaks, and external injury of the vascular graft. Mechanical forces in direct relation to the device were implicated in fistula formation in 35% of cases of graft infection. Partial rupture and graft migration leading to gradual erosion of the bowel wall and aortoenteric fistulas have been reported in 30.8% of cases. Rarely, infection via continuous tissues may affect the spine, resulting in spondylitis. Even though graft explantation and surgical debridement is usually the preferred course of action, comorbidities and increased perioperative risk may preclude patients from surgery and endorse a conservative approach as the treatment of choice. In contrast, conservative treatment is the treatment of choice for spondylitis; surgery may be indicated in approximately 8.5% of patients with neural compression or excessive spinal infection. To enhance the literature, we searched the related literature for published studies on continuous spondylitis from infected endovascular grafts aiming to summarize the pathogenesis and diagnosis, and to discuss the treatment and outcome of the patients with these rare and complex infections.
Collapse
Affiliation(s)
- Panayiotis D Megaloikonomos
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, ATTIKON University Hospital, Athens, Greece
| | - Thekla Antoniadou
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, ATTIKON University Hospital, Athens, Greece
| | - Leonidas Dimopoulos
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, ATTIKON University Hospital, Athens, Greece
| | - Marcos Liontos
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, ATTIKON University Hospital, Athens, Greece
| | - Vasilios Igoumenou
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, ATTIKON University Hospital, Athens, Greece
| | - Georgios N Panagopoulos
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, ATTIKON University Hospital, Athens, Greece
| | - Efthymia Giannitsioti
- Fourth Department of Internal Medicine, National and Kapodistrian University of Athens, School of Medicine, ATTIKON University Hospital, Athens, Greece
| | - Andreas Lazaris
- Department of Vascular Surgery, National and Kapodistrian University of Athens, School of Medicine, ATTIKON University Hospital, Athens, Greece
| | - Andreas F Mavrogenis
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, ATTIKON University Hospital, Athens, Greece
| |
Collapse
|
14
|
Concomitant Pasteurella multocida aortic endograft infection and Bartonella henselae endocarditis. Med Mal Infect 2015; 45:424-6. [DOI: 10.1016/j.medmal.2015.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 06/25/2015] [Accepted: 09/07/2015] [Indexed: 11/17/2022]
|
15
|
Huang SY, Philip A, Richter MD, Gupta S, Lessne ML, Kim CY. Prevention and management of infectious complications of percutaneous interventions. Semin Intervent Radiol 2015; 32:78-88. [PMID: 26038616 DOI: 10.1055/s-0035-1549372] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Infectious complications following interventional radiology (IR) procedures can cause significant patient morbidity and, potentially, mortality. As the number and breadth of IR procedures grow, it becomes increasingly evident that interventional radiologists must possess a thorough understanding of these potential infectious complications. Furthermore, given the increasing incidence of antibiotic-resistant bacteria, emphasis on cost containment, and attention to quality of care, it is critical to have infection control strategies to maximize patient safety. This article reviews infectious complications associated with percutaneous ablation of liver tumors, transarterial embolization of liver tumors, uterine fibroid embolization, percutaneous nephrostomy, percutaneous biliary interventions, central venous catheters, and intravascular stents. Emphasis is placed on incidence, risk factors, prevention, and management. With the use of these strategies, IR procedures can be performed with reduced risk of infectious complications.
Collapse
Affiliation(s)
- Steven Y Huang
- Department of Interventional Radiology, The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Asher Philip
- Department of Interventional Radiology, The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Michael D Richter
- Department of Interventional Radiology, The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Sanjay Gupta
- Department of Interventional Radiology, The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Mark L Lessne
- Vascular and Interventional Specialists of Charlotte Radiology, Charlotte, North Carolina
| | - Charles Y Kim
- Division of Vascular and Interventional Radiology, Duke University Medical Center, Durham, North Carolina
| |
Collapse
|
16
|
Setacci C, Chisci E, Setacci F, Ercolini L, de Donato G, Troisi N, Galzerano G, Michelagnoli S. How To Diagnose and Manage Infected Endografts after Endovascular Aneurysm Repair. AORTA : OFFICIAL JOURNAL OF THE AORTIC INSTITUTE AT YALE-NEW HAVEN HOSPITAL 2014; 2:255-64. [PMID: 26798744 DOI: 10.12945/j.aorta.2014.14-036] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 10/03/2014] [Indexed: 12/14/2022]
Abstract
The prevalence of endograft infections (EI) after endovascular abdominal aortic aneurysm repair is below 1%. With the growing number of patients with aortic endografts and the aging population, the number of patients with EI might also increase. The diagnosis is based on an association of clinical symptoms, imaging, and microbial cultures. Angio-computed tomography is currently the gold-standard technique for diagnosis. Low-grade infection sometimes requires nuclear medicine imaging to make a correct diagnosis. There is no good evidence to guide management so far. In the case of active gastrointestinal bleeding, pseudoaneurysm, or extensive perigraft purulence involving adjacent organs, an invasive treatment should always be attempted. In the other cases (the majority), when there is not an immediate danger to the patient's life, a conservative management is started with a proper antimicrobial therapy. Any infectious cavity can be percutaneously drained. Management depends on the patient's condition and a tailored approach should always be offered. In the case of a patient who is young, has a good life expectancy, or in whom there is absence of significant comorbidities, a surgical attempt can be proposed. Surgical techniques favor, in terms of mortality, patency, and reinfection rate, the in situ reconstruction. Choice of technique relies on the center and the operator's experience. Long-term antibiotic therapy is always required in all cases, with close monitoring of the C-reactive protein.
Collapse
Affiliation(s)
- Carlo Setacci
- Vascular and Endovascular Surgery Unit, University of Siena, Siena, Italy
| | - Emiliano Chisci
- Department of Surgery, Vascular and Endovascular Surgery Unit, "San Giovanni di Dio" Hospital, Florence, Italy; and
| | - Francesco Setacci
- P. Valdoni Department of Surgery, La Sapienza University, Rome, Italy
| | - Leonardo Ercolini
- Department of Surgery, Vascular and Endovascular Surgery Unit, "San Giovanni di Dio" Hospital, Florence, Italy; and
| | | | - Nicola Troisi
- Department of Surgery, Vascular and Endovascular Surgery Unit, "San Giovanni di Dio" Hospital, Florence, Italy; and
| | - Giuseppe Galzerano
- Vascular and Endovascular Surgery Unit, University of Siena, Siena, Italy
| | - Stefano Michelagnoli
- Department of Surgery, Vascular and Endovascular Surgery Unit, "San Giovanni di Dio" Hospital, Florence, Italy; and
| |
Collapse
|
17
|
Erb S, Sidler JA, Elzi L, Gurke L, Battegay M, Widmer AF, Weisser M. Surgical and antimicrobial treatment of prosthetic vascular graft infections at different surgical sites: a retrospective study of treatment outcomes. PLoS One 2014; 9:e112947. [PMID: 25393400 PMCID: PMC4231097 DOI: 10.1371/journal.pone.0112947] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Accepted: 10/17/2014] [Indexed: 11/24/2022] Open
Abstract
Objective Little is known about optimal management of prosthetic vascular graft infections, which are a rare but serious complication associated with graft implants. The goal of this study was to compare and characterize these infections with respect to the location of the graft and to identify factors associated with outcome. Methods This was a retrospective study over more than a decade at a tertiary care university hospital that has an established multidisciplinary approach to treating graft infections. Cases of possible prosthetic vascular graft infection were identified from the hospital's infectious diseases database and evaluated against strict diagnostic criteria. Patients were divided into groups according to the locations of their grafts: thoracic-aortic, abdominal-aortic, or peripheral-arterial. Statistical analyses included evaluation of patient and infection characteristics, time to treatment failure, and factors associated specifically with cure rates in aortic graft infections. The primary endpoint was cure at one year after diagnosis of the infection. Results Characterization of graft infections according to the graft location did show that these infections differ in terms of their characteristics and that the prognosis for treatment seems to be influenced by the location of the infection. Cure rate and all-cause mortality at one year were 87.5% and 12.5% in 24 patients with thoracic-aortic graft infections, 37.0% and 55.6% in 27 patients with abdominal-aortic graft infections, and 70.0% and 30.0% in 10 patients with peripheral-arterial graft infections. In uni- and multivariate analysis, the type of surgical intervention used in managing infections (graft retention versus graft replacement) did not affect primary outcome, whereas a rifampicin-based antimicrobial regimen was associated with a higher cure rate. Conclusions We recommend that future prospective studies differentiate prosthetic vascular graft infections according to the location of the grafts and that rifampicin-based antimicrobial regimens be evaluated in clinical trials involving vascular graft infections caused by staphylococci.
Collapse
Affiliation(s)
- Stefan Erb
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, Basel, Switzerland
| | - Jan A. Sidler
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, Basel, Switzerland
| | - Luigia Elzi
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, Basel, Switzerland
| | - Lorenz Gurke
- Department of Vascular Surgery, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, Basel, Switzerland
| | - Manuel Battegay
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, Basel, Switzerland
| | - Andreas F. Widmer
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, Basel, Switzerland
| | - Maja Weisser
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, Basel, Switzerland
- * E-mail:
| |
Collapse
|
18
|
Mancini F, Ascoli-Marchetti A, Garro L, Caterini R. Aseptic lysis L2-L3 as complication of abdominal aortic aneurysm repair. J Orthop Traumatol 2014; 15:291-4. [PMID: 25017025 PMCID: PMC4244547 DOI: 10.1007/s10195-014-0308-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2013] [Accepted: 06/23/2014] [Indexed: 11/29/2022] Open
Abstract
Osteolytic vertebral erosion is usually related to tumours, spondylitis or spondylodiscitis. Few reports in the literature describe lytic lesions of anterior lumbar vertebral bodies resulting from abdominal aortic aneurysm or false aneurysm. We report a case of abdominal aortic false aneurysm that caused lytic lesions of the second and third vertebral bodies in an 80-year-old man who underwent endovascular aneurysm repair. Fluoroscopy guided biopsy excluded infection or tumour. We performed a posterior spinal fusion and decompression because of bone loss of the second and third lumbar vertebral bodies and central stenosis. Postoperatively the patient showed satisfactory relief in low-back and thigh pain but, unfortunately, he died 1 month after surgery because of respiratory complications. This case suggests that when a lytic lesion of a lumbar vertebral body is discovered in a patient who has undergone endovascular aneurysm repair, an abdominal aortic false aneurysm may be the cause of the vertebral erosion even in cases without infective pathogenesis.
Collapse
Affiliation(s)
- Federico Mancini
- Department of Orthopaedics and Traumatology, University of Rome "Tor Vergata", Viale Oxford, 81, 00133, Rome, Italy
| | | | | | | |
Collapse
|
19
|
Moulakakis KG, Sfyroeras GS, Mylonas SN, Mantas G, Papapetrou A, Antonopoulos CN, Kakisis JD, Liapis CD. Outcome After Preservation of Infected Abdominal Aortic Endografts. J Endovasc Ther 2014; 21:448-55. [DOI: 10.1583/13-4575mr.1] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
20
|
Legout L, Delia P, Sarraz-Bournet B, Rouyer C, Massongo M, Valette M, Leroy O, Haulon S, Senneville E. Factors predictive of treatment failure in staphylococcal prosthetic vascular graft infections: a prospective observational cohort study: impact of rifampin. BMC Infect Dis 2014; 14:228. [PMID: 24775563 PMCID: PMC4049509 DOI: 10.1186/1471-2334-14-228] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 03/12/2014] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND There exists considerable debate concerning management of prosthetic vascular graft infection (PVGI), especially in terms of antimicrobial treatment. This report studies factors associated with treatment failure in a cohort of patients with staphylococcal PVGI, along with the impact of rifampin (RIF). METHODS All data on patients with PVGI between 2006 and 2010 were reviewed. Cure was defined as the absence of evidence of infection during the entire post-treatment follow-up for a minimum of one year. Failure was defined as any other outcome. RESULTS 84 patients (72 M/12 F, median age 64.5 ± 11 y) with diabetes mellitus (n = 25), obesity (n = 48), coronary artery disease (n = 48), renal failure (n = 24) or COPD (n = 22) were treated for PVGI (median follow-up was 470 ± 469 d). PVGI was primarily intracavitary (n = 47). Staphylococcus aureus (n = 65; including 17 methicillin-resistant S. aureus) and coagulase-negative Staphylocococcus (n = 22) were identified. Surgical treatment was performed in 71 patients. In univariate analysis, significant risk factors associated with failure were renal failure (p = 0.04), aortic aneurysm (p = 0.03), fever (p = 0.009), aneurysm disruption (p = 0.02), septic shock in the peri-operative period (p = 0.005) and antibiotic treatment containing RIF (p = 0.03). In multivariate analysis, 2 variables were independently associated with failure:septic shock [OR 4.98: CI 95% 1.45-16.99; p=0.01] and antibiotic containing rifampin [OR: 0.32: CI95% 0.10-0.96; p=0.04]. CONCLUSION Results of the present study suggest that fever, septic shock and non-use of antibiotic treatment containing RIF are associated with poor outcome.
Collapse
Affiliation(s)
- Laurence Legout
- Infectious Diseases Department, Dron Hospital of Tourcoing, Rue du Président Coty, Tourcoing 59208, France
| | - Piervito Delia
- Department of Vascular Surgery, Dron Hospital of Tourcoing, Tourcoing, France
- Department of Vascular Surgery, University Hospital of Lille, Lille, France
| | | | - Cécile Rouyer
- Infectious Diseases Department, Dron Hospital of Tourcoing, Rue du Président Coty, Tourcoing 59208, France
| | - Massongo Massongo
- Infectious Diseases Department, Dron Hospital of Tourcoing, Rue du Président Coty, Tourcoing 59208, France
| | - Michel Valette
- Infectious Diseases Department, Dron Hospital of Tourcoing, Rue du Président Coty, Tourcoing 59208, France
| | - Olivier Leroy
- Intensive Care and Infectious Diseases Unit, Dron Hospital of Tourcoing, Tourcoing, France
| | - Stephan Haulon
- Department of Vascular Surgery, University Hospital of Lille, Lille, France
| | - Eric Senneville
- Infectious Diseases Department, Dron Hospital of Tourcoing, Rue du Président Coty, Tourcoing 59208, France
| |
Collapse
|
21
|
Heafner TA, Clemens M, Scott D, Ching Y, Hislop S, Arthurs ZM. Endovascular aortoiliac reconstruction to allow excision of an infected axillobifemoral bypass. Ann Vasc Surg 2014; 28:1792.e11-4. [PMID: 24704583 DOI: 10.1016/j.avsg.2014.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 02/28/2014] [Accepted: 03/07/2014] [Indexed: 11/28/2022]
Abstract
Axillofemoral graft reconstructions were initially intended to restore lower extremity perfusion in high-risk patients with symptomatic aortoiliac atherosclerotic occlusive disease. However, these reconstructions are now relegated to "bailout" procedures for infected grafts or high-risk critical limb ischemia patients that fail endovascular therapy. Infection of an extra-anatomic bypass graft is a challenging complication as it occurs in poor operative candidates with limited revascularization options and failure has a high rate of amputation and mortality. Described is a novel approach using endovascular reconstruction to treat symptomatic Trans-Atlantic Inter-Society Consensus-II type D aortoiliac lesions allowing for complete excision of an infected axillobifemoral bypass.
Collapse
Affiliation(s)
- Thomas A Heafner
- Department of Vascular Surgery, San Antonio Military Medical Center, San Antonio, TX.
| | - Michael Clemens
- Department of Vascular Surgery, San Antonio Military Medical Center, San Antonio, TX
| | - Daniel Scott
- Department of Vascular Surgery, San Antonio Military Medical Center, San Antonio, TX
| | - Yiming Ching
- Department of Vascular Surgery, San Antonio Military Medical Center, San Antonio, TX
| | - Sean Hislop
- Department of Vascular Surgery, San Antonio Military Medical Center, San Antonio, TX
| | - Zachary M Arthurs
- Department of Vascular Surgery, San Antonio Military Medical Center, San Antonio, TX
| |
Collapse
|
22
|
Buora A, Floriani M, Gabrielli L. Extra-anatomic autologous reconstruction with hepatic-iliac artery bypass graft for aortic endograft infection. J Vasc Surg 2013; 61:237-9. [PMID: 24176632 DOI: 10.1016/j.jvs.2013.08.091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Revised: 08/28/2013] [Accepted: 08/29/2013] [Indexed: 11/18/2022]
Abstract
We present a new intra-abdominal extra-anatomic bypass graft for a 64-year-old man treated with an abdominal aortic endograft and with signs of endograft infection. We performed surgical removal of the endograft and intra-abdominal extra-anatomic reconstruction of a hepatic-to-right external iliac artery bypass with autologous superficial femoral vein and a crossover graft between the right and left external iliac artery with the great saphenous vein. The later occlusion of the saphenous vein graft led us to perform a femoral-femoral prosthetic crossover. At 42 months from the intervention, the patient was in good health, and duplex scanning confirmed the patency of all grafts.
Collapse
Affiliation(s)
- Adelaide Buora
- Vascular Surgery, Department of Clinical Sciences and Community Health, Ospedale Maggiore Policlinico, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda, University of Milan, Milan, Italy.
| | - Marco Floriani
- Vascular Surgery, Department of Clinical Sciences and Community Health, Ospedale Maggiore Policlinico, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda, University of Milan, Milan, Italy
| | - Livio Gabrielli
- Vascular Surgery, Department of Clinical Sciences and Community Health, Ospedale Maggiore Policlinico, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda, University of Milan, Milan, Italy
| |
Collapse
|
23
|
Lyons O, Patel A, Saha P, Clough R, Price N, Taylor P. A 14-year Experience with Aortic Endograft Infection: Management and Results. Eur J Vasc Endovasc Surg 2013; 46:306-13. [DOI: 10.1016/j.ejvs.2013.04.021] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 04/10/2013] [Indexed: 02/05/2023]
|
24
|
Lee SH, Song PS, Kim WS, Park KB, Choi SH. A case of stent graft infection coupled with aorto-esophageal fistula following thoracic endovascular aortic repair in a complex patient. Korean Circ J 2012. [PMID: 22701140 DOI: 10.4070/kcj.2012.42.5.36] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The incidence of peri-stent graft infection (PGI) following thoracic endovascular aortic repair (TEVAR) is low, but the associated mortality rates are extremely high. The diagnosis of this complication can be difficult due to nonspecific symptoms. Here, we report a case of PGI combined with an aorto-esophageal fistula (AEF) diagnosed by computed tomography (CT) and positron emission tomography (PET) imaging after TEVAR. A 50-year-old woman with a history of diabetes mellitus and chronic hemodialysis had received a stent graft for a contained rupture of a pseudoaneurysm of the descending thoracic aorta. Three months after stent-grafting, she experienced back pain. CT and PET imaging suggested a PGI. The patient underwent surgical treatment for PGI with AEF.
Collapse
Affiliation(s)
- Sung Ho Lee
- Division of Cardiology, Department of Medicine, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | | | | | | | | |
Collapse
|
25
|
Lee SH, Song PS, Kim WS, Park KB, Choi SH. A case of stent graft infection coupled with aorto-esophageal fistula following thoracic endovascular aortic repair in a complex patient. Korean Circ J 2012; 42:366-8. [PMID: 22701140 PMCID: PMC3369972 DOI: 10.4070/kcj.2012.42.5.366] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2011] [Revised: 10/17/2011] [Accepted: 10/25/2011] [Indexed: 11/11/2022] Open
Abstract
The incidence of peri-stent graft infection (PGI) following thoracic endovascular aortic repair (TEVAR) is low, but the associated mortality rates are extremely high. The diagnosis of this complication can be difficult due to nonspecific symptoms. Here, we report a case of PGI combined with an aorto-esophageal fistula (AEF) diagnosed by computed tomography (CT) and positron emission tomography (PET) imaging after TEVAR. A 50-year-old woman with a history of diabetes mellitus and chronic hemodialysis had received a stent graft for a contained rupture of a pseudoaneurysm of the descending thoracic aorta. Three months after stent-grafting, she experienced back pain. CT and PET imaging suggested a PGI. The patient underwent surgical treatment for PGI with AEF.
Collapse
Affiliation(s)
- Sung Ho Lee
- Division of Cardiology, Department of Medicine, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | | | | | | | | |
Collapse
|
26
|
West CA, Karam J, Poopat C, Shepard AD, Nypaver TJ, Weaver M. Late endovascular aneurysm repair infection presenting with juxatrenal aortic rupture treated with in situ aortic replacement. J Vasc Surg 2011; 54:1157-60. [PMID: 21723686 DOI: 10.1016/j.jvs.2011.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Revised: 03/31/2011] [Accepted: 04/01/2011] [Indexed: 10/18/2022]
Abstract
Infection of an endovascular abdominal aneurysm repair (EVAR) is rare but has become more prevalent with the standardization of EVAR for treating infrarenal abdominal aortic aneurysms. The understanding of this complex aortic condition has improved but still remains to evolve. We present a patient with an EVAR infection manifesting with juxtarenal aortic rupture as a result of a urinary tract infection. This report describes an unusual presentation of an EVAR infection treated with in situ aortic reconstruction and provides >1 year of follow-up.
Collapse
Affiliation(s)
- Charles A West
- Department of Surgery, Division of Vascular Surgery, The Edith and Benson Ford Cardiovascular Institute, Henry Ford Hospital, Detroit, Mich., USA.
| | | | | | | | | | | |
Collapse
|
27
|
|