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Monnier B, Couture T, Dechartres A, Sitruk S, Gaillard J, Bleibtreu A, Chiche L, Gaudric J, Arzoine J. Fungal versus non-fungal supra-inguinal prosthetic vascular graft infections: A cohort study. Infect Dis Now 2024; 54:104792. [PMID: 37777183 DOI: 10.1016/j.idnow.2023.104792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/13/2023] [Accepted: 09/25/2023] [Indexed: 10/02/2023]
Abstract
OBJECTIVES Fungal prosthetic vascular graft infections are rare and mainly supra-inguinal. Current guidelines are based on the few studies that have specifically investigated this population, with few risk factors described. The objective of this study is to compare fungal and non-fungal supra-inguinal prosthetic vascular graft infections (PVGI), describing their specificities, identifying risk factors, and evaluating outcomes. PATIENTS AND METHODS This is a single-center retrospective cohort study carried out at the Pitié-Salpêtrière Hospital in Paris, including all patients who were treated for a supra-inguinal PVGI between January 1st, 2009 and February 28th, 2021. Preoperative, intraoperative and postoperative data were compared between fungal and non-fungal PVGI. RESULTS Out of the 475 patients screened, 148 developed a supra-inguinal PVGI: 32 fungal and 116 non-fungal. Factors independently associated with fungal PVGI were presence of a prostheto-digestive fistula (OR 5.98; 95% CI 2.29-15.62) and preoperative antibiotic therapy of seven days or more (OR 2.87; 95% CI 1.12-7.38). Mortality rate at 180 days was significantly higher for fungal as compared to non-fungal PVGIs (38% vs. 16% p = 0.009) and for fungal PVGI with prostheto-digestive fistula. However, there was no statistically significant relation between mortality due to prostheto-digestive fistula in contrast with fungal PVGI alone (p = 0.21). CONCLUSION Prostheto-digestive fistula was strongly associated with fungal PVGI, which leads us to suggest that in such cases, an anti-fungal agent should be prescribed.
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Affiliation(s)
- Baptiste Monnier
- Département d'Anesthésie-Réanimation, Hôpital Pitié-Salpétrière, AP-HP, France.
| | - Thibault Couture
- Service de Chirurgie Vasculaire et Endovasculaire, Hôpital Pitié-Salpêtrière, AP-HP, France
| | - Agnès Dechartres
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, AP-HP, Hôpital Pitié-Salpêtrière, Département de Santé Publique, Paris, France
| | - Samuel Sitruk
- Département de Santé Publique, Hôpital Pitié-Salpêtrière, AP-HP, France
| | - Johann Gaillard
- Département d'Anesthésie-Réanimation, Hôpital Pitié-Salpêtrière, AP-HP, France
| | - Alexandre Bleibtreu
- Département de Maladie Infectieuses et Tropicales, Hôpital Pitié-Salpêtrière, AP-HP, France
| | - Laurent Chiche
- Sorbonne Université. Département de Chirurgie Vasculaire et Endovasculaire, Hôpital Pitié-Salpêtrière, AP-HP, France
| | - Julien Gaudric
- Service de Chirurgie Vasculaire et Endovasculaire, Hôpital Pitié-Salpêtrière, AP-HP, France
| | - Jérémy Arzoine
- Département d'Anesthésie-Réanimation, Hôpital Pitié-Salpêtrière AP-HP, France
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Isselbacher EM, Preventza O, Hamilton Black J, Augoustides JG, Beck AW, Bolen MA, Braverman AC, Bray BE, Brown-Zimmerman MM, Chen EP, Collins TJ, DeAnda A, Fanola CL, Girardi LN, Hicks CW, Hui DS, Schuyler Jones W, Kalahasti V, Kim KM, Milewicz DM, Oderich GS, Ogbechie L, Promes SB, Ross EG, Schermerhorn ML, Singleton Times S, Tseng EE, Wang GJ, Woo YJ, Faxon DP, Upchurch GR, Aday AW, Azizzadeh A, Boisen M, Hawkins B, Kramer CM, Luc JGY, MacGillivray TE, Malaisrie SC, Osteen K, Patel HJ, Patel PJ, Popescu WM, Rodriguez E, Sorber R, Tsao PS, Santos Volgman A, Beckman JA, Otto CM, O'Gara PT, Armbruster A, Birtcher KK, de Las Fuentes L, Deswal A, Dixon DL, Gorenek B, Haynes N, Hernandez AF, Joglar JA, Jones WS, Mark D, Mukherjee D, Palaniappan L, Piano MR, Rab T, Spatz ES, Tamis-Holland JE, Woo YJ. 2022 ACC/AHA guideline for the diagnosis and management of aortic disease: A report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. J Thorac Cardiovasc Surg 2023; 166:e182-e331. [PMID: 37389507 PMCID: PMC10784847 DOI: 10.1016/j.jtcvs.2023.04.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
AIM The "2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease" provides recommendations to guide clinicians in the diagnosis, genetic evaluation and family screening, medical therapy, endovascular and surgical treatment, and long-term surveillance of patients with aortic disease across its multiple clinical presentation subsets (ie, asymptomatic, stable symptomatic, and acute aortic syndromes). METHODS A comprehensive literature search was conducted from January 2021 to April 2021, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, CINHL Complete, and other selected databases relevant to this guideline. Additional relevant studies, published through June 2022 during the guideline writing process, were also considered by the writing committee, where appropriate. STRUCTURE Recommendations from previously published AHA/ACC guidelines on thoracic aortic disease, peripheral artery disease, and bicuspid aortic valve disease have been updated with new evidence to guide clinicians. In addition, new recommendations addressing comprehensive care for patients with aortic disease have been developed. There is added emphasis on the role of shared decision making, especially in the management of patients with aortic disease both before and during pregnancy. The is also an increased emphasis on the importance of institutional interventional volume and multidisciplinary aortic team expertise in the care of patients with aortic disease.
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Mulatti GC, Joviliano EE, Pereira AH, Fioranelli A, Pereira AA, Brito-Queiroz A, Von Ristow A, Freire LMD, Ferreira MMDV, Lourenço M, De Luccia N, Silveira PG, Yoshida RDA, Fidelis RJR, Boustany SM, de Araujo WJB, de Oliveira JCP. Brazilian Society for Angiology and Vascular Surgery guidelines on abdominal aortic aneurysm. J Vasc Bras 2023; 22:e20230040. [PMID: 38021279 PMCID: PMC10648059 DOI: 10.1590/1677-5449.202300402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 06/15/2023] [Indexed: 12/01/2023] Open
Abstract
The Brazilian Society of Angiology and Vascular Surgery, through the Guidelines Project, presents new Abdominal Aortic Aneurysm Guidelines, on the subject of care for abdominal aortic aneurysm patients. Its development prioritized descriptive guidelines, using the EMBASE, LILACS, and PubMed databases. References include randomized controlled trials, systematic reviews, meta-analyses, and cohort studies. Quality of evidence was evaluated by a pair of coordinators, aided by the RoB 2 Cochrane tool and the Newcastle Ottawa Scale forms. The subjects include juxtarenal aneurysms, infected aneurysms, and new therapeutic techniques, especially endovascular procedures. The current version of the guidelines include important recommendations for the primary topics involving diagnosis, treatment, and follow-up for abdominal aortic aneurysm patients, providing an objective guide for medical practice, based on scientific evidence and widely available throughout Brazil.
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Affiliation(s)
- Grace Carvajal Mulatti
- Universidade de São Paulo - USP, Faculdade de Medicina, Hospital das Clínicas, São Paulo, SP, Brasil.
| | - Edwaldo Edner Joviliano
- Universidade de São Paulo - USP, Faculdade de Medicina de Ribeirão Preto - FMRP, Ribeirão Preto, SP, Brasil.
| | - Adamastor Humberto Pereira
- Universidade Federal do Rio Grande do Sul - UFRGS, Hospital de Clínicas de Porto Alegre - HCPA, Porto Alegre, RS, Brasil.
| | | | - Alexandre Araújo Pereira
- Universidade Federal do Rio Grande do Sul - UFRGS, Hospital de Clínicas de Porto Alegre - HCPA, Porto Alegre, RS, Brasil.
| | - André Brito-Queiroz
- Universidade Federal da Bahia - UFBA, Hospital Ana Nery, Salvador, BA, Brasil.
| | - Arno Von Ristow
- Pontifícia Universidade Católica do Rio de Janeiro - PUC-Rio, Rio de Janeiro, RJ, Brasil.
| | | | | | | | - Nelson De Luccia
- Universidade de São Paulo - USP, Faculdade de Medicina, São Paulo, SP, Brasil.
| | | | - Ricardo de Alvarenga Yoshida
- Universidade Estadual Paulista “Júlio de Mesquita Filho” - UNESP, Faculdade de Medicina de Botucatu, Botucatu, SP, Brasil.
| | | | - Sharbel Mahfuz Boustany
- Universidade Federal do Rio Grande do Sul - UFRGS, Hospital de Clínicas de Porto Alegre - HCPA, Porto Alegre, RS, Brasil.
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Colacchio EC, D'Oria M, Grando B, Rinaldi Garofalo A, D'Andrea A, Bassini S, Lepidi S, Antonello M, Ruaro B. A Systematic Review of In-situ Aortic Reconstructions for Abdominal Aortic Graft and Endograft Infections: Outcomes of Currently Available Options for Surgical Replacement. Ann Vasc Surg 2023; 95:307-316. [PMID: 37023924 DOI: 10.1016/j.avsg.2023.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/17/2023] [Accepted: 03/22/2023] [Indexed: 04/08/2023]
Abstract
BACKGROUND This review synthetizes recent literature about in-situ aortic reconstructions for abdominal aortic graft or endograft infections (AGEIs), aiming to report outcomes individually related to currently available vascular substitutes (VSs). METHODS We performed a systematic review of all published literature from January 2005 to December 2022. We included articles reporting on open surgical treatment of abdominal AGEIs, with removal of the infected graft and in-situ reconstruction with biological or prosthetic material. Articles not distinguishing between abdominal and thoracic aortic-related outcomes were excluded, as well as studies reporting on cumulative in-situ and extra-anatomic reconstruction results. RESULTS Of 500 records identified through database searching (Pubmed: 226; Embase: 274), 8 of them were included in the present review. Overall, 30-days mortality rate was 8.7% (25/285), while the most frequent early complications were respiratory adverse events (46/346, 13.3%) and renal function deterioration (26/85, 30%). In 250/350 cases (71.4%), a biological VS was utilized. In 4 articles, the outcomes of different types of VSs were presented jointly. Patients analyzed in the remaining 4 reports were sorted in a "biological" and a "prosthetic" group (BG and PG). The cumulative mortality rate of the BG and PG were 15.6% (33/212) and 27% (9/33), respectively, while graft reinfection was 6.3% (15/236) in the BG, and 9% (3/33) in the PG. The cumulative mortality rate reported in articles focused on autologous veins was 14.8% (30/202), while their 30-days reinfection rate was 5.7% (13/226). CONCLUSIONS Since abdominal AGEIs are uncommon conditions, literature focused on direct comparison between different types of VSs is scarce, particularly when related to materials other than autologous veins. Although we found a lower overall mortality rate in patients treated with biological material or with autologous veins only, in recent reports prosthesis provide promising results in terms of mortality and reinfection rate. However, none of the available studies distinguish and compares different types of prosthetic material. Large multicenter studies are advisable, especially focused on different types of VSs and their comparison.
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Affiliation(s)
- Elda Chiara Colacchio
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Vascular and Endovascular Surgery Clinic, School of Medicine, Padova University, Padova, Italy.
| | - Mario D'Oria
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Cattinara, University of Trieste, Trieste, Italy
| | - Beatrice Grando
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Vascular and Endovascular Surgery Clinic, School of Medicine, Padova University, Padova, Italy; Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Cattinara, University of Trieste, Trieste, Italy
| | - Alessandra Rinaldi Garofalo
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Vascular and Endovascular Surgery Clinic, School of Medicine, Padova University, Padova, Italy
| | - Alessia D'Andrea
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Vascular and Endovascular Surgery Clinic, School of Medicine, Padova University, Padova, Italy; Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Cattinara, University of Trieste, Trieste, Italy
| | - Silvia Bassini
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Cattinara, University of Trieste, Trieste, Italy
| | - Sandro Lepidi
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Cattinara, University of Trieste, Trieste, Italy
| | - Michele Antonello
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Vascular and Endovascular Surgery Clinic, School of Medicine, Padova University, Padova, Italy
| | - Barbara Ruaro
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, Trieste, Italy
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Dominguez-Cainzos J, Rodrigo-Manjon A, Rodriguez-Chinesta JM, Apodaka-Diez A, Bonmatí G, Bereciartua E. Abdominal aortic endograft infection. A decade of experience and literature review. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2023; 41:155-161. [PMID: 35906173 DOI: 10.1016/j.eimce.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 06/24/2021] [Accepted: 06/28/2021] [Indexed: 10/16/2022]
Abstract
INTRODUCTION Aortic endograft infection is an infrequent but life-threatening complication after endovascular abdominal aortic repair (EVAR). There is no consensus on management of endograft infection and little evidence has been published in our country. Endograft explantation is considered the "gold standar" treatment whereas percutaneous or surgical perigraft and sac drainage associated to antibiotics should be considered and alternative therapy. METHODS We carried out a retrospective and descriptive review of abdominal aortic endograft infections at our tertiary center (Hospital Universitario Cruces) during last ten years (2010-2019). RESULTS We describe the clinical and microbiological characteristics of 10 EVAR infections, their management and outcomes. The incidence of graft infection after EVAR was 3%. The mean time to the clinical presentation of infection was 16.9 months (median 4.5 months). The microbiological diagnosis was reached in 100% of cases (predominance of gram-positive species). The overall mortality rate was 50% (although the survival rate was 100% after surgical drainage of the sac). CONCLUSION Perigraft or aneurysm sac aspiration culture show their diagnostic utility as microbiological diagnosis was reached in all cases despite of blood cultures being only positive in 50% of the samples. Surgical drainage and endograft preservation combined with antibiotherapy show remarkable results. The high heterogeneity in our case series makes difficult to offer general recommendations, thus far, a tailored approach to treatment is suggested.
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Affiliation(s)
| | | | | | - Ana Apodaka-Diez
- Servicio de Medicina Interna, Hospital Universitario Cruces, Barakaldo, Spain
| | - Gonzalo Bonmatí
- Servicio de Medicina Interna, Hospital Universitario Cruces, Barakaldo, Spain
| | - Elena Bereciartua
- Servicio de Enfermedades Infecciosas, Hospital Universitario Cruces, Barakaldo, Spain.
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Tello-Díaz C, Palau M, Muñoz E, Gomis X, Gavaldà J, Fernández-Hidalgo N, Bellmunt-Montoya S. Methicillin-Susceptible Staphylococcus aureus Biofilm Formation on Vascular Grafts: an In Vitro Study. Microbiol Spectr 2023; 11:e0393122. [PMID: 36749062 PMCID: PMC10100994 DOI: 10.1128/spectrum.03931-22] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 01/06/2023] [Indexed: 02/08/2023] Open
Abstract
The aim of this study was to quantify in vitro biofilm formation by methicillin-susceptible Staphylococcus aureus (MSSA) on the surfaces of different types of commonly used vascular grafts. We performed an in vitro study with two clinical strains of MSSA (MSSA2 and MSSA6) and nine vascular grafts: Dacron (Hemagard), Dacron-heparin (Intergard heparin), Dacron-silver (Intergard Silver), Dacron-silver-triclosan (Intergard Synergy), Dacron-gelatin (Gelsoft Plus), Dacron plus polytetrafluoroethylene (Fusion), polytetrafluoroethylene (Propaten; Gore), Omniflow II, and bovine pericardium (XenoSure). Biofilm formation was induced in two phases: an initial 90-minute adherence phase and a 24-hour growth phase. Quantitative cultures were performed, and the results were expressed as log10 CFU per milliliter. The Dacron-silver-triclosan graft and Omniflow II were associated with the least biofilm formation by both MSSA2 and MSSA6. MSSA2 did not form a biofilm on the Dacron-silver-triclosan graft (0 CFU/mL), and the mean count on the Omniflow II graft was 3.89 CFU/mL (standard deviation [SD] 2.10). The mean count for the other grafts was 7.01 CFU/mL (SD 0.82). MSSA6 formed a biofilm on both grafts, with 2.42 CFU/mL (SD 2.44) on the Dacron-silver-triclosan graft and 3.62 CFU/mL (SD 2.21) on the Omniflow II. The mean biofilm growth on the remaining grafts was 7.33 CFU/mL (SD 0.28). The differences in biofilm formation on the Dacron-silver-triclosan and Omniflow II grafts compared to the other tested grafts were statistically significant. Our findings suggest that of the vascular grafts we studied, the Dacron-silver-triclosan and Omniflow II grafts might prevent biofilm formation by MSSA. Although further studies are needed, these grafts seem to be good candidates for clinical use in vascular surgeries at high risk of infections due to this microorganism. IMPORTANCE The Dacron silver-triclosan and Omniflow II vascular grafts showed the greatest resistance to in vitro methicillin-susceptible Staphylococcus aureus biofilm formation compared to other vascular grafts. These findings could allow us to choose the most resistant to infection prosthetic graft.
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Affiliation(s)
- Cristina Tello-Díaz
- Department of Vascular and Endovascular Surgery, Hospital de la Santa Creu i Sant Pau, Institute of Biomedical Research (II-B Sant Pau), CIBER CV, Barcelona, Spain
- Universitat Autònoma de Barcelona (UAB), Departament de Cirurgia i Ciències Morfològiques, Barcelona, Spain
| | - Marta Palau
- Antimicrobial Resistance Laboratory, Vall d'Hebron Research Institute (VHIR), Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Estela Muñoz
- Antimicrobial Resistance Laboratory, Vall d'Hebron Research Institute (VHIR), Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Xavier Gomis
- Antimicrobial Resistance Laboratory, Vall d'Hebron Research Institute (VHIR), Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Joan Gavaldà
- Antimicrobial Resistance Laboratory, Vall d'Hebron Research Institute (VHIR), Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Nuria Fernández-Hidalgo
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Infectious Diseases Department, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
- Red Española de Investigación en Patología Infecciosa (REIPI RD16/0016/0003), Instituto de Salud Carlos III, Madrid, Spain
| | - Sergi Bellmunt-Montoya
- Universitat Autònoma de Barcelona (UAB), Departament de Cirurgia i Ciències Morfològiques, Barcelona, Spain
- Antimicrobial Resistance Laboratory, Vall d'Hebron Research Institute (VHIR), Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Department of Angiology, Vascular and Endovascular Surgery, Hospital Universitari Vall d’Hebron, Barcelona, Spain
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D'Oria M, Veraldi GF, Mastrorilli D, Mezzetto L, Calvagna C, Taglialavoro J, Bassini S, Griselli F, Grosso L, Carere A, D'Andrea A, Lepidi S. Association Between the Lockdown for SARS-CoV-2 (COVID-19) and Reduced Surgical Site Infections after Vascular Exposure in the Groin at Two Italian Academic Hospitals. Ann Vasc Surg 2023; 89:60-67. [PMID: 36404473 PMCID: PMC9613778 DOI: 10.1016/j.avsg.2022.09.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/28/2022] [Accepted: 09/29/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND The aim of this study was to evaluate whether the scrupulous hygiene rules and the restriction of contacts during the lockdown owing to the COVID-19 pandemic affected the rate and severity of surgical site infections (SSI) after vascular exposure in the groin at two Italian University Hospitals. METHODS Starting from March 2020, strict hygiene measures for protection of health care workers (HCW) and patients from COVID-19 infection were implemented, and partly lifted in July 2020. The main exposure for analysis purposes was the period in which patients were operated. Accordingly, study subjects were divided into two groups for subsequent comparisons (preCOVID-19 era: March-June 2018-2019 versus COVID-19 era: March-June 2020). The primary endpoint was the occurrence of superficial and/or deep SSI within 30 days after surgery. The Centers for Disease Control and Prevention definitions were used to classify superficial and deep SSI. RESULTS A total of 194 consecutive patients who underwent vascular exposure in the groin were retrospectively analyzed. Of those, 60 underwent surgery from April 1, 2018 to June 30 of the same year; 83 from April 1, 2019 to June 30 of the same year; and 51 from April 1, 2020 to June 30 of the same year. The mean age of the study cohort was 75 years and 140 (72%) were males. Patients who were operated in the COVID-19 era were less likely to develop SSI (10% vs. 28%; P = 0.008), including both deep SSI (4% vs. 13%; P = 0.04) and superficial SSI (6% vs. 15%; P = 0.05). After multivariate adjustments, being operated in the COVID-19 era was found to be a negative predictor for development of an SSI (odds ratio [OR] = 0.31; 95% confidence interval [CI] = 0.09-0.76; P < 0.001) or deep SSI (OR = 0.21; 95% CI = 0.03-0.98; P < 0.001). Operative time was also found as independent predictor for the development of deep SSI (OR = 1.21; 95%CI = 1.21-1.52; P = 0.02). Using binary logistic regression, there were no independent predictors of superficial SSI that could be identified. CONCLUSIONS Vascular exposure in the groin carries a non-negligible risk of SSI. In this study, we provided important insights that are simple and easily viable precautions (such as the universal use of surgical masks both for patients and health care professionals during wound care, the widespread diffusion of hand sanitizers, and the reduction of the number of visitors in the surgical wards) could be promising and safe tools for SSI risk reduction.
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Affiliation(s)
- Mario D'Oria
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, Trieste, Italy,Correspondence to: Mario D'Oria, MD, Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, Strada di Fiume 447, 34149, Trieste, Italy
| | - Gian Franco Veraldi
- Department of Vascular Surgery, University Hospital and Trust of Verona, Italy
| | - Davide Mastrorilli
- Department of Vascular Surgery, University Hospital and Trust of Verona, Italy
| | - Luca Mezzetto
- Department of Vascular Surgery, University Hospital and Trust of Verona, Italy
| | - Cristiano Calvagna
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, Trieste, Italy
| | - Jacopo Taglialavoro
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, Trieste, Italy
| | - Silvia Bassini
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, Trieste, Italy
| | - Filippo Griselli
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, Trieste, Italy
| | - Lorenzo Grosso
- Department of Vascular Surgery, University Hospital and Trust of Verona, Italy
| | - Andrea Carere
- Faculty of Medicine, University of Trieste Medical School, Italy
| | - Alessia D'Andrea
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, Trieste, Italy
| | - Sandro Lepidi
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, Trieste, Italy
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Tabbara D, Frankel A, Thomson I. Primary and subsequent secondary aorto-enteric fistulae in the setting of chronic Q fever. J Surg Case Rep 2023; 2023:rjac579. [PMID: 36727123 PMCID: PMC9885518 DOI: 10.1093/jscr/rjac579] [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: 10/17/2022] [Accepted: 11/26/2022] [Indexed: 01/31/2023] Open
Abstract
We report the case of an 80-year-old male with stage three kidney disease, who survived a primary aorto-enteric fistula (AEF) in the setting of chronic Q fever after presenting with melena and syncope. His initial surgical treatment included endovascular aortic repair. Type 2 endoleak was present post-operatively. Six months later, he was diagnosed with a secondary AEF after syncope and large volume hematemesis. He was definitively treated with an open explant of his stent, repair of the duodenum and bilateral axillofemoral bypass. Two years later, he remains active and independent on life-long antibiotics.
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Affiliation(s)
- Dana Tabbara
- Correspondence address. Department of Surgical Specialties, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, QLD 4102, Australia. E-mail:
| | - Adam Frankel
- Department of Surgery, Princess Alexandra Hospital, Woolloongabba, QLD, Australia,Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Iain Thomson
- Department of Surgery, Princess Alexandra Hospital, Woolloongabba, QLD, Australia,Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
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9
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Whitlock RS, Patel VA, Mills JL, Pallister ZS, Gilani R. Utilization of arterial transposition for vascular reconstruction within contaminated or infected abdominal fields. J Vasc Surg Cases Innov Tech 2023. [DOI: 10.1016/j.jvscit.2023.101104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
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10
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Xu J, Bettendorf B, D'Oria M, Sharafuddin MJ. Multidisciplinary diagnosis and management of inflammatory aortic aneurysms. J Vasc Surg 2022:S0741-5214(22)02645-3. [PMID: 36565773 DOI: 10.1016/j.jvs.2022.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 12/07/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Inflammatory abdominal aortic aneurysms (IAAAs) are a variant involving a distinct immunoinflammatory process, with nearly one half believed to be associated with IgG4-related disease (IgG4-RD). METHODS MEDLINE and Google Scholar searches were conducted for English-language publications relevant to inflammatory aortic aneurysms from January 1970 onward. The search terms included inflammatory aortic aneurysms, aortitis, periaortitis, IgG4-related disease, and retroperitoneal fibrosis. Relevant studies were selected for review based on their relevance. RESULTS Morphologically, IAAAs are characterized by a thickened aneurysm wall often displaying contrast enhancement and elevated metabolic activity on fluorine-18 fluorodeoxyglucose-positron emission tomography imaging. A strong association exists with perianeurysmal and retroperitoneal fibrosis. Although the rupture risk appears lower with IAAAs than with noninflammatory abdominal aortic aneurysms (AAAs), the currently recommended diameter threshold for operative management is the same. Open repair has been associated with increased morbidity compared with noninflammatory AAAs, and a retroperitoneal approach or minimal dissection transperitoneal approach has been recommended to avoid duodenal and retroperitoneal structural injuries. Endovascular aneurysm repair has been increasingly used, especially for patients unfit for open surgery. It is important to exclude an infectious etiology before the initiation of immunosuppressive therapy or operative repair. Multimodality imaging follow-up is critical to monitor disease activity and secondary involvement of retroperitoneal structures by the associated fibrotic process. Maintenance of immunosuppressive therapy will be needed postoperatively for most patients with active systemic disease, especially those with IgG4-RD and those with persistent symptoms. Additional interventions aimed at ureteral decompression could also be required, and lifelong follow-up is mandatory. CONCLUSIONS Preoperative multimodality imaging is a diagnostic cornerstone for assessment of the disease extent and activity. IgG4-RD is an increasingly recognized category of IAAAs, with implications for tailoring adjunctive medical therapy. Open surgical repair remains the procedure of choice, although endovascular aneurysm repair is increasingly being offered. Maintenance immunosuppressive therapy can be offered according to the disease activity as assessed by follow-up imaging studies.
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Affiliation(s)
- Jun Xu
- Division of Vascular Surgery, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Brittany Bettendorf
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Mario D'Oria
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste, Trieste, Italy
| | - Mel J Sharafuddin
- Division of Vascular Surgery, University of Iowa Carver College of Medicine, Iowa City, IA.
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11
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Isselbacher EM, Preventza O, Hamilton Black J, Augoustides JG, Beck AW, Bolen MA, Braverman AC, Bray BE, Brown-Zimmerman MM, Chen EP, Collins TJ, DeAnda A, Fanola CL, Girardi LN, Hicks CW, Hui DS, Schuyler Jones W, Kalahasti V, Kim KM, Milewicz DM, Oderich GS, Ogbechie L, Promes SB, Gyang Ross E, Schermerhorn ML, Singleton Times S, Tseng EE, Wang GJ, Woo YJ. 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation 2022; 146:e334-e482. [PMID: 36322642 PMCID: PMC9876736 DOI: 10.1161/cir.0000000000001106] [Citation(s) in RCA: 376] [Impact Index Per Article: 188.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AIM The "2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease" provides recommendations to guide clinicians in the diagnosis, genetic evaluation and family screening, medical therapy, endovascular and surgical treatment, and long-term surveillance of patients with aortic disease across its multiple clinical presentation subsets (ie, asymptomatic, stable symptomatic, and acute aortic syndromes). METHODS A comprehensive literature search was conducted from January 2021 to April 2021, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, CINHL Complete, and other selected databases relevant to this guideline. Additional relevant studies, published through June 2022 during the guideline writing process, were also considered by the writing committee, where appropriate. Structure: Recommendations from previously published AHA/ACC guidelines on thoracic aortic disease, peripheral artery disease, and bicuspid aortic valve disease have been updated with new evidence to guide clinicians. In addition, new recommendations addressing comprehensive care for patients with aortic disease have been developed. There is added emphasis on the role of shared decision making, especially in the management of patients with aortic disease both before and during pregnancy. The is also an increased emphasis on the importance of institutional interventional volume and multidisciplinary aortic team expertise in the care of patients with aortic disease.
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Affiliation(s)
| | | | | | | | | | | | | | - Bruce E Bray
- AHA/ACC Joint Committee on Clinical Data Standards liaison
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Y Joseph Woo
- AHA/ACC Joint Committee on Clinical Practice Guidelines liaison
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12
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Isselbacher EM, Preventza O, Hamilton Black Iii J, Augoustides JG, Beck AW, Bolen MA, Braverman AC, Bray BE, Brown-Zimmerman MM, Chen EP, Collins TJ, DeAnda A, Fanola CL, Girardi LN, Hicks CW, Hui DS, Jones WS, Kalahasti V, Kim KM, Milewicz DM, Oderich GS, Ogbechie L, Promes SB, Ross EG, Schermerhorn ML, Times SS, Tseng EE, Wang GJ, Woo YJ. 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2022; 80:e223-e393. [PMID: 36334952 PMCID: PMC9860464 DOI: 10.1016/j.jacc.2022.08.004] [Citation(s) in RCA: 129] [Impact Index Per Article: 64.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AIM The "2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease" provides recommendations to guide clinicians in the diagnosis, genetic evaluation and family screening, medical therapy, endovascular and surgical treatment, and long-term surveillance of patients with aortic disease across its multiple clinical presentation subsets (ie, asymptomatic, stable symptomatic, and acute aortic syndromes). METHODS A comprehensive literature search was conducted from January 2021 to April 2021, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, CINHL Complete, and other selected databases relevant to this guideline. Additional relevant studies, published through June 2022 during the guideline writing process, were also considered by the writing committee, where appropriate. STRUCTURE Recommendations from previously published AHA/ACC guidelines on thoracic aortic disease, peripheral artery disease, and bicuspid aortic valve disease have been updated with new evidence to guide clinicians. In addition, new recommendations addressing comprehensive care for patients with aortic disease have been developed. There is added emphasis on the role of shared decision making, especially in the management of patients with aortic disease both before and during pregnancy. The is also an increased emphasis on the importance of institutional interventional volume and multidisciplinary aortic team expertise in the care of patients with aortic disease.
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13
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Goyal N, Keir G, Pavlica M, Little BP. Nonpulmonary Infections of the Thorax. Semin Roentgenol 2022; 57:105-118. [DOI: 10.1053/j.ro.2021.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/29/2021] [Accepted: 10/30/2021] [Indexed: 11/11/2022]
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14
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D'Oria M, Budtz-Lilly J, Lindstrom D, Lundberg G, Jonsson M, Wanhainen A, Mani K, Unosson J. Comparison of Early and Mid-Term Outcomes After Fenestrated-Branched Endovascular Aortic Repair in Patients With or Without Prior Infrarenal Repair. J Endovasc Ther 2021; 29:544-554. [PMID: 34781751 DOI: 10.1177/15266028211058686] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The purpose of this study was to compare short- and mid-term outcomes of fenestrated-branched endovascular repair (F-BEVAR) of pararenal (PRAA)/thoracoabdominal (TAAA) aortic aneurysms in patients with or without prior endovascular/open (EVAR/OAR) infrarenal aortic repair. METHODS Data from consecutive F-BEVAR (2010-2019) at two high-volume aortic centers were retrospectively reviewed. Primary endpoints were technical success, 30-day mortality, and overall survival. Secondary endpoints included 30-day major adverse events (MAE), freedom from type I/III endoleaks, reinterventions, sac expansion, and target vessel (TV) primary patency. RESULTS A total of 222 consecutive patients were included for analysis; of these 58 (26.1%) had prior infrarenal repair (EVAR=33, OAR=25) and 164 (73.9%) had native PRAA/TAAA. At baseline, patients with prior infrarenal repair were older (mean age=75.1 vs 71.6 years, p=.005) and the proportion of females was lower (8.6% vs 29.3%, p=.002). Technical success was 97.8% (n=217) in the entire cohort, without any significant differences between study groups (94.8% vs 98.8%, p=.08). At 30 days, there were no significant differences between patients with prior infrarenal repair as compared with those without in rate of MAE (44.8% vs 54.9%, p=.59). The 5-year estimate of survival for those who underwent native aortic repair was 61.6%, versus 61.3% for those who had a previous repair (p=.67). The 5-year freedom from endoleaks I/III estimates were significantly lower in patients who had prior infrarenal repair as compared with patients undergoing treatment of native aneurysms (57.1% vs 66.1%, p=.03), mainly owing to TV-related endoleaks (ie, type IC and/or IIIC endoleaks). No significant differences were found between study groups in rates of reinterventions and TV primary patency. Five-year estimates of freedom from sac increase >5mm were significantly lower in patients who received F-BEVAR after previous infrarenal repair as compared with those who underwent treatment of native aneurysms (48.6% vs 77.5%, p=.002). CONCLUSIONS F-BEVAR is equally safe and feasible for treatment of patients with prior infrarenal repair as compared with those undergoing treatment for native aneurysms. Increased rates of TV-related endoleaks were observed which could lead to lower freedom from aneurysm sac shrinkage during follow-up. Nevertheless, the 5-year rates of reinterventions and TV patency were similar, thereby indicating that overall effectiveness of treatment remained satisfactory at mid-term.
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Affiliation(s)
- Mario D'Oria
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden.,Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste-ASUGI, Trieste, Italy
| | - Jacob Budtz-Lilly
- Division of Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - David Lindstrom
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden
| | - Goran Lundberg
- Vascular Surgery, Department of Molecular Medicine and Surgery, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Jonsson
- Vascular Surgery, Department of Molecular Medicine and Surgery, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Anders Wanhainen
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden.,Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Kevin Mani
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden
| | - Jon Unosson
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden
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15
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Impact of proximal neck anatomy on short-term and mid-term outcomes after treatment of abdominal aortic aneurysms with new-generation low-profile endografts. Results from the multicentric "ITAlian north-east registry of ENDOvascular aortic repair with the BOltOn Treo endograft (ITA-ENDOBOOT)". Ann Vasc Surg 2021; 80:37-49. [PMID: 34752851 DOI: 10.1016/j.avsg.2021.08.059] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/25/2021] [Accepted: 08/30/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The aim of the study was to evaluate the short-term and mid-term technical and clinical outcomes of the Bolton Treo endograft in subjects with abdominal aortic aneurysm (AAA) requiring endovascular aortic repair (EVAR) and assess if presence of hostile proximal neck would represent a risk factor for increased failure rates. METHODS A retrospective review of all consecutive patients who had undergone elective or non-elective EVAR with the Bolton Treo endograft at five institutions located in the North-East of Italy (January 2016-December 2020) was performed. The main exposure variable for this study was presence of hostile (HAN) or friendly (FAN) aortic neck. RESULTS A total of 137 consecutive patients were treated with the Bolton Treo endograft at participating institutions; of these 63 (46%) presented HAN while 74 (54%) had FAN. At baseline, no significant differences were observed in the distribution of demographics and comorbidities between study groups. Two type Ia endoleaks (EL) were detected at completion angiography, all in patients with HAN but none in patients with FAN (3% vs 0%, p=.04), but no type III EL were identified in the whole cohort. The median duration of follow-up in the study cohort was 30 months (IQR 22-34 months) and was similar between study groups (p=.87). At three-years, survival estimates were 89% and 91% (p=.82) in patients with HAN and FAN, respectively. At three years, patients with HAN had significantly lower freedom from type IA endoleak as compared with patients with FAN (87% vs 94%, p=.02). No significant differences were found between study groups in the three-year estimates of freedom from reinterventions (80% vs 86%, p=.28). Using cox proportional hazards, presence of type II EL (HR 3.15, 95%CI 1.18-8.5, p=.02) and presence of type IA EL (HR 4.22, 95%CI 1.39-12.85, p=.01) were found as independent predictors for reinterventions in univariate analysis, although they were no longer significant in the multivariate model. Freedom from sac increase >5mm at three years were not significantly different between study groups (92% vs 91%, p=.95). CONCLUSIONS Within a contemporary multicentric real-world experience, EVAR with the Bolton Treo endograft shows a satisfactory safety profile in the immediate postoperative phase and acceptable outcomes during mid-term follow-up. Presence of HAN is correlated with development of type Ia EL (either early following stent-graft implantation or late after EVAR) which, in turn, may represent a significant factor leading to reinterventions.
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16
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Dominguez-Cainzos J, Rodrigo-Manjon A, Rodriguez-Chinesta JM, Apodaka-Diez A, Bonmatí G, Bereciartua E. Abdominal aortic endograft infection. A decade of experience and literature review. Enferm Infecc Microbiol Clin 2021; 41:S0213-005X(21)00219-6. [PMID: 34452794 DOI: 10.1016/j.eimc.2021.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 06/24/2021] [Accepted: 06/28/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Aortic endograft infection is an infrequent but life-threatening complication after endovascular abdominal aortic repair (EVAR). There is no consensus on management of endograft infection and little evidence has been published in our country. Endograft explantation is considered the "gold standard" treatment whereas percutaneous or surgical perigraft and sac drainage associated to antibiotics should be considered and alternative therapy. METHODS We carried out a retrospective and descriptive review of abdominal aortic endograft infections at our tertiary center (Hospital Universitario Cruces) during last ten years (2010-2019). RESULTS We describe the clinical and microbiological characteristics of 10 EVAR infections, their management and outcomes. The incidence of graft infection after EVAR was 3%. The mean time to the clinical presentation of infection was 16.9 months (median 4.5 months). The microbiological diagnosis was reached in 100% of cases (predominance of gram-positive species). The overall mortality rate was 50% (although the survival rate was 100% after surgical drainage of the sac). CONCLUSIONS Perigraft or aneurysm sac aspiration culture shows their diagnostic utility as microbiological diagnosis was reached in all cases despite of blood cultures being only positive in 50% of the samples. Surgical drainage and endograft preservation combined with antibiotherapy show remarkable results. The high heterogeneity in our case series makes difficult to offer general recommendations, thus far, a tailored approach to treatment is suggested.
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Affiliation(s)
| | | | | | - Ana Apodaka-Diez
- Servicio de Medicina Interna, Hospital Universitario Cruces, Baracaldo, España
| | - Gonzalo Bonmatí
- Servicio de Medicina Interna, Hospital Universitario Cruces, Baracaldo, España
| | - Elena Bereciartua
- Servicio de Enfermedades Infecciosas, Hospital Universitario Cruces, Baracaldo, España.
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17
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Xodo A, D'Oria M, Squizzato F, Antonello M, Grego F, Bonvini S, Milite D, Frigatti P, Cognolato D, Veraldi GF, Perkmann R, Garriboli L, Jannello AM, Lepidi S. Early and mid-term outcomes following open surgical conversion after failed endovascular aneurysm repair from the "Italian North-easT RegIstry of surgical Conversion AfTer Evar" (INTRICATE). J Vasc Surg 2021; 75:153-161.e2. [PMID: 34182022 DOI: 10.1016/j.jvs.2021.05.053] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 05/21/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To report the early and mid-term outcomes following open surgical conversion (OSC) after failed endovascular aortic repair (EVAR) using data from a multicentric registry. METHODS A retrospective study was carried out on consecutive patients undergoing OSC after failed EVAR at eight tertiary vascular units from the same geographic area in the North-East of Italy, from April 2005 to November 2019. Study endpoints included early and follow-up outcomes. RESULTS 144 consecutive patients were included in the study. Endoleaks were the most common indication for OSC (50.7%), with endograft infection (24.6%) and occlusion (21.9%) being the second most prevalent causes. The overall rate of 30-day all-cause mortality was 13.9% (n=20); 32 patients (22.2%) experienced at least one major complication. Mean length of stay (LoS) was 13 ± 12.7 days. On multivariate logistic regression, age (OR 1.09, 95% CI 1.01-1-19, p= .02), renal clamping time (OR 1.07, 95% CI 1.02-1.13, p= .01), and suprarenal/celiac clamping (OR 6.66, 95% CI 1.81-27.1, p= .005) were identified as independent predictors of peri-operative major complications. Age was the only factor associated with peri-operative mortality at 30 days. Renal clamping time > 25 minutes had sensitivity of 65% and specificity of 70% in predicting the occurring of major adverse events (AUC 0.72; 95% CI 0.61-0.82). At 5 years, estimated survival was significantly lower for patients treated due to aortic rupture/dissection (28%, 95% CI 13-61), compared to patients in whom the indication for treatment was endoleak (54%, 95% CI 40-73), infection (53%, 95% CI 30-94), or thrombosis (82%, 95% CI 62-100; p= .0019). 5-year survival rates were significantly lower in patients who received emergent treatment (28%, 95% CI 14-55) as compared with those who were treated in urgent (67%, 95% CI 48-93) or elective setting (57%, 95% CI 43-76; p= .00026). Subjects who received suprarenal/celiac (54%, 95% CI 36-82) or suprarenal (46%, 95% CI 34-62) aortic cross-clamping had lower survival rates at 5 years than those whose aortic-cross clamp site was infrarenal (76%, 95% CI 59-97; p= .041). Using multivariate Cox Proportional Hazard, older age and emergency setting were independently associate with higher risk for overall 5 years mortality. CONCLUSIONS OSC after failed EVAR was associated with relatively high rates of early morbidity and mortality, particularly for emergency setting surgery. Endoleaks with secondary sac expansion were the main indication for OSC and suprarenal aortic cross-clamping was frequently required. Endograft infection and emergent treatment remained associated with poorer short-term and long-term survival.
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Affiliation(s)
- Andrea Xodo
- Vascular and Endovascular Surgery Division, Padova University, School of Medicine, Padova, Italy
| | - Mario D'Oria
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University of Trieste Medical School, Trieste, Italy
| | - Francesco Squizzato
- Vascular and Endovascular Surgery Division, Padova University, School of Medicine, Padova, Italy
| | - Michele Antonello
- Vascular and Endovascular Surgery Division, Padova University, School of Medicine, Padova, Italy
| | - Franco Grego
- Vascular and Endovascular Surgery Division, Padova University, School of Medicine, Padova, Italy
| | - Stefano Bonvini
- Department of Vascular Surgery, Santa Chiara Hospital, Trento, Italy
| | - Domenico Milite
- Operative Unit of Vascular and Endovascular Surgery, "S. Bortolo" Hospital, Vicenza, Italy
| | - Paolo Frigatti
- Vascular Surgery Department, University Hospital of Udine, Udine, Italy
| | - Diego Cognolato
- Vascular Surgery Department, "S. Bassiano" Hospital, Bassano del Grappa, Italy
| | | | | | - Luca Garriboli
- Department of Vascular Surgery, IRCCS Sacro Cuore Don Calabria, Negrar, Verona, Italy
| | | | - Sandro Lepidi
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University of Trieste Medical School, Trieste, Italy.
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18
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Betz T, Steinbauer M, Toepel I, Uhl C. Midterm outcome of biosynthetic collagen prosthesis for treating aortic and peripheral prosthetic graft infections. Vascular 2021; 30:690-697. [PMID: 34112039 DOI: 10.1177/17085381211025380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To report the midterm outcomes of treating prosthetic peripheral and aortic graft infections using a biosynthetic collagen prosthesis in a tertiary vascular center. METHODS A retrospective analysis of all patients with prosthetic peripheral and aortic graft infections who underwent in situ reconstruction using a biosynthetic collagen prosthesis between March 2015 and November 2020 was conducted. Perioperative and midterm outcomes were analyzed. RESULTS A biosynthetic collagen prosthesis was used in 19 patients (14 males, median age 66 years) to reconstruct the femoral artery (n = 6), iliac artery (n = 1), and infrarenal aorta (n = 12). All patients were treated for a prosthetic vascular graft infection. The median follow-up period was 26.6 months (range 1-66 months). The 30-day graft failure rate was 15.7% (n = 3), leading to a major amputation in one patient (5.3%). All grafts were occluded aortofemoral reconstructions in patients with occluded superficial femoral artery and were treated by immediate thrombectomy. The 30-day mortality rate was 5.3% (n = 1), and survival after 3 years was 63.2%. The reinfection rate was 5.3% (n = 1). At 13.6 months, the occlusion of a femoral graft was detected in 5.3% (n = 1) and was treated with a new interposition graft. We observed no graft rupture or degeneration during follow-up. CONCLUSIONS Although results of in situ repair with autologous vein seem to be superior with little or none reinfection and low number of occlusions, biosynthetic collagen prostheses show acceptable midterm outcomes in terms of graft occlusion and mortality after prosthetic peripheral and aortic graft infections. Similar to other xenogenous materials, the reinfection rate is low with this prosthesis. With regard to immediate availability and easy handling, the use of a biosynthetic collagen prosthesis might be favorable compared to other replacement materials while treating prosthetic graft infections.
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Affiliation(s)
- Thomas Betz
- Department of Vascular Surgery, 155897Barmherzige Brüder Hospital, Regensburg, Germany
| | - Markus Steinbauer
- Department of Vascular Surgery, 155897Barmherzige Brüder Hospital, Regensburg, Germany
| | - Ingolf Toepel
- Department of Vascular Surgery, 155897Barmherzige Brüder Hospital, Regensburg, Germany
| | - Christian Uhl
- Department of Vascular Surgery, 155897Barmherzige Brüder Hospital, Regensburg, Germany
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Infections of the aorta. Indian J Thorac Cardiovasc Surg 2021; 38:101-114. [PMID: 35463716 PMCID: PMC8980989 DOI: 10.1007/s12055-021-01173-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 02/21/2021] [Accepted: 02/23/2021] [Indexed: 10/21/2022] Open
Abstract
Infection of the aorta continues to be a clinical challenge with high morbidity and mortality. The incidence varies between 0.6 and 2.6%. There has been a steady increase in graft infections, especially endograft infections, due to increased procedures (0.2 to 5%). Staphylococcus species remains the most common organism; however, gram-negative and rare causative agents are also reported. The clinical presentation can be very diverse and a high degree of suspicion is necessary to diagnose them. Sometimes, they may present as an emergency with rupture or fistulation. Diagnosis is based on a triad of clinical features, microbial cultures and imaging. Culture-specific antibiotics are mandatory during the entire course, but seldom cure alone. Surgical management remains the standard of care and involves an integrated approach involving debridement, reconstruction and use of adjuncts. Various aortic substitutes have been described with advantages and limitations. Pericardial tube grafts have emerged as a good option. Endo-vascular options are practiced mostly as a bridge to definitive surgery. A small role for conservative management is described. Aortic fistulation to the gut and airway carries a very high mortality. There are no large series in the literature to define guideline-directed treatment and most often it is a customized solution. The 30-day mortality remains close to 30%. Outcomes depend on multiple factors including patient's age, the timing of presentation, diagnosis, causative organism, host status and the treatment strategy adopted.
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20
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Iatrogenic sigmoid perforation by vascular prosthesis during aortobifemoral bypass. ANGIOLOGIA 2021. [DOI: 10.20960/angiologia.00225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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21
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Aortic graft infection: outcomes of graft excision and extra anatomic revascularization. ANGIOLOGIA 2021. [DOI: 10.20960/angiologia.00289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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22
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Chen CL, Kuo TT, Chen IM, Chen TW, Chen PL, Huang CY, Shih CC. Mid-Term Outcome of Infected Abdominal Aortic Stent Graft Dismantlement with Reconstruction of Bilateral Axillofemoral Bypass. Surg Infect (Larchmt) 2020; 22:680-683. [PMID: 33337972 DOI: 10.1089/sur.2020.332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Abdominal aortic stent graft infection (AAGI) is a severe complication. The optimal management of AAGI remains unclear. This study provides updated results of bilateral axillofemoral bypasses (AFBs) for patients with AAGI. Patients and Methods: In total, 31 patients (25 men; mean age, 67.1 years) with AAGI treated using AFB between January 2006 and April 2020 were included. Overall, the mean follow-up duration was 24 months (range, 1-72). In the 23 patients who survived the post-operative period, the mean follow-up duration was 32 months (range, 12-72). Results: Thirty-day and in-hospital mortality rates was 16% and 26%, respectively. The 12-month primary and secondary patency rates for the AFB graft were both 91%. In total, seven (30%) patients received re-interventions such as thrombectomy and balloon angioplasty. No amputation was required during follow-up. Culture results were positive in 87% of pre-operative cultures and 84% of intra-operative cultures. Staphylococcus aureus was the most prevalent pathogen, with four cases of methicillin-resistant Staphylococcus aureus and one each of vancomycin-resistant enterococci, carbapenem-resistant Klebsiella pneumoniae, and carbapenem-resistant Enterobacteriaceae. In-hospital mortality rate was 57% in patients with drug-resistant pathogens. Conclusions: Reconstruction with bilateral AFB and stent graft removal in patients with AAGI is a feasible treatment modality and provided an acceptable patency rate and low amputation rate. Additional studies investigating long-term results and the optimal treatment of AAGI are required.
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Affiliation(s)
- Ching-Li Chen
- Department of Medical Education, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, School of Medicine, School of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Tzu-Ting Kuo
- Department of Medicine, School of Medicine, School of Medicine, National Yang Ming University, Taipei, Taiwan
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - I-Ming Chen
- Department of Medicine, School of Medicine, School of Medicine, National Yang Ming University, Taipei, Taiwan
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Tai-Wei Chen
- Department of Medicine, School of Medicine, School of Medicine, National Yang Ming University, Taipei, Taiwan
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Po-Lin Chen
- Department of Medicine, School of Medicine, School of Medicine, National Yang Ming University, Taipei, Taiwan
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chun-Yang Huang
- Department of Medicine, School of Medicine, School of Medicine, National Yang Ming University, Taipei, Taiwan
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chun-Che Shih
- Institute of Clinical Medicine, School of Medicine, National Yang Ming University, Taipei, Taiwan
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23
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Munir W, Tarkas TN, Bashir M, Adams B. Update on graft infections in thoracoabdominal aortic aneurysm surgery. THE JOURNAL OF CARDIOVASCULAR SURGERY 2020; 62:339-346. [PMID: 33302614 DOI: 10.23736/s0021-9509.20.11702-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
The incidence of an aortic graft infection following the repair of thoracoabdominal aortic aneurysm, is a rare yet insidious complication which requires prompt recognition and management. The decision-making framework for management encompasses the choice or antimicrobial therapy alone versus pursuing surgical intervention, which can then also lead to considering the potential for allografts. The current literature on the matter is heavily burdened by limitations of the reported retrospective experiences consisting of small patient cohorts. Studies have reported the favored approach of surgical intervention, although statistical significance is not reached. There is a clear recognized impact that the event surrounding the initial repair has on the occurrence of graft infection itself; with emergency repairs, and incidence of nosocomial infection being associated with higher rates of graft infection. We must consider the influencers of this ominous complications, which go back to the perioperative events itself, whether the initial intervention was elective or an emergency, the impact of nosocomial infections, the choice of open versus endovascular for initial repair. Only with the appropriate management strategy that encompasses all these factors, will allow the best treatment to be provided for patients. A sound understanding and appreciation for the aforementioned can allow the stratification of the risk associated with the occurrence of an aortic graft infection, leading to surveillance opportunities to provide the crucial ability to rapidly recognize this complication.
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Affiliation(s)
- Wahaj Munir
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Tillana N Tarkas
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Mohamad Bashir
- Department of Vascular Surgery, Royal Blackburn Teaching Hospital, Blackburn, UK -
| | - Benjamin Adams
- Department of Aortovascular Surgery, Barts Heart Centre, St. Bartholomew's Hospital, London, UK
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24
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Uslu HY, Kurt H. A case report of a unique aorto-bifemoral graft infection and its treatment. J Surg Case Rep 2020; 2020:rjaa382. [PMID: 33214865 PMCID: PMC7655013 DOI: 10.1093/jscr/rjaa382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 08/20/2020] [Accepted: 08/24/2020] [Indexed: 12/30/2022] Open
Abstract
In this study, we report a unique case of aorto-bifemoral graft infection, which developed in a 47-year-old male patient after endovascular aortic aneurysmal repair (EVAR) and extra anatomic axillo-femoral bypass. The patient had previously been treated by EVAR for an infrarenal abdominal aortic aneurysm. Earlier, the EVAR was blocked by a thrombosis and treated with an extra-anatomic axillo femoral bypass, which then became occluded. The patient was then treated with an aorto-bifemoral bypass using a Dacron Y graft. A few months later, he was referred to our cardiovascular center with high body temperature, weight loss, inability to stand and walk, and very serious sepsis. A computed abdominal tomography scan revealed that a part of the graft proximal to the bifurcation had totally eroded into the proximal jejunum. We treated this patient with multiple surgeries, antibiotic administrations and hypochlorous acid irrigation without graft excision, which carries a high morbidity and mortality risks.
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Affiliation(s)
- Hatim Yahya Uslu
- Department of General Surgery, TOBB ETU University, Ankara, TURKIYE
| | - Halil Kurt
- Department of Internal Medicine (Infectious Diseases), TOBB ETU University, Ankara, TURKIYE
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25
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Joshi G, Ogbudinkpa C, Stecher J, Khoury RE, Resnick DJ, Jacobs CE, White JV, Schwartz LB. Treatment of Post-Evar Aortoduodenal Fistula Without Endograft Excision. Vasc Endovascular Surg 2020; 55:282-285. [PMID: 33047669 DOI: 10.1177/1538574420966455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
An 80 year-old gentleman presented with aortoduodenal fistula 2 months after uncomplicated endovascular aneurysm repair (EVAR). Upon laparotomy and fistula takedown, there was no active hemorrhage from the excluded aneurysm. It was theorized the fistula had originated from an occult type II endoleak which had since thrombosed. The duodenum was repaired primarily; the anterior defect in the aneurysm sac was packed and covered with omentum. The patient recovered uneventfully and remains well after 9 months. This is the first case, to our knowledge, of a post-EVAR aortoduodenal fistula successfully treated without endograft excision.
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Affiliation(s)
- Gaurang Joshi
- Department of Surgery, 21886Advocate Lutheran General Hospital, Park Ridge, IL, USA
| | - Chinelo Ogbudinkpa
- Department of Surgery, 21886Advocate Lutheran General Hospital, Park Ridge, IL, USA
| | - Johanna Stecher
- Department of Surgery, 21886Advocate Lutheran General Hospital, Park Ridge, IL, USA
| | - Rym El Khoury
- Department of Surgery, 8785University of California San Francisco, San Francisco, CA, USA
| | - Daniel J Resnick
- Department of Surgery, 21886Advocate Lutheran General Hospital, Park Ridge, IL, USA
| | - Chad E Jacobs
- Department of Surgery, 21886Advocate Lutheran General Hospital, Park Ridge, IL, USA
| | - John V White
- Department of Surgery, 21886Advocate Lutheran General Hospital, Park Ridge, IL, USA
| | - Lewis B Schwartz
- Department of Surgery, 21886Advocate Lutheran General Hospital, Park Ridge, IL, USA
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26
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Inaraja-Pérez GC, Adoración RC, Jose-Antonio LS, Maria-Isabel LG, Irene SV. A Bail Out Solution for an Urgent Situation: Endovascular Exclusion and Embolization of an Infected Femoral Pseudoaneurysm. Ann Vasc Surg 2020; 69:454.e1-454.e5. [PMID: 32768535 DOI: 10.1016/j.avsg.2020.07.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/01/2020] [Accepted: 07/09/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE The aim of this study is to show the utility of the combination of thrombin and endograft to solve an urgent situation related to femoral infections. CASE We present the case of a 91-year-old female patient who underwent a femoral endarterectomy and superficial femoral artery angioplasty and developed a surgical site infection. She was readmitted to the hospital because of bleeding and was operated to suture the femoral patch and to do a plasty of sartorius muscle. Six days after the last intervention a femoral pulsatile mass was noted, and the computed tomography showed a big femoral pseudoaneurysm. Taken again to the theater and via a contralateral puncture a viabahn covered endograft was deployed from the external iliac artery to the yet diseased but patent femoral superficial femoral artery and the pseudoaneurysm was punctured, emptied, and filled with thrombin. The patient was discharged 2 weeks after the last procedure and lived for 10 months (she died because of a nonvascular related cause) with a patent graft and with healed lesions. CONCLUSIONS In this case the endovascular solution was a definitive solution in a very old patient with several comorbidities.
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27
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Surgical "New Aortic Carrefour Technique" for Late Open Conversion After Endovascular Aortic Repair. Ann Vasc Surg 2020; 70:434-443. [PMID: 32599108 DOI: 10.1016/j.avsg.2020.06.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 06/11/2020] [Accepted: 06/12/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND The aim of the study is to report the early and midterm outcomes of late open conversion (LOC) after endovascular aortic repair (EVAR) using the "new aortic carrefour technique" (NACT) for preservation of the stent-graft iliac limbs. Late conversions were defined as explants >6 months after previous EVAR. METHODS Patients treated for elective or urgent LOC after EVAR with the NACT at a single center (2009-2019), and with ≥6 months of follow-up, were included. Briefly, after completing the proximal aortic anastomosis, the endograft iliac limbs were truncated and sutured together to create a "new aortic carrefour" (Veraldi's technique). A Dacron-knitted straight graft was therefore sutured to the newly created aortic bifurcation. Outcomes of interest were as follows: immediate technical success, intraoperative characteristics, and reinterventions. Results are reported as the number (and percentages) or median (and interquartile range [IQR]). RESULTS During the study period, 433 patients underwent standard EVAR for abdominal aortic aneurysm and 20 underwent LOC. Of these, 9 consecutive patients were deemed suitable and treated with NACT. The indication for conversion was endoleak in 6 (type IA n = 1, type II n = 4, type III n = 1), complete graft thrombosis (n = 2), and one case of sac enlargement without any clear signs of endoleak at computed tomography angiography. Of these cases, six were treated electively, while three were treated in urgent setting including one case of rupture. The median procedure, aortic cross-clamping, and distal anastomosis times were 280 minutes (IQR: 225-290), 24 minutes (IQR: 22-29), and 15 minutes (IQR: 14-18), respectively. The median blood loss was 1,600 mL (IQR: 700-1,900), and the median hospital stay was 8 days (IQR 7-12). None of the patients died and neither required unplanned reintervention within 30 days. At a median imaging follow-up of 13 months (IQR 8-43), there were no reinterventions due to residual leaks or technical defects. One patient died during follow-up, and the recorded cause of death was heart failure. CONCLUSIONS The use of the NACT with preservation of the original endograft iliac limbs for LOC after EVAR is a safe and feasible technique, which results in a low perioperative morbidity and mortality rate in selected patients. The technique is effective during midterm follow-up and might represent a valuable tool to expand the armamentarium of vascular surgeons for surgical regrafting after EVAR.
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28
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Lauri C, Iezzi R, Rossi M, Tinelli G, Sica S, Signore A, Posa A, Tanzilli A, Panzera C, Taurino M, Erba PA, Tshomba Y. Imaging Modalities for the Diagnosis of Vascular Graft Infections: A Consensus Paper amongst Different Specialists. J Clin Med 2020; 9:jcm9051510. [PMID: 32429584 PMCID: PMC7290746 DOI: 10.3390/jcm9051510] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 05/14/2020] [Accepted: 05/15/2020] [Indexed: 12/18/2022] Open
Abstract
Vascular graft infection (VGI) is a rare but severe complication of vascular surgery that is associated with a bad prognosis and high mortality rate. An accurate and prompt identification of the infection and its extent is crucial for the correct management of the patient. However, standardized diagnostic algorithms and a univocal consensus on the best strategy to reach a diagnosis still do not exist. This review aims to summarize different radiological and Nuclear Medicine (NM) modalities commonly adopted for the imaging of VGI. Moreover, we attempt to provide evidence-based answers to several practical questions raised by clinicians and surgeons when they approach imaging in order to plan the most appropriate radiological or NM examination for their patients.
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Affiliation(s)
- Chiara Lauri
- Nuclear Medicine Unit, Department of Medical-Surgical Sciences and of Translational Medicine, “Sapienza” University of Rome, 00161 Rome, Italy;
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, 9700 Groningen, The Netherlands;
- Correspondence: ; Tel.: +39-06-3377-6191
| | - Roberto Iezzi
- Radiology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma-Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (R.I.); (A.P.); (A.T.)
| | - Michele Rossi
- Radiology Unit, Department of Medical-Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, Sant’Andrea Hospital, “Sapienza” University of Rome, 00161 Rome, Italy;
| | - Giovanni Tinelli
- Unit of Vascular Surgery, Fondazione Policlinico Universitario Gemelli IRCCS, Roma-Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (G.T.); (S.S.); (Y.T.)
| | - Simona Sica
- Unit of Vascular Surgery, Fondazione Policlinico Universitario Gemelli IRCCS, Roma-Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (G.T.); (S.S.); (Y.T.)
| | - Alberto Signore
- Nuclear Medicine Unit, Department of Medical-Surgical Sciences and of Translational Medicine, “Sapienza” University of Rome, 00161 Rome, Italy;
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, 9700 Groningen, The Netherlands;
| | - Alessandro Posa
- Radiology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma-Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (R.I.); (A.P.); (A.T.)
| | - Alessandro Tanzilli
- Radiology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma-Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (R.I.); (A.P.); (A.T.)
| | - Chiara Panzera
- Vascular Surgery Unit, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant’Andrea Hospital, “Sapienza” University of Rome, 00161 Rome, Italy; (C.P.); (M.T.)
| | - Maurizio Taurino
- Vascular Surgery Unit, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant’Andrea Hospital, “Sapienza” University of Rome, 00161 Rome, Italy; (C.P.); (M.T.)
| | - Paola Anna Erba
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, 9700 Groningen, The Netherlands;
- Nuclear Medicine, Department of Translational Research and New Technology in Medicine, University of Pisa, 56123 Pisa, Italy
| | - Yamume Tshomba
- Unit of Vascular Surgery, Fondazione Policlinico Universitario Gemelli IRCCS, Roma-Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (G.T.); (S.S.); (Y.T.)
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29
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Georgiadis GS, Argyriou C, Georgakarakos EI, Koutsoumpelis A, Papatheodorou N, Lazarides MK. Composite Contralateral Axillobifemoral Bypass for Ipsilateral Axillobifemoral Bypass Infection. Ann Vasc Surg 2020; 68:568.e1-568.e5. [PMID: 32278872 DOI: 10.1016/j.avsg.2020.03.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 03/26/2020] [Accepted: 03/27/2020] [Indexed: 10/24/2022]
Abstract
We report an innovative technique in an 82-year-old patient with a patent but infected right axillobifemoral (AxBF) bypass performed 7 years ago owingto critical limb ischemia who underwent a semielective de novo left-sided composite AxBF bypass consisting of a central prosthetic polytetrafluoroethylene segment and distal autologous limbs to the femoral regions (femoral crossover bypass vein to the right limb using the femoral vein and jump graft to the left femoral limb using the great saphenous vein.) Although AxBF bypass is not considered the "gold standard" surgical composite revascularization procedure in the suprainguinal region, it can constitute an acceptable intervention in selected cases.
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Affiliation(s)
- George S Georgiadis
- Department of Vascular Surgery, "Democritus" University of Thrace, University General Hospital of Evros, Alexandroupolis, Greece.
| | - Christos Argyriou
- Department of Vascular Surgery, "Democritus" University of Thrace, University General Hospital of Evros, Alexandroupolis, Greece
| | - Efstratios I Georgakarakos
- Department of Vascular Surgery, "Democritus" University of Thrace, University General Hospital of Evros, Alexandroupolis, Greece
| | - Andreas Koutsoumpelis
- Department of Vascular Surgery, "Democritus" University of Thrace, University General Hospital of Evros, Alexandroupolis, Greece
| | - Nikolaos Papatheodorou
- Department of Vascular Surgery, "Democritus" University of Thrace, University General Hospital of Evros, Alexandroupolis, Greece
| | - Miltos K Lazarides
- Department of Vascular Surgery, "Democritus" University of Thrace, University General Hospital of Evros, Alexandroupolis, Greece
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30
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Denny KJ, Kumar A, Timsit JF, Laupland KB. Extra-cardiac endovascular infections in the critically ill. Intensive Care Med 2019; 46:173-181. [PMID: 31745594 DOI: 10.1007/s00134-019-05855-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 11/04/2019] [Indexed: 01/16/2023]
Abstract
Vascular infections are associated with high complication rates and mortality. While there is an extensive body of literature surrounding cardiac infections including endocarditis, this is less so the case for other endovascular infections. The objective of this narrative review is to summarize the epidemiology, clinical features, and selected management of severe vascular infections exclusive of those involving the heart. Endovascular infections may involve either the arterial or venous vasculature and may arise in native vessels or secondary to implanted devices. Management is complex and requires multi-disciplinary involvement from the outset. Infective arteritis or device-related arterial infection involves removal of the infected tissue or device. In cases where complete excision is not possible, prolonged courses of antimicrobials are required. Serious infections associated with the venous system include septic thrombophlebitis of the internal jugular and other deep veins, and intracranial/venous sinuses. Source control is of paramount importance in these cases with adjunctive antimicrobial therapy. The role of anticoagulation is controversial although recommended in the absence of contraindications. An improved understanding of the management of these infections, and thus improved patient outcomes, requires multi-center, international collaboration.
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Affiliation(s)
- Kerina J Denny
- Department of Intensive Care, Gold Coast University Hospital, Gold Coast, QLD, Australia.,Burns, Trauma and Critical Care Research Centre, University of Queensland, Herston, QLD, Australia
| | - Anand Kumar
- Sections of Critical Care Medicine and Infectious Diseases, Health Sciences Centre, Department of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Jean-Francois Timsit
- AP-HP, Bichat Hospital, Medical and Infectious Diseases ICU (MI2), 75018, Paris, France.,University of Paris, IAME, INSERM, 75018, Paris, France
| | - Kevin B Laupland
- Department of Intensive Care Services, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia. .,Queensland University of Technology, Brisbane, QLD, Australia.
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