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Znaniecki Ł, Brzeziński J, Halman J, Marciniuk P, Michalski P, Wojciechowski J. Early and Mid-Term Results of Native and Abdominal Aortic Graft Infection Treatment via Surgeon-Constructed Porcine Pericardial Aortic Tubes. Angiology 2024; 75:565-575. [PMID: 36898732 DOI: 10.1177/00033197231162721] [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: 03/12/2023]
Abstract
The search for optimal material for aortic infection reconstruction is ongoing. Our study presents the early and mid-term results of surgeon-constructed porcine pericardial tubes in the in-situ reconstruction of abdominal aortic infections, focusing on the safety as well as the durability of surgeon-created tubes. We performed a retrospective analysis of 8 patients treated for native aortic (n = 3) and aortic graft infections (n = 5) with surgeon-created tubes made of porcine pericardium patch (8 × 14 cm NO-REACT Ⓡ, BioIntegral Surgical Inc., Mississauga, ON, Canada). There were 7 males and 1 female, aged 68.5 (±4.8 years). Three patients had an aorto-enteric fistula. Technical success was obtained in all patients. Thirty-day mortality was 12.5% (n = 1). Mid-term follow-up was 12 months (2-63 months). One-year mortality was 37.5% (n = 3). Reintervention rate was 28.5% (n = 2). False aneurysm rate in the follow-up was 14.2% (n = 1). Surgeon-constructed porcine pericardial tubes seem to be a promising alternative as a replacement for native as well as graft-related abdominal aortic infections. The mid-term durability is encouraging, once the infection is controlled in cases with successful fistula repair and in native aortic infections patients. Further observations on larger groups, in longer follow-ups are necessary to confirm these preliminary observations.
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Affiliation(s)
- Łukasz Znaniecki
- Department of Vascular Surgery, Medical University of Gdańsk, Gdansk, Poland
| | - Jakub Brzeziński
- Department of Vascular Surgery, Medical University of Gdańsk, Gdansk, Poland
| | - Joanna Halman
- Department of Vascular Surgery, Medical University of Gdańsk, Gdansk, Poland
| | - Piotr Marciniuk
- Department of Vascular Surgery, Medical University of Gdańsk, Gdansk, Poland
| | - Paweł Michalski
- Department of Vascular Surgery, Medical University of Gdańsk, Gdansk, Poland
| | - Jacek Wojciechowski
- Department of Vascular Surgery, Medical University of Gdańsk, Gdansk, Poland
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2
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Czerny M, Grabenwöger M, Berger T, Aboyans V, Della Corte A, Chen EP, Desai ND, Dumfarth J, Elefteriades JA, Etz CD, Kim KM, Kreibich M, Lescan M, Di Marco L, Martens A, Mestres CA, Milojevic M, Nienaber CA, Piffaretti G, Preventza O, Quintana E, Rylski B, Schlett CL, Schoenhoff F, Trimarchi S, Tsagakis K, Siepe M, Estrera AL, Bavaria JE, Pacini D, Okita Y, Evangelista A, Harrington KB, Kachroo P, Hughes GC. EACTS/STS Guidelines for Diagnosing and Treating Acute and Chronic Syndromes of the Aortic Organ. Ann Thorac Surg 2024; 118:5-115. [PMID: 38416090 DOI: 10.1016/j.athoracsur.2024.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Affiliation(s)
- Martin Czerny
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany; Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany.
| | - Martin Grabenwöger
- Department of Cardiovascular Surgery, Clinic Floridsdorf, Vienna, Austria; Medical Faculty, Sigmund Freud Private University, Vienna, Austria.
| | - Tim Berger
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany; Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Victor Aboyans
- Department of Cardiology, Dupuytren-2 University Hospital, Limoges, France; EpiMaCT, Inserm 1094 & IRD 270, Limoges University, Limoges, France
| | - Alessandro Della Corte
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli", Naples, Italy; Cardiac Surgery Unit, Monaldi Hospital, Naples, Italy
| | - Edward P Chen
- Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Nimesh D Desai
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Julia Dumfarth
- University Clinic for Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - John A Elefteriades
- Aortic Institute at Yale New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut
| | - Christian D Etz
- Department of Cardiac Surgery, University Medicine Rostock, University of Rostock, Rostock, Germany
| | - Karen M Kim
- Division of Cardiovascular and Thoracic Surgery, The University of Texas at Austin/Dell Medical School, Austin, Texas
| | - Maximilian Kreibich
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany; Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Mario Lescan
- Department of Thoracic and Cardiovascular Surgery, University Medical Centre Tübingen, Tübingen, Germany
| | - Luca Di Marco
- Cardiac Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Andreas Martens
- Department of Cardiac Surgery, Klinikum Oldenburg, Oldenburg, Germany; The Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Carlos A Mestres
- Department of Cardiothoracic Surgery and the Robert WM Frater Cardiovascular Research Centre, The University of the Free State, Bloemfontein, South Africa
| | - Milan Milojevic
- Department of Cardiac Surgery and Cardiovascular Research, Dedinje Cardiovascular Institute, Belgrade, Serbia
| | - Christoph A Nienaber
- Division of Cardiology at the Royal Brompton & Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom; National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Gabriele Piffaretti
- Vascular Surgery Department of Medicine and Surgery, University of Insubria School of Medicine, Varese, Italy
| | - Ourania Preventza
- Division of Cardiothoracic Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Eduard Quintana
- Department of Cardiovascular Surgery, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Bartosz Rylski
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany; Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Christopher L Schlett
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany; Department of Diagnostic and Interventional Radiology, University Hospital Freiburg, Freiburg, Germany
| | - Florian Schoenhoff
- Department of Cardiac Surgery, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Santi Trimarchi
- Department of Cardiac Thoracic and Vascular Diseases, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Konstantinos Tsagakis
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University Medicine Essen, Essen, Germany
| | - Matthias Siepe
- EACTS Review Coordinator; Department of Cardiac Surgery, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Anthony L Estrera
- STS Review Coordinator; Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at UTHealth Houston, Houston, Texas
| | - Joseph E Bavaria
- Department of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Davide Pacini
- Division of Cardiac Surgery, S. Orsola University Hospital, IRCCS Bologna, Bologna, Italy
| | - Yutaka Okita
- Cardio-Aortic Center, Takatsuki General Hospital, Osaka, Japan
| | - Arturo Evangelista
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Vall d'Hebron Institut de Recerca, Barcelona, Spain; Biomedical Research Networking Center on Cardiovascular Diseases, Instituto de Salud Carlos III, Madrid, Spain; Departament of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain; Instituto del Corazón, Quirónsalud-Teknon, Barcelona, Spain
| | - Katherine B Harrington
- Department of Cardiothoracic Surgery, Baylor Scott and White The Heart Hospital, Plano, Texas
| | - Puja Kachroo
- Division of Cardiothoracic Surgery, Washington University School of Medicine, St Louis, Missouri
| | - G Chad Hughes
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Duke University, Durham, North Carolina
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Stockschläder L, Margaryan D, Omran S, Schomaker M, Greiner A, Trampuz A. Characteristics and Outcome of Vascular Graft Infections: A Risk Factor and Survival Analysis. Open Forum Infect Dis 2024; 11:ofae271. [PMID: 38868303 PMCID: PMC11167665 DOI: 10.1093/ofid/ofae271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 05/10/2024] [Indexed: 06/14/2024] Open
Abstract
Background Vascular graft infection (VGI) is a serious complication after implantation of arterial vascular grafts. Optimal surgical and pathogen-specific antimicrobial treatment regimens for VGI are largely unknown. We evaluated patients with arterial VGI according to onset, location, microbiological and imaging characteristics, and surgical and antimicrobial treatment and performed an outcome evaluation. Methods Consecutive patients with VGI treated in 2 hospitals from 2010 through 2020 were retrospectively analyzed. Uniform definition criteria and standardized outcome evaluation were applied. Logistic regression was used for multiple analysis; survival analysis was performed with Kaplan-Meier analysis and a log-rank test. Results Seventy-eight patients with VGI were included: 30 early-onset cases (<8 weeks after graft implantation) and 48 late-onset cases, involving 49 aortic and 29 peripheral grafts. The median time from initial implantation to diagnosis of VGI was significantly longer in aortic than peripheral VGIs (363 vs 56 days, P = .018). Late-onset VGI (odds ratio [OR], 7.3; P = .005) and the presence of surgical site infection/complication (OR, 8.21; P = .006) were independent risk factors for treatment failure. Surgical site infection/complication was associated with a higher risk for early-onset VGI (OR, 3.13; P = .040). Longer infection-free survival was observed in cases where the infected graft was surgically removed (P = .037). Conclusions This study underlines the importance of timely diagnosis of VGI and preventing surgical site infections/complications at graft implantation. It highlights the complexity of infection eradication, especially for late-onset infections, and the importance of adequate antimicrobial and surgical treatment.
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Affiliation(s)
- Leonie Stockschläder
- Center for Musculoskeletal Surgery, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Donara Margaryan
- Center for Musculoskeletal Surgery, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Safwan Omran
- Department of Vascular Surgery, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Martin Schomaker
- Department of Vascular Surgery, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Andreas Greiner
- Department of Vascular Surgery, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Andrej Trampuz
- Center for Musculoskeletal Surgery, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Caulier T, Senneville E, Sobocinski J, Leroy O, Patoz P, Blondiaux N, Georges H, Pierre-Yves D, d'Elia P, Robineau O. Burden of Candida-related vascular graft infection: a nested-case control study. Infection 2024; 52:1153-1158. [PMID: 38329687 DOI: 10.1007/s15010-023-02172-y] [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: 09/21/2023] [Accepted: 12/29/2023] [Indexed: 02/09/2024]
Abstract
PURPOSE We aimed to assess risk factors of candida-related Vascular Graft Infections (VGIs). METHODS We did a case-control study (1:4) matched by age and year of infection, nested in a cohort of patient with a history of VGIs. Cases were defined by a positive culture for Candida spp. in biological samples and controls were defined by a positive culture for bacterial strains only in biological samples. Risk factors for Candida-related VGIs were investigated using multivariate logistic regression. Mortality were compared using survival analysis. RESULTS 16 Candida-related VGIs were matched to 64 bacterial-related VGIs. The two groups were comparable regarding medical history and clinical presentation. Candida-related VGIs were associated with bacterial strains in 88% (14/16). Gas/fluid-containing collection on abdominal CT scan and the presence of an aortic endoprosthesis were risk factors for Candida spp.-related VGIs [RRa 10.43 [1.81-60.21] p = 0.009 RRa and 6.46 [1.17-35.73] p = 0.03, respectively]. Candida-related VGIs were associated with a higher mortality when compared to bacterial-related VGIs (p = 0.002). CONCLUSIONS Candida-related VGIs are severe. Early markers of Candida spp. infection are needed to improve their outcome. The suspicion of aortic endoprosthesis infection may necessitate probabilistic treatment with antifungal agents.
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Affiliation(s)
| | - Eric Senneville
- Service Universitaire Des Maladies Infectieuses Et du Voyageur, Centre Hospitalier Gustave Dron, 59210, Tourcoing, France
- University of Lille, CHU Lille, ULR 2694, METRICS, Évaluation Des Technologies de Santé Et Des Pratiques Médicales, 59000, Lille, France
| | | | | | | | - Nicolas Blondiaux
- Service de Biologie, CH de Tourcoing, France
- University of Lille, CNRS, Inserm, Institut Pasteur de Lille, U1019, UMR9017 Center for Infection and Immunity of Lille, Lille, France
| | | | | | | | - Olivier Robineau
- Service Universitaire Des Maladies Infectieuses Et du Voyageur, Centre Hospitalier Gustave Dron, 59210, Tourcoing, France.
- University of Lille, CHU Lille, ULR 2694, METRICS, Évaluation Des Technologies de Santé Et Des Pratiques Médicales, 59000, Lille, France.
- INSERM u1136, Institut Pierre Louis de Santé Publique, Paris, France.
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Tabiei A, Cifuentes S, Colglazier JJ, Shuja F, Kalra M, Mendes BC, Schaller MS, Rasmussen TE, DeMartino RR. Cryopreserved arterial allografts vs autologous vein for arterial reconstruction in infected fields. J Vasc Surg 2024; 79:941-947. [PMID: 38101708 DOI: 10.1016/j.jvs.2023.12.011] [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: 07/24/2023] [Revised: 12/06/2023] [Accepted: 12/08/2023] [Indexed: 12/17/2023]
Abstract
OBJECTIVE Peripheral arterial infections are rare and difficult to treat when an in situ reconstruction is required. Autologous vein (AV) is the conduit of choice in many scenarios. However, cryopreserved arterial allografts (CAAs) are an alternative. We aimed to assess our experience with CAAs and AVs for reconstruction in primary and secondary peripheral arterial infections. METHODS Data from patients with peripheral arterial infections undergoing reconstruction with CAA or AV from January 2002 through August 2022 were retrospectively analyzed. Patients with aortic- or iliac-based infections were excluded. RESULTS A total of 42 patients (28 CAA, 14 AV) with a mean age of 65 and 69 years, respectively, were identified. Infections were secondary in 31 patients (74%) and primary in 11 (26%). Secondary infections included 10 femoral-femoral grafts, 10 femoropopliteal or femoral-distal grafts, five femoral patches, four carotid-subclavian grafts, one carotid-carotid graft, and one infected carotid patch. Primary infection locations included six femoral, three popliteal, and two subclavian arteries. In patients with lower extremity infections, associated groin infections were present in 19 (56%). Preoperative blood cultures were positive in 17 patients (41%). AVs included saphenous vein in eight and femoral vein in six. Intraoperative cultures were negative in nine patients (23%), polymicrobial in eight (21%), and monomicrobial in 22 (56%). Thirty-day mortality occurred in four patients (10%), two due to multisystem organ failure, one due to graft rupture causing acute blood loss and myocardial infarction, and one due to an unknown cause post-discharge. Median follow-up was 20 months and 46 months in the CAA and AV group, respectively. Graft-related reintervention was performed in six patients in the CAA group (21%) and one patient in the AV group (7%). Freedom from graft-related reintervention rates at 3 years were 82% and 92% in the CAA and AV group, respectively (P = .12). Survival rates at 1 and 3 years were 85% and 65% in the CAA group and 92% and 84% in the AV group (P = .13). Freedom from loss of primary patency was similar with 3-year rates of 77% and 83% in the CAA and AV group, respectively (P = .25). No patients in either group were diagnosed with reinfection. CONCLUSIONS CAAs are an alternative conduit for peripheral arterial reconstructions when AV is not available. Although there was a trend towards higher graft-related reintervention rates in the CAA group, patency is similar and reinfection is rare.
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Affiliation(s)
- Armin Tabiei
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN
| | | | - Jill J Colglazier
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN
| | - Fahad Shuja
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN
| | - Manju Kalra
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN
| | - Bernardo C Mendes
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN
| | - Melinda S Schaller
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN
| | - Todd E Rasmussen
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN
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Akamatsu D, Serizawa F, Umetsu M, Suzuki S, Goto H, Unno M, Kamei T. Revascularization and Digestive Tract Repair in Secondary Aortoenteric Fistula Using a Single-Center in Situ Revascularization Strategy. Ann Vasc Surg 2024; 101:148-156. [PMID: 38159719 DOI: 10.1016/j.avsg.2023.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 07/31/2023] [Accepted: 10/22/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Information regarding optimal revascularization and digestive tract repair in secondary aortoenteric fistula (sAEF) remains unclear. Thus, reporting treatment outcomes and presenting comprehensive patient details through a structured treatment approach are necessary to establish a treatment strategy for this rare, complex, and fatal condition. METHODS We performed a single-center retrospective review of consecutive sAEF managed based on our in situ revascularization and intestinal repair strategy. The primary endpoint of this study was all-cause mortality, and secondary endpoints were the incidence of in-hospital complications and midterm reinfections. RESULTS Between 2007 and 2020, 16 patients with sAEF, including 13 men (81%), underwent in situ revascularization and digestive tract repair. The median follow-up duration for all participants was 36 (interquartile range, 6-62) months. Among the participants, 81% (n = 13), 13% (n = 2), and 6% (n = 1) underwent aortic reconstruction with rifampin-soaked grafts, unsoaked Dacron grafts, and femoral veins, respectively. The duodenum was the most commonly involved site in enteric pathology (88%; n = 14), and 57% (n = 8) of duodenal breaks were repaired by a simple closure. Duodenum's second part-jejunum anastomosis was performed in 43% of patients (n = 6), and 19% of the patients (n = 3) died perioperatively. In-hospital complications occurred in 88% patients (n = 14), and the most frequent complication was gastrointestinal. Finally, 81% patients (n = 13) were discharged home. Oral antibiotics were administered for a median duration of 5.7 months postoperatively; subsequently, the participants were followed up carefully. Reinfection was detected in 6% of the patients (n = 1) who underwent reoperation without any complications. The 1-year and 3-year overall survival rates of participants were 75% (n = 12) and 75% (n = 9), respectively, and no sAEF-related deaths occurred, except perioperative death. CONCLUSIONS Surgical intervention with contemporary management based on our vascular strategy and digestive tract procedure may be a durable treatment for sAEF.
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Affiliation(s)
| | - Fukashi Serizawa
- Department of Surgery, Tohoku University Hospital, Sendai, Japan
| | - Michihisa Umetsu
- Department of Surgery, Tohoku University Hospital, Sendai, Japan
| | - Shunya Suzuki
- Department of Surgery, Tohoku University Hospital, Sendai, Japan
| | | | - Michiaki Unno
- Department of Surgery, Tohoku University Hospital, Sendai, Japan
| | - Takashi Kamei
- Department of Surgery, Tohoku University Hospital, Sendai, Japan
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Ge J, Weng C, Zhao J, Yuan D, Huang B, Wang T. Diagnosis and treatment of carotid-left subclavian bypass graft infection complicated with mitral valve aneurysm and perforation following hybrid TEVAR: A case report. Heliyon 2024; 10:e25517. [PMID: 38333831 PMCID: PMC10850958 DOI: 10.1016/j.heliyon.2024.e25517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/14/2023] [Accepted: 01/29/2024] [Indexed: 02/10/2024] Open
Abstract
Hybrid thoracic endovascular aortic repair (TEVAR) has been proved to be an effective and reliable treatment option for aortic arch diseases requiring extension of the proximal landing zone. However, hybrid TEVAR was associated with potential risk of post-operative complications, including cerebral infarction, endoleaks and paraplegia. Here we reported a rare case of bypass graft infection complicated with mitral valve aneurysm and perforation following landing zone 2 hybrid TEVAR procedure, who presented with symptoms of fever, major bleeding and anastomotic pseudoaneurysm and received emergency bypass graft removal and stent implantation with acceptable short and midterm follow-up results.
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Affiliation(s)
| | | | - Jichun Zhao
- Division of Vascular Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Ding Yuan
- Division of Vascular Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Bin Huang
- Division of Vascular Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Tiehao Wang
- Division of Vascular Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China
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Czerny M, Grabenwöger M, Berger T, Aboyans V, Della Corte A, Chen EP, Desai ND, Dumfarth J, Elefteriades JA, Etz CD, Kim KM, Kreibich M, Lescan M, Di Marco L, Martens A, Mestres CA, Milojevic M, Nienaber CA, Piffaretti G, Preventza O, Quintana E, Rylski B, Schlett CL, Schoenhoff F, Trimarchi S, Tsagakis K. EACTS/STS Guidelines for diagnosing and treating acute and chronic syndromes of the aortic organ. Eur J Cardiothorac Surg 2024; 65:ezad426. [PMID: 38408364 DOI: 10.1093/ejcts/ezad426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 09/15/2023] [Accepted: 12/19/2023] [Indexed: 02/28/2024] Open
Affiliation(s)
- Martin Czerny
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Martin Grabenwöger
- Department of Cardiovascular Surgery, Clinic Floridsdorf, Vienna, Austria
- Medical Faculty, Sigmund Freud Private University, Vienna, Austria
| | - Tim Berger
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Victor Aboyans
- Department of Cardiology, Dupuytren-2 University Hospital, Limoges, France
- EpiMaCT, Inserm 1094 & IRD 270, Limoges University, Limoges, France
| | - Alessandro Della Corte
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli", Naples, Italy
- Cardiac Surgery Unit, Monaldi Hospital, Naples, Italy
| | - Edward P Chen
- Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Nimesh D Desai
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Julia Dumfarth
- University Clinic for Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - John A Elefteriades
- Aortic Institute at Yale New Haven Hospital, Yale University School of Medicine, New Haven, CT, USA
| | - Christian D Etz
- Department of Cardiac Surgery, University Medicine Rostock, University of Rostock, Rostock, Germany
| | - Karen M Kim
- Division of Cardiovascular and Thoracic Surgery, The University of Texas at Austin/Dell Medical School, Austin, TX, USA
| | - Maximilian Kreibich
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Mario Lescan
- Department of Thoracic and Cardiovascular Surgery, University Medical Centre Tübingen, Tübingen, Germany
| | - Luca Di Marco
- Cardiac Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Andreas Martens
- Department of Cardiac Surgery, Klinikum Oldenburg, Oldenburg, Germany
- The Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Carlos A Mestres
- Department of Cardiothoracic Surgery and the Robert WM Frater Cardiovascular Research Centre, The University of the Free State, Bloemfontein, South Africa
| | - Milan Milojevic
- Department of Cardiac Surgery and Cardiovascular Research, Dedinje Cardiovascular Institute, Belgrade, Serbia
| | - Christoph A Nienaber
- Division of Cardiology at the Royal Brompton & Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
| | - Gabriele Piffaretti
- Vascular Surgery Department of Medicine and Surgery, University of Insubria School of Medicine, Varese, Italy
| | - Ourania Preventza
- Division of Cardiothoracic Surgery, Department of Surgery, University of Virginia, Charlottesville, VA, USA
| | - Eduard Quintana
- Department of Cardiovascular Surgery, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Bartosz Rylski
- Clinic for Cardiovascular Surgery, Department University Heart Center Freiburg Bad Krozingen, University Clinic Freiburg, Freiburg, Germany
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | - Christopher L Schlett
- Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Freiburg, Freiburg, Germany
| | - Florian Schoenhoff
- Department of Cardiac Surgery, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Santi Trimarchi
- Department of Cardiac Thoracic and Vascular Diseases, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Konstantinos Tsagakis
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University Medicine Essen, Essen, Germany
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Tabiei A, Cifuentes S, Kalra M, Colglazier JJ, Mendes BC, Schaller MS, Shuja F, Rasmussen TE, DeMartino RR. Cryopreserved Arterial Allografts Versus Rifampin-Soaked Dacron for the Treatment of Infected Aortic and Iliac Aneurysms. Ann Vasc Surg 2023; 97:49-58. [PMID: 37121339 DOI: 10.1016/j.avsg.2023.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 04/21/2023] [Accepted: 04/21/2023] [Indexed: 05/02/2023]
Abstract
BACKGROUND Infected aortic and iliac artery aneurysms are challenging to treat. Cryopreserved arterial allografts (CAAs) or rifampin-soaked Dacron (RSD) are standard options for in situ reconstruction. Our aim was to compare the safety and effectiveness of CAA versus RSD for these complex pathologies. METHODS This is a retrospective review of infected iliac, abdominal, and thoracoabdominal aortic aneurysms treated with either CAAs or RSD between 2002 and 2022 at our institution. The diagnosis was confirmed by intraoperative, radiologic, or microbiological evidence of aortic infection. Perioperative events, 30-day and long-term mortality, reinfection, and reintervention were analyzed. RESULTS Thirty patients (17 CAA, 13 RSD) with a mean age of 61 and 68 years, respectively, were identified. The infected aneurysm was most commonly suprarenal or infrarenal. Culture-negative infections were present in 47% of the CAA group and 54% in the RSD group. Early major morbidity was 57% and 54% for the CAA and RSD, respectively. Thirty-day mortality was similar between groups (18% vs. 23% CAA vs. RSD, P ≥ 0.99). Median follow-up was longer in the RSD group (14.5 months vs. 13 months). Overall survival at 1 and 5 years was 80.8% and 64.8% in the CAA group and 69.2% and 57.7% in the RSD group. Reinterventions only occurred with CAA repairs and indications included graft occlusion (2), multiple pseudoaneurysms and reinfection (1), and hemorrhagic shock caused by graft rupture (1). Freedom from reintervention at 1 and 3 years was 87.5% and 79.5% (CAA group) versus 100% and 100% (RSD, P = 0.06). Freedom from reinfection at 1 year was 100% in both groups, while at 3 years it was 90.9% for the CAA group and 100% for the RSD group (P = 0.39). CONCLUSIONS Infected aortic and iliac aneurysms have high early morbidity and mortality. CAA and RSD had similar outcomes in our series; CAA trended toward higher reintervention rates. Both remain viable options for complex scenarios but require close surveillance.
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Affiliation(s)
- Armin Tabiei
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN
| | | | - Manju Kalra
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN
| | - Jill J Colglazier
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN
| | - Bernardo C Mendes
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN
| | - Melinda S Schaller
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN
| | - Fahad Shuja
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN
| | - Todd E Rasmussen
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN
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10
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Yang G, Sun T, Chen H, Zhang L. In situ reconstruction of an infected infrarenal aortic pseudoaneurysm and arteriovenous fistula with self-made pericardium graft. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2023; 37:ivad100. [PMID: 37364018 PMCID: PMC10576634 DOI: 10.1093/icvts/ivad100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 05/09/2023] [Accepted: 06/24/2023] [Indexed: 06/28/2023]
Abstract
Infectious aortic disease is a challenging life-threatening disease in cardiovascular surgery. A 70-year-old man patient presented with an infected infrarenal aortic pseudoaneurysm and right iliac artery- left iliac vein fistula (arteriovenous fistula). He underwent total infected tissues excision, debridement, in situ reconstructions of the aorta using a self-made pericardium graft with omental coverage and arteriovenous fistula patch repair to prevent leakage. One-year follow-up revealed the absence of clinically relevant infection with patency of the graft and the absence of biochemical inflammatory markers.
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Affiliation(s)
- Guangmin Yang
- Department of Thoracic and Cardiovascular Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Tao Sun
- Department of Thoracic and Cardiovascular Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Hongwei Chen
- Department of Thoracic and Cardiovascular Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Leiyang Zhang
- Department of Thoracic and Cardiovascular Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
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11
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Tabiei A, Cifuentes S, Glasgow AE, Colglazier JJ, Kalra M, Mendes BC, Rasmussen TE, Shuja F, DeMartino RR. Cryopreserved arterial allografts vs rifampin-soaked Dacron for the treatment of infected aortic and iliac grafts. J Vasc Surg 2023; 78:1064-1073.e1. [PMID: 37336464 DOI: 10.1016/j.jvs.2023.05.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 05/26/2023] [Accepted: 05/26/2023] [Indexed: 06/21/2023]
Abstract
OBJECTIVE Aortic and iliac graft infections remain complex clinical problems with high mortality and morbidity. Cryopreserved arterial allografts (CAAs) and rifampin-soaked Dacron (RSD) are options for in situ reconstruction. This study aimed to compare the safety and effectiveness of CAA vs RSD in this setting. METHODS Data from patients with aortic and iliac graft infections undergoing in situ reconstruction with either CAA or RSD from January 2002 through August 2022 were retrospectively analyzed. Our primary outcomes were freedom from graft-related reintervention and freedom from reinfection. Secondary outcomes included comparing trends in the use of CAA and RSD at our institution, overall survival, perioperative mortality, and major morbidity. RESULTS A total of 149 patients (80 RSD, 69 CAA) with a mean age of 68.9 and 69.1 years, respectively, were included. Endovascular stent grafts were infected in 60 patients (41 CAA group and 19 RSD group; P ≤ .01). Graft-enteric fistulas were more common in the RSD group (48.8% RSD vs 29.0% CAA; P ≤ .01). Management included complete resection of the infected graft (85.5% CAA vs 57.5% RSD; P ≤ .01) and aortic reconstructions were covered in omentum in 57 (87.7%) and 63 (84.0%) patients in the CAA and RSD group, respectively (P = .55). Thirty-day/in-hospital mortality was similar between the groups (7.5% RSD vs 7.2% CAA; P = 1.00). One early graft-related death occurred on postoperative day 4 due to CAA rupture and hemorrhagic shock. Median follow-up was 20.5 and 21.5 months in the CAA and RSD groups, respectively. Overall post-discharge survival at 5 years was similar, at 59.2% in the RSD group and 59.0% in the CAA group (P = .80). Freedom from graft-related reintervention at 1 and 5 years was 81.3% and 66.2% (CAA) vs 95.6% and 92.5% (RSD; P = .02). Indications for reintervention in the CAA group included stenosis (n = 5), pseudoaneurysm (n = 2), reinfection (n = 2), occlusion (n = 2), rupture (n = 1), and graft-limb kinking (n = 1). In the RSD group, indications included reinfection (n = 3), occlusion (n = 1), endoleak (n = 1), omental coverage (n = 1), and rupture (n = 1). Freedom from reinfection at 1 and 5 years was 98.3% and 94.9% (CAA) vs 92.5% and 87.2% (RSD; P = .11). Two (2.9%) and three patients (3.8%) in the CAA and RSD group, respectively, required graft explantation due to reinfection. CONCLUSIONS Aorto-iliac graft infections can be managed safely with either CAA or RSD in selected patients for in situ reconstruction. However, reintervention was more common with CAA use. Freedom from reinfection rates in the RSD group was lower, but this was not statistically significant. Conduit choice is associated with long-term surveillance needs and reinterventions.
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Affiliation(s)
- Armin Tabiei
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN
| | | | - Amy E Glasgow
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Jill J Colglazier
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN
| | - Manju Kalra
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN
| | - Bernardo C Mendes
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN
| | - Todd E Rasmussen
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN
| | - Fahad Shuja
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN
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12
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Hosaka A, Kumamaru H, Usune S, Miyata H, Goto H. Surgical Repair of Abdominal Aorto-Iliac Prosthetic Graft Infections: A Nationwide Japanese Cohort Study. Eur J Vasc Endovasc Surg 2023; 66:407-416. [PMID: 37391011 DOI: 10.1016/j.ejvs.2023.06.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 05/23/2023] [Accepted: 06/23/2023] [Indexed: 07/02/2023]
Abstract
OBJECTIVE Prosthetic graft infection (PGI) after open abdominal aortic and iliac artery reconstruction is life threatening. However, because it is rare and frequently difficult to diagnose, robust evidence on its treatment and optimal management strategies are lacking. This study aimed to clarify the clinical characteristics and surgical treatment outcomes of this condition and to identify pre-operative and operative factors affecting its prognosis. METHODS This was a nationwide cohort study. Using a nationwide clinical registry system, patients who were treated surgically for PGI after open abdominal aortic and iliac artery reconstruction between 2011 and 2017 were investigated, and their profiles and clinical courses were analysed. The relationships between the pre-operative and operative factors and the post-operative outcomes, including death and persistent or recurrent graft related infection, were evaluated. RESULTS The study included 213 patients. The median duration between the index arterial reconstruction and surgical treatment for PGI was 644 days. Fistula development to the gastrointestinal tract was confirmed during surgery in 53.1% of patients. The cumulative overall survival rates at 30 and 90 days, one, three, and five years were 87.3%, 74.8%, 62.2%, 54.5%, and 48.1%, respectively. Pre-operative shock was the only factor independently associated with 90 day and three year death. Short term and late mortality rates, as well as the rate of persistent or recurrent graft related infection, did not differ significantly between patients treated with total removal of the infected graft and those treated with partial removal of the graft. CONCLUSION Surgery for PGI after open reconstruction of the abdominal aorta and iliac arteries is complex, and the post-operative mortality rate remains high. Partial removal of the infected graft may be an alternative in selected patients with limited extent of infection.
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Affiliation(s)
- Akihiro Hosaka
- Department of Vascular Surgery, Tokyo Metropolitan Tama Medical Centre, Tokyo, Japan; Japanese Society for Vascular Surgery, Tokyo, Japan.
| | - Hiraku Kumamaru
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shiyori Usune
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroaki Miyata
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hitoshi Goto
- Japanese Society for Vascular Surgery, Tokyo, Japan; Department of Vascular Surgery, South Miyagi Medical Centre, Miyagi, Japan
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13
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Kuzmova M, Rondelet B, Belhaj A. A rare case of aortic endograft infection by Francisella tularensis: A case report. Int J Surg Case Rep 2023; 110:108685. [PMID: 37634431 PMCID: PMC10509798 DOI: 10.1016/j.ijscr.2023.108685] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/15/2023] [Accepted: 08/15/2023] [Indexed: 08/29/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE: endovascular repair is an alternative to open repair for abdominal aortic aneurysms (AAA), which lowers morbidity and mortality but may presents infectious complications. Endograft infection is a rare but serious life-threatening condition with a mortality rate up to 50 %. We reported a case of aortic endograft infection by Francisella tularensis, rare and highly virulent gram-negative coccobacillus known for use in bioterrorism. CASE PRESENTATION: A 79-year-old man presented with asthenia, weight loss, night sweats and one episode of fever. In 2007, he underwent aorto-bi-iliac endograft repair for AAA without any complication. The diagnostic workup showed some signs of inflammation, but negative blood cultures and no sign of infection on CT scan. The combination of positron emission tomography (PET) and white blood cell (WBC) scintigraphy led to the diagnosis of aortic endograft infection. The management was antimicrobial therapy and surgery. Perioperative analysis shows the presence of Francisella Tularensis. DISCUSSION AND CONCLUSIONS: Aortic endograft infection is a serious complication with a high mortality rate. Its diagnosis may be difficult, but the combination of WBC scintigraphy and PET scan may improve identification of the infection, even if blood cultures and CT scan are negative. The gold standard treatment is removal of the endograft, debridement, and in situ reconstruction along with antibacterial therapy.
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Affiliation(s)
- Miroslava Kuzmova
- Department of Cardio-Vascular, Thoracic Surgery and Lung Transplantation, CHU UCL Namur, UCLouvain, Yvoir, Belgium.
| | - Benoît Rondelet
- Department of Cardio-Vascular, Thoracic Surgery and Lung Transplantation, CHU UCL Namur, UCLouvain, Yvoir, Belgium
| | - Asmae Belhaj
- Department of Cardio-Vascular, Thoracic Surgery and Lung Transplantation, CHU UCL Namur, UCLouvain, Yvoir, Belgium
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14
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Caradu C, Jolivet B, Puges M, Cazanave C, Ducasse E, Berard X. Reconstruction of primary and secondary aortic infections with an antimicrobial graft. J Vasc Surg 2023; 77:1226-1237.e10. [PMID: 36572322 DOI: 10.1016/j.jvs.2022.11.065] [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: 08/12/2022] [Revised: 11/22/2022] [Accepted: 11/28/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION In situ reconstruction (ISR) with autologous veins is the preferred method in infectious native aortic aneurysms (INAAs) or vascular (endo)graft infection (VGEI). However, access to biological substitutes can prove difficult and lacks versatility. This study evaluates survival and freedom from reinfection after ISR of INAA/VGEI using the antimicrobial Intergard Synergy graft combining silver and triclosan. METHODS From February 2014 to April 2020, 86 antimicrobial grafts were implanted for aortic infection. The diagnosis of INAA/VGEI and reinfection was established based on the Management of Aortic Graft Infection Collaboration criteria. Survival was analyzed using the Kaplan-Meier method and log-rank P values. RESULTS The antimicrobial graft was implanted in 32 cases of INAA, 28 of VGI, and 26 of VEI. The median age was 69.0 (interquartile range: 62.0; 74.0), with a history of coronary artery disease (n = 21; 24.4%), chronic kidney disease (n = 11; 12.8%), cancer (n = 21; 24.4%), and immunosuppression (n = 27; 31.4%). Imaging showed infiltration (n = 14; 16.3%), air (n = 10; 11.6%), and rupture (n = 16; 18.6% including 22 aortoenteric fistulae [AEnF]). Symptoms included fever (n = 37; 43.0%), shock (n = 11; 12.8%), and pain (n = 47; 54.7%). Repair was undertaken through a midline laparotomy in 75 cases (87.2%) and coeliac cross-clamping in 19 (22.1%), suprarenal in 26 (30.2%), plus celiac trunk (n = 3), mesenteric (n = 5), renal (n = 13), or hypogastric (n = 4) artery reconstruction, and omental flap coverage (n = 41; 48.8%). For AEnF, the gastrointestinal tract was repaired using direct suture (n = 14; 16.3%) or resection anastomosis (n = 8; 9.3%). Causative organisms were identified in 74 patients (86.0%), with polymicrobial infection in 32 (37.2%) and fungal coinfection in 7 (8.1%). Thirty-day and in-hospital mortality were 14.0% and 22.1% (n = 12 and 19, respectively, 3 INAA [9.4%], 7 VGI [25.0%], and 9 VEI [34.6%]). Seventy patients (81.4%) had a postoperative complication, 44 (51.2%) of whom returned to the operative room. The 1- and 2-year survival rates were 74.0% (95% confidence interval [CI]: 63.3-82.1) and 69.8% (95% CI: 58.5-78.5), respectively. Survival was significantly better for INAA vs VGEI (P = .01) and worse for AEnF (P = .001). Freedom from reinfection was 97.2% (95% CI: 89.2-99.3) and 95.0% (95% CI: 84.8-98.4) with six reinfections (7.0%) requiring two radiological/six surgical drainage and two graft removals. Primary patency was 88.0% (95% CI: 78.1-93.6) and 79.9% (95% CI: 67.3-88.1) with no significant difference between INAA and VGEI (P = .16). CONCLUSIONS ISR of INAA or VGEI with the antimicrobial graft showed encouraging early mortality, comparable to the rates found in femoral vein (9%-16%) and arterial allograft (8%-28%) studies, as well as mid-term reinfection. The highest in-hospital mortality was noted for VEI including nearly 50% of AEnF.
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Affiliation(s)
- Caroline Caradu
- Vascular Surgery Department, Bordeaux University Hospital, Bordeaux, France
| | - Benjamin Jolivet
- Vascular Surgery Department, Bordeaux University Hospital, Bordeaux, France
| | - Mathilde Puges
- Infectious Disease Department, Bordeaux University Hospital, Bordeaux, France
| | - Charles Cazanave
- Infectious Disease Department, Bordeaux University Hospital, Bordeaux, France
| | - Eric Ducasse
- Vascular Surgery Department, Bordeaux University Hospital, Bordeaux, France
| | - Xavier Berard
- Vascular Surgery Department, Bordeaux University Hospital, Bordeaux, France.
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15
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Kasa K, Hirukawa H, Fukuda S, Asami F, Katsu M, Yamamoto K, Yoshi S. A Case Series of Secondary Aortoenteric Fistula after Open Aortic Aneurysm Repair: Timing and Technique of Surgery. Ann Vasc Dis 2022; 15:324-328. [PMID: 36644267 PMCID: PMC9816031 DOI: 10.3400/avd.cr.22-00031] [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: 03/07/2022] [Accepted: 08/21/2022] [Indexed: 11/06/2022] Open
Abstract
Secondary aortoenteric fistula (sAEF) is a rare but serious complication after open aortic aneurysm repair (OAR). Although there is no consensus on the treatment strategy for sAEF, acute management of bleeding and infection control greatly affect the outcome. We report five cases of sAEF following OAR from 2016 to 2021. One patient died of sepsis following graft infection, whereas the others had relatively good outcomes. No recurrence of infection or fistula has been observed over an average follow-up period of 29.8 months. Timely management of bleeding and infection with surgical intervention resulted in favorable outcomes in our patients.
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Affiliation(s)
- Kentaro Kasa
- Department of Surgery, Tachikawa General Hospital, Nagaoka, Niigata, Japan,Division of Vascular Surgery, Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan,Corresponding author: Kentaro Kasa, MD. Department of Surgery, Tachikawa General Hospital, 1-24 Asahioka, Nagaoka, Niigata 940-8621, Japan Tel: +81-258-33-3111, Fax: +81-258-33-8811, E-mail:
| | - Hiroshi Hirukawa
- Department of Surgery, Tachikawa General Hospital, Nagaoka, Niigata, Japan
| | - Shintaro Fukuda
- Department of Surgery, Tachikawa General Hospital, Nagaoka, Niigata, Japan
| | - Fuyuki Asami
- Department of Cardiovascular Surgery, Tachikawa General Hospital, Nagaoka, Niigata, Japan
| | - Masatake Katsu
- Department of Cardiovascular Surgery, Tachikawa General Hospital, Nagaoka, Niigata, Japan
| | - Kazuo Yamamoto
- Department of Cardiovascular Surgery, Tachikawa General Hospital, Nagaoka, Niigata, Japan
| | - Shinpei Yoshi
- Department of Cardiovascular Surgery, Tachikawa General Hospital, Nagaoka, Niigata, Japan
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16
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Eidt JF, Gucwa AL, Ali A. How I do it: The neoaortoiliac system for treatment of aortoduodenal fistula after endovascular aortic repair. J Vasc Surg Cases Innov Tech 2022; 8:830-839. [PMID: 36561355 PMCID: PMC9763360 DOI: 10.1016/j.jvscit.2022.11.001] [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: 10/18/2022] [Accepted: 11/07/2022] [Indexed: 11/17/2022] Open
Abstract
The term neoaortoiliac system (NAIS) was coined by Clagett in 1993 to describe the use of the deep veins in the thigh to replace the aorta and iliac arteries in the setting of graft infection. Since that time, the NAIS procedure has been used to treat a wide array of both infectious and noninfectious conditions affecting the aortoiliac segment. In this article, we present a 10-step description of the NAIS procedure to treat an aortoduodenal fistula in a patient with an infected endovascular aneurysm repair.
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Affiliation(s)
- John F. Eidt
- Department of Surgery, Texas A&M College of Medicine, Bryan, TX,Department of Vascular Surgery, Baylor Scott and White Heart and Vascular Hospital, Dallas, TX,Correspondence: John F. Eidt, MD, Baylor Scott and White Heart and Vascular Hospital, 621 N Hall St, Ste H-030, Dallas, TX
| | - Angela L. Gucwa
- Department of Cardiothoracic and Vascular Surgery, Luminis Health Doctors Community Medical Center, Lanham, MD
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17
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Ge J, Weng C, Zhao J, Yuan D, Huang B, Wang T. Management and Clinical Outcome of Aortic Graft Infections: A Single-Center Retrospective Study. J Clin Med 2022; 11:6588. [PMID: 36362816 PMCID: PMC9656002 DOI: 10.3390/jcm11216588] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 10/27/2022] [Accepted: 11/04/2022] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND This study aimed to evaluate the outcome of various treatment options for aortic graft infection (AGI) patients and identify factors affecting their prognosis. METHODS The data of AGI patients from January 2008 to December 2019 were retrospectively collected and analyzed. The primary endpoints were 30-day mortality and perioperative complication-related morbidity; the secondary endpoints were re-infection (RI) rates, primary and secondary graft patency, overall mortality, duration of antibiotic therapy, and the number of antibiotic types used in treatment. RESULTS There was no significant difference in the 30-day mortality and perioperative-related complications between the conservative treatment, in-situ reconstruction (ISR), and extra-anatomic reconstruction (EAR) groups. The ISR group had lower re-infection rates and better overall survival rates than the EAR and conservative treatment groups. Different bypass graft conduits had no significant influence on the RI rate or primary and secondary graft patency. AGI patients infected with high-virulence pathogens had higher RI and overall mortality rates than those infected with low virulence pathogens, but this was not statistically significant. Initial procedures prior to the AGI also had no influence on the prognosis of AGI patients. Patients undergoing ISR or EAR surgery received antibiotic therapy for a longer duration than patients undergoing conservative treatment. Patients without RI received more types of antibiotics than patients with RI. CONCLUSIONS ISR had lower RI rates and better overall survival rates than EAR and conservative treatment and may be a better choice for patients with AGI. Several factors were found to have no influence on patients' prognosis however, further studies are required.
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Affiliation(s)
| | | | | | | | | | - Tiehao Wang
- Department of Vascular Surgery, West China Hospital, Sichuan University, 37 Guo Xue Alley, Chengdu 610041, China
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18
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Janko MR, Hubbard G, Back M, Shah SK, Pomozi E, Szeberin Z, DeMartino R, Wang LJ, Crofts S, Belkin M, Davila VJ, Lemmon GW, Wang SK, Czerny M, Kreibich M, Humphries MD, Shutze W, Joh JH, Cho S, Behrendt CA, Setacci C, Hacker RI, Sobreira ML, Yoshida WB, D'Oria M, Lepidi S, Chiesa R, Kahlberg A, Go MR, Rizzo AN, Black JH, Magee GA, Elsayed R, Baril DT, Beck AW, McFarland GE, Gavali H, Wanhainen A, Kashyap VS, Stoecker JB, Wang GJ, Zhou W, Fujimura N, Obara H, Wishy AM, Bose S, Smeds M, Liang P, Schermerhorn M, Conrad MF, Hsu JH, Patel R, Lee JT, Liapis CD, Moulakakis KG, Farber MA, Motta F, Ricco JB, Bath J, Coselli JS, Aziz F, Coleman DM, Davis FM, Fatima J, Irshad A, Shalhub S, Kakkos S, Zhang Q, Lawrence PF, Woo K, Chung J. In-situ Bypass Is Associated with Superior Infection-free Survival Compared to Extra-Anatomic Bypass for the Management of Secondary Aortic Graft Infections Without Enteric Involvement. J Vasc Surg 2022; 76:546-555.e3. [PMID: 35470015 DOI: 10.1016/j.jvs.2022.03.869] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 03/27/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The optimal revascularization modality following complete resection of aortic graft infection (AGI) without enteric involvement remains unclear. The purpose of this investigation is to determine the revascularization approach associated with the lowest morbidity and mortality using real-world data in patients undergoing complete excision of AGI. METHODS A retrospective, multi-institutional study of AGI from 2002-2014 was performed using a standardized database. Baseline demographics, comorbidities, and perioperative variables were recorded. The primary outcome was infection-free survival. Descriptive statistics, Kaplan-Meier survival analysis, and univariate and multivariable analyses were performed. RESULTS 241 patients at 34 institutions from 7 countries presented with AGI during the study period (median age 68 years; 75% male). The initial aortic procedures that resulted in AGI were 172 surgical grafts (71%) and 66 endografts (27%) and 3 unknown (2%). 172 (71%) of the patients underwent complete excision of infected aortic graft material followed by in situ (in-line) bypass (ISB), including antibiotic-treated prosthetic graft (35%), autogenous femoral vein (NAIS) (24%), and cryopreserved allograft (41%). 69 patients (29%) underwent extra-anatomic bypass (EAB). Overall median Kaplan-Meier (KM) estimated survival was 5.8 years. Perioperative mortality was 16%. When stratified by ISB versus EAB, there was a significant difference in KM estimated infection-free survival (2910 days, IQR 391, 3771 versus 180 days, IQR 27, 3750 days; p<0.001). There were otherwise no significant differences in presentation, comorbidities, nor perioperative variables. Multivariable Cox regression showed lower infection-free survival among patients with EAB (HR 2.4, 95% CI 1.6-3.6; p<0.001), polymicrobial infection (HR 2.2, 95% CI 1.4-3.5; p=0.001), MRSA infection (HR 1.7, 95% CI 1.1-2.7; p=0.02), as well as the protective effect of omental/muscle flap coverage (HR 0.59, 95% CI 0.37-0.92; p=0.02). CONCLUSIONS After complete resection of AGI, perioperative mortality is 16% and median overall survival is 5.8 years. EAB is associated with nearly a two-and-half fold higher re-infection/mortality compared to ISB. Omental and/or muscle flap coverage of the repair appear protective.
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Affiliation(s)
- Matthew R Janko
- Division of Vascular Surgery and Endovascular Therapy, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Grant Hubbard
- Division of Vascular Surgery and Endovascular Therapy, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Martin Back
- Division of Vascular Surgery, Department of Surgery, University of Florida, Gainesville, FL
| | - Samir K Shah
- Division of Vascular Surgery, Department of Surgery, University of Florida, Gainesville, FL
| | - Eniko Pomozi
- Department of Vascular and Endovascular Surgery, Semmelweis University, Budapest, Hungary
| | - Zoltan Szeberin
- Department of Vascular and Endovascular Surgery, Semmelweis University, Budapest, Hungary
| | - Randall DeMartino
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN
| | - Linda J Wang
- Department of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA
| | - Sarah Crofts
- Department of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA
| | - Michael Belkin
- Department of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Victor J Davila
- Division of Vascular Surgery, Department of General Surgery, Mayo Clinic Arizona, Phoenix, AZ
| | - Gary W Lemmon
- Division of Vascular Surgery, Department of Surgery, Indiana University, Indianapolis, IN
| | - Shihuan K Wang
- Division of Vascular Surgery, Department of Surgery, Indiana University, Indianapolis, IN
| | - Martin Czerny
- Department of Cardiovascular Surgery, University Heart Center Freiburg Bad Krozingen, Freiburg, Germany
| | - Maximilian Kreibich
- Department of Cardiovascular Surgery, University Heart Center Freiburg Bad Krozingen, Freiburg, Germany
| | - Misty D Humphries
- Division of Vascular Surgery, Department of Surgery, UC Davis Health, Sacramento, CA
| | - William Shutze
- Texas Vascular Associates, The Heart Hospital Plano, Plano, TX
| | - Jin Hyun Joh
- Division of Vascular Surgery, Department of Surgery, Kyung Hee University Hospital at Gangdong, Seoul, South Korea
| | - Sungsin Cho
- GermanVasc Research Group, Department of Vascular Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian-Alexander Behrendt
- GermanVasc Research Group, Department of Vascular Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Carlo Setacci
- Department of Vascular and Endovascular Surgery, University of Siena, Sienna, Italy
| | - Robert I Hacker
- Division of Vascular Surgery, Surgical Arts of St. Louis, Bridgeton, MO
| | - Marcone Lima Sobreira
- Department of Surgery and Orthopedics, Botucatu School of Medicine, Paulista State University, São Paulo, Brazil
| | - Winston Bonetti Yoshida
- Department of Surgery and Orthopedics, Botucatu School of Medicine, Paulista State University, São Paulo, Brazil
| | - Mario D'Oria
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste, Trieste, Italy
| | - Sandro Lepidi
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste, Trieste, Italy
| | - Roberto Chiesa
- Department of Vascular Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Kahlberg
- Department of Vascular Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - Michael R Go
- Division of Vascular Diseases and Surgery, Department of Surgery, The Ohio State University College of Medicine, Columbus, OH
| | - Anthony N Rizzo
- Division of Vascular Diseases and Surgery, Department of Surgery, The Ohio State University College of Medicine, Columbus, OH
| | - James H Black
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Johns Hopkins Hospital, Baltimore, MD
| | - Gregory A Magee
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Southern California, Los Angeles, CA
| | - Ramsey Elsayed
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Southern California, Los Angeles, CA
| | - Donald T Baril
- Division of Vascular Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Adam W Beck
- Division of Vascular Surgery and Endovascular Therapy, University of Alabama at Birmingham, Birmingham, AL
| | - Graeme E McFarland
- Division of Vascular Surgery and Endovascular Therapy, University of Alabama at Birmingham, Birmingham, AL
| | - Hamid Gavali
- Section of Vascular Surgery, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Anders Wanhainen
- Section of Vascular Surgery, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Vikram S Kashyap
- Division of Vascular Surgery and Endovascular Therapy, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Jordan B Stoecker
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Grace J Wang
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Wei Zhou
- Division of Vascular Surgery, Department of Surgery, University of Arizona, Tucson, AZ
| | - Naoki Fujimura
- Department of Surgery, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Hideaki Obara
- Department of Surgery, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Andrew M Wishy
- Division of Vascular and Endovascular Surgery, Brooke Army Medical Center, San Antonio, TX
| | - Saideep Bose
- Division of Vascular Surgery, Department of Surgery, Saint Louis University, St Louis, MO
| | - Matthew Smeds
- Division of Vascular Surgery, Department of Surgery, Saint Louis University, St Louis, MO
| | - Patric Liang
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Marc Schermerhorn
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Mark F Conrad
- Division of Vascular Surgery, St Elizabeth's Hospital, Brighton, MA
| | - Jeffrey H Hsu
- Division of Vascular Surgery, Kaiser Permanente, Fontana, CA
| | - Rhusheet Patel
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Jason T Lee
- Division of Vascular Surgery, Department of Surgery, Stanford University Medical Center, Stanford, CA
| | - Christos D Liapis
- Department of Vascular Surgery, Attikon University Hospital, National & Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos G Moulakakis
- Department of Vascular Surgery, Attikon University Hospital, National & Kapodistrian University of Athens, Athens, Greece
| | - Mark A Farber
- Division of Vascular Surgery, Department of Surgery, University of North Carolina, Chapel Hill, NC
| | - Fernando Motta
- Division of Vascular Surgery, Department of Surgery, University of North Carolina, Chapel Hill, NC
| | - Jean-Baptiste Ricco
- Department of Clinical Research, University of Poitiers Medical School, Poitiers, France
| | - Jonathan Bath
- Cardiovascular Surgical Clinics, University of Missouri, Columbia, MO
| | - Joseph S Coselli
- Division of Vascular Surgery, Penn State Health Heart and Vascular Institute, Hershey, PA
| | - Faisal Aziz
- Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Dawn M Coleman
- MedStar Heart and Vascular Institute, Georgetown University, Washington, DC
| | - Frank M Davis
- MedStar Heart and Vascular Institute, Georgetown University, Washington, DC
| | - Javairiah Fatima
- Cardiovascular Center at Tufts Medical Center, Tufts University School of Medicine, Boston, MA
| | - Ali Irshad
- Division of Vascular Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, WA
| | - Sherene Shalhub
- Division of Vascular Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, WA
| | - Stavros Kakkos
- Department of Vascular Surgery, University of Patras Medical School, Patras, Greece
| | - Qianzi Zhang
- Division of Vascular and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX
| | - Peter F Lawrence
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Karen Woo
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Jayer Chung
- Division of Vascular and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX.
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Shiraev TP, de Boer M, Joseph S, Loa J, Qasabian R. Aortic graft explants - A single institution analysis of incidence and outcomes. Vascular 2022; 31:433-440. [PMID: 35103533 DOI: 10.1177/17085381211068219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Explantation of both endovascular endovascular aneurysm repair and open aortic grafts is a procedure associated with high peri-operative risk, and the current study sought to determine the outcomes and trends over time in these patients. METHODS This study examined data from all patients undergoing explant of an aortic graft (both open and endovascular) between January 2004 and December 2020 at a single centre. Variables analysed included comorbidities, duration to and indication for explantation, type of revascularization, in-hospital complications and mortality, duration of hospital and ICU stay, and out-patient mortality. RESULTS Of 688 open and 1352 EVARs performed, 46 patients underwent 48 explants. Five were open grafts and 43 were endografts, equating to an explant rate of 0.73% of open and 3.18% EVARs. Average time to explant was 70 months, with patients presenting electively having a significantly longer duration to representation than those presenting emergently (51 vs 44 months, p=0.003). Indication for explant was endoleak in 70%, infection in 23%, and occlusion in 6%. Of the endoleaks, 61% of were Type 1, 22% Type II, 11% Type IV, and 6% Type V. On representation, 17 patients (35%) were symptomatic. Overall mortality rate was 8.3%, with a trend for higher mortality in emergent than elective presentations (11.8 vs 6.5%, p=0.55). There was no change in explant rate over time. CONCLUSIONS Elective aortic graft explantation is associated with low mortality, despite its complexity and patient comorbidities. Patients presenting with symptoms suffered higher mortality and a longer post-operative course, suggesting that aortic graft explantation should be considered sooner rather than later, rather than persisting with repeated endovascular management.
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Affiliation(s)
- Timothy P Shiraev
- Vascular Surgery, 2205Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.,523002The University of Notre Dame, Sydney
| | - Madeleine de Boer
- Vascular Surgery, 2205Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Simon Joseph
- Vascular Surgery, 2205Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Jacky Loa
- Vascular Surgery, 2205Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Raffi Qasabian
- Vascular Surgery, 2205Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
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20
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Vascular Graft Infections: An Overview of Novel Treatments Using Nanoparticles and Nanofibers. FIBERS 2022. [DOI: 10.3390/fib10020012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Vascular disease in elderly patients is a growing health concern, with an estimated prevalence of 15–20% in patients above 70 years old. Current treatment for vascular diseases requires the use of a vascular graft (VG) to revascularize lower or upper extremities, create dialysis access, treat aortic aneurysms, and repair dissection. However, postoperative infection is a major complication associated with the use of these VG, often necessitating several operations to achieve complete or partial graft excision, vascular coverage, and extra-anatomical revascularization. There is also a high risk of morbidity, mortality, and limb loss. Therefore, it is important to develop a method to prevent or reduce the incidence of these infections. Numerous studies have investigated the efficacy of antibiotic- and antiseptic-impregnated grafts. In comparison to these traditional methods of creating antimicrobial grafts, nanotechnology enables researchers to design more efficient VG. Nanofibers and nanoparticles have a greater surface area compared to bulk materials, allowing for more efficient encapsulation of antibiotics and better control over their temporo-spatial release. The disruptive potential of nanofibers and nanoparticles is exceptional, and they could pave the way for a new generation of prosthetic VG. This review aims to discuss how nanotechnology is shaping the future of cardiovascular-related infection management.
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21
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Cajas-Monson L, Park M, Kalra M. A 73-year-old woman with delayed intra-abdominal and systemic sepsis following complicated aortobifemoral bypass. J Vasc Surg 2021; 74:2074-2075. [PMID: 34809815 DOI: 10.1016/j.jvs.2020.12.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 12/05/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Luis Cajas-Monson
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn
| | - Myung Park
- Division of Trauma, Critical Care, and General Surgery, Mayo Clinic, Rochester, Minn
| | - Manju Kalra
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn.
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22
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Contemporary Outcomes After Partial Resection of Infected Aortic Grafts. Ann Vasc Surg 2021; 76:202-210. [PMID: 34437963 DOI: 10.1016/j.avsg.2021.07.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 07/01/2021] [Accepted: 07/05/2021] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Aortic graft infection remains a considerable clinical challenge, and it is unclear which variables are associated with adverse outcomes among patients undergoing partial resection. METHODS A retrospective, multi-institutional study of patients who underwent partial resection of infected aortic grafts from 2002 to 2014 was performed using a standard database. Baseline demographics, comorbidities, operative, and postoperative variables were recorded. The primary outcome was mortality. Descriptive statistics, Kaplan-Meier (KM) survival analysis, and Cox regression analysis were performed. RESULTS One hundred fourteen patients at 22 medical centers in 6 countries underwent partial resection of an infected aortic graft. Seventy percent were men with median age 70 years. Ninety-seven percent had a history of open aortic bypass graft: 88 (77%) patients had infected aortobifemoral bypass, 18 (16%) had infected aortobiiliac bypass, and 1 (0.8%) had an infected thoracic graft. Infection was diagnosed at a median 4.3 years post-implant. All patients underwent partial resection followed by either extra-anatomic (47%) or in situ (53%) vascular reconstruction. Median follow-up period was 17 months (IQR 1, 50 months). Thirty-day mortality was 17.5%. The KM-estimated median survival from time of partial resection was 3.6 years. There was no significant survival difference between those undergoing in situ reconstruction or extra-anatomic bypass (P = 0.6). During follow up, 72% of repairs remained patent and 11% of patients underwent major amputation. On univariate Cox regression analysis, Candida infection was associated with increased risk of mortality (HR 2.4; P = 0.01) as well as aortoenteric fistula (HR 1.9, P = 0.03). Resection of a single graft limb only to resection of abdominal (graft main body) infection was associated with decreased risk of mortality (HR 0.57, P = 0.04), as well as those with American Society of Anesthesiologists classification less than 3 (HR 0.35, P = 0.04). Multivariate analysis did not reveal any factors significantly associated with mortality. Persistent early infection was noted in 26% of patients within 30 days postoperatively, and 39% of patients were found to have any post-repair infection during the follow-up period. Two patients (1.8%) were found to have a late reinfection without early persistent postoperative infection. Patients with any post-repair infection were older (67 vs. 60 years, P = 0.01) and less likely to have patent repairs during follow up (59% vs. 32%, P = 0.01). Patients with aortoenteric fistula had a higher rate of any post-repair infection (63% vs. 29%, P < 0.01) CONCLUSION: This large multi-center study suggests that patients who have undergone partial resection of infected aortic grafts may be at high risk of death or post-repair infection, especially older patients with abdominal infection not isolated to a single graft limb, or with Candida infection or aortoenteric fistula. Late reinfection correlated strongly with early persistent postoperative infection, raising concern for occult retained infected graft material.
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Banks CA, Beck AW, McFarland GE, Eudailey K. Concomitant paravisceral and thoracic mycotic aortic aneurysms in a cirrhotic patient. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2021; 7:496-501. [PMID: 34386680 PMCID: PMC8346550 DOI: 10.1016/j.jvscit.2021.06.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 06/13/2021] [Indexed: 11/23/2022]
Abstract
In the present case report, we have described concomitant, rapidly expanding, abdominal and thoracic mycotic aortic pseudoaneurysms in a patient who had originally presented for right arm superficial thrombophlebitis and a right-hand abscess in the presence of methicillin sensitive Staphylococcus aureus bacteremia. Within 12 days, the patient had developed a rapidly expanding paravisceral mycotic abdominal aortic pseudoaneurysm that required open surgical repair. After the initial operation, she developed a thoracic mycotic aortic aneurysm that ultimately required open surgical repair. Her postoperative course after the initial operation was complicated by decompensated hepatitis C cirrhosis that required convalescence before repair of the thoracic aneurysm. Follow-up data were available for ≤10 months after the initial operation.
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Affiliation(s)
- C. Adam Banks
- Division of Vascular Surgery and Endovascular Therapy, University of Alabama at Birmingham, Birmingham, Ala
| | - Adam W. Beck
- Division of Vascular Surgery and Endovascular Therapy, University of Alabama at Birmingham, Birmingham, Ala
| | - Graeme E. McFarland
- Division of Vascular Surgery and Endovascular Therapy, University of Alabama at Birmingham, Birmingham, Ala
- Correspondence: Graeme E. McFarland, MD, Division of Vascular Surgery and Endovascular Therapy, University of Alabama at Birmingham, 1720 University Blvd, Birmingham, AL 35294
| | - Kyle Eudailey
- Division of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, Ala
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Treatment and Outcomes of Aortic Graft Infections Using a Decision Algorithm. Ann Vasc Surg 2021; 76:254-268. [PMID: 34182116 DOI: 10.1016/j.avsg.2021.04.047] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/21/2021] [Accepted: 04/22/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Aortic graft infection (AGI) is a rare but devastating complication requiring both explant of the infected prosthesis and lower extremity revascularization. Despite a variety of methods to treat AGI, there is a paucity of evidence that describes comparative outcomes. Moreover, controversy exists surrounding what the optimal repair strategy is with limited descriptions of how these techniques should be employed in this complex group of patients. Therefore, the purpose of this analysis was to review our experience with AGI management while highlighting a practice philosophy that can achieve acceptable outcomes. METHODS All AGI patients between 2002-2019 were reviewed. The primary end-point was 30-day mortality. Secondary end-points included complications, re-infection, unplanned re-operation and all-cause mortality. Kaplan-Meier methodology was used to estimate time to events. Cox regression models were employed to identify association between patient factors and operative strategy with survival. Subgroup analysis included outcome comparison among four different operative approaches(extra-anatomic bypass with aortic ligation [EAB] and in-situ reconstruction [ISR] using either NAIS, cryopreserved allograft [Cryo], or antibiotic-soaked prosthetic grafts [Other]). RESULTS 142 patients (male-69%, mean age 67 ± 11 years) were reviewed. Median time to AGI presentation was 52 (IQR 16-128) months. ISR was performed in 70% (n = 99)[ISR: NAIS-49% (n = 49), Cryo, 33% (n = 33) and Other-23% (n = 23)]. EAB was used in 26% (n = 37), of which 57% (n = 21) were staged repairs[no reconstruction, 4%: intraoperative death-2, AGI removal without reconstruction-2]. A graft enteric erosion/fistula was identified in 39% (n = 55). Mean follow-up time was 14 ± 27 (median 2.2[IQR 0.1-16]) months. Overall, 30-day mortality was 21% and 69% (n = 98) experienced a complication. The most common complications were pulmonary (35%;n = 50), vascular (28%;n = 39), gastrointestinal (22%;n = 31) and renal (21%;n = 30). Freedom from re-infection at one and three years was 78 ± 5% and 73 ± 6% while freedom from unplanned re-operation was 50 ± 5% and 40 ± 6%, respectively. Corresponding one- and five-year freedom from all-cause mortality was 67 ± 4% and 53 ± 4%. When stratified by the four different repair strategies, unadjusted rates of postoperative complications and mortality were not different. However, EAB patients had more renal complications. All-cause mortality predictors included age (HR 1.04, 95%CI 1.01-1.1; P = 0.003), CHF (HR 2.7, 1.3-5.7; P = 0.01), and graft enteric erosion/fistula (HR 2.2, 1.3-3.8;P = 0.005) while total graft excision was protective (HR 0.34, 0.2-0.7; P = 0.003). CONCLUSIONS AGI repair, regardless of operative strategy, results in significant early morbidity, and mortality. The need for unplanned re-operation is common; however, long-term survival is acceptable in appropriately selected patients. Re-infection risk mandates life-long surveillance and consideration of indefinite anti-microbial suppression in certain subgroups. Due to the complexity and intensity of care, all AGI should be treated, when possible, at centers performing high-volume aortic surgery.
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Georges G, Allard B, Dakkak M, Nourissat G, Febrer G. Appraising 5 years in activity of the largest public Canadian vascular graft bank. J Vasc Surg 2021; 74:972-978. [PMID: 33684476 DOI: 10.1016/j.jvs.2021.02.022] [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: 09/03/2020] [Accepted: 02/08/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND In Canada, tissue distribution is managed by provincial entities. In 2014, Hema-Quebec established a cryopreserved vascular tissue bank accessible to all Canadian hospitals. The objectives of this report were to review the first 5 years of activity of Hema-Quebec's vascular bank and to briefly assess the competitiveness of its products. METHODS Deceased donors, ages 15 to 60, were screened for common blood-borne diseases. Grafts were treated in a triple-antibiotic solution at 35°C before preservation at -100°C. Hema-Quebec's vascular graft records were analyzed from 2014 to 2019 inclusively. RESULTS The average donor age was 35 years old and 78% of donors were men. Overall, 63% of harvested grafts cleared the quality management system. Positive microbial cultures and morphologic defects were the major reasons for graft discard. As such, a total of 60 grafts were delivered between 2016 and 2019 to 8 hospital centers. Moreover, the bank achieved a mean activity increase of 55% per year and Hema-Quebec's homografts were 48% less costly compared with similar homographs from for-profit organizations. CONCLUSIONS Our findings demonstrate that Hema-Quebec has established a viable cryopreserved vascular tissue bank with steady increase in activity and an acceptable graft discard rates and pricing. Based on our findings, we recommend that efforts should be directed to expand the tissue bank graft distribution outside the province of Quebec.
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Affiliation(s)
- Gabriel Georges
- Laval University, Cardiac Surgery Department, Institut Universitaire de Cardiologie et de Pneumologie de Québec (IUCPQ), Quebec City, Canada.
| | | | - Mazen Dakkak
- Héma-Québec, Côte-Vertu Ouest, Saint-Laurent, Canada
| | - Ghislain Nourissat
- Laval University, Vascular Surgery Department, Saint-François d'Assise Hospital, Quebec City, Canada
| | - Guillaume Febrer
- Hôpital du Sacré-Coeur de Montréal, Vascular Surgery Department, Montreal, Canada
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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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Burghuber CK, Konzett S, Eilenberg W, Nanobachvili J, Funovics MA, Hofmann WJ, Neumayer C, Domenig CM. Novel prefabricated bovine pericardial grafts as alternate conduit for septic aortoiliac reconstruction. J Vasc Surg 2020; 73:2123-2131.e2. [PMID: 33278536 DOI: 10.1016/j.jvs.2020.11.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 11/05/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Infection of prosthetic aortic grafts represents a serious complication with high morbidity and mortality. Replacement with autologous material is recommended; however, in its absence, biological material should be favored. In the present retrospective cohort study, we evaluated the short- and midterm results with the use of commercially available prefabricated bovine pericardium grafts (BPGs) used for the management of aortic graft infection or aortic reconstructive surgery in the presence of systemic infection. METHODS We performed a retrospective analysis of patients in whom BPGs had been used for aortic reconstruction at two vascular centers. Prefabricated vascular pericardium grafts were preferred over other biological reconstruction techniques for selected cases. Comorbidities, procedure-related details, perioperative morbidity, clinical outcomes, and mortality were analyzed. RESULTS From 2014 to 2019, 21 patients had received BPGs at two Austrian vascular centers. Their median age was 63 years (interquartile range [IQR], 55-71 years), the patients were predominantly male (76%), and the median body mass index was 25.3 kg/m2 (IQR, 21.7-27.3 kg/m2). The major comorbidities included arterial hypertension, peripheral artery disease, smoking, and chronic pulmonary disease. The indications for surgery were vascular graft or endograft infection in 62% and aortic reconstruction in the presence of systemic infection in 38%. Three patients (14%) had aortoenteric fistulas. Surgery was technically successful in all cases. The median follow-up was 21.6 months (IQR, 6.0-34.6 months). The 30-day mortality was 9.5%. The 1- and 2-year overall survival was 84% and 75%, respectively. Of the 21 patients, 89% had remained free of recurrent infection. One of the two reinfections had resolved after treatment of the underlying focus. At 2 years, the primary and assisted primary patency rates were 86% and 94%, respectively. No limbs were lost during follow-up. CONCLUSIONS Prefabricated BPGs represent a promising alternative for the management of aortic graft infections and aortoiliac reconstruction in the presence of systemic infection.
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Affiliation(s)
- Christopher K Burghuber
- Division of Vascular Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Sophie Konzett
- Department of Vascular Surgery, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - Wolf Eilenberg
- Division of Vascular Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Josif Nanobachvili
- Division of Vascular Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Martin A Funovics
- Division of Angiography and Interventional Radiology, Department of Radiology, Medical University of Vienna, Vienna, Austria
| | - Wolfgang J Hofmann
- Department of Vascular Surgery, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - Christoph Neumayer
- Division of Vascular Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Christoph M Domenig
- Division of Vascular Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria.
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Moriyama H, Kimura K, Takago S, Nishida Y, Shimada M, Takemura H. Aortoduodenal Fistula After Endovascular Aortic Repair for an Inflammatory Abdominal Aortic Aneurysm: A Case Report. Vasc Endovascular Surg 2020; 55:95-99. [PMID: 32875968 DOI: 10.1177/1538574420954307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Aortoenteric fistula after endovascular aortic repair for an abdominal aortic aneurysm is a rare but severe complication. Particularly, a case of inflammatory abdominal aortic aneurysm is extremely rare and there are only 3 reported cases. A 70-year-old man underwent endovascular aortic repair for impending rupture of an inflammatory abdominal aortic aneurysm and was medicated steroids for approximately 2 years. Four years after endovascular aortic repair, he developed endograft infection with an aortoduodenal fistula and a left psoas abscess. He underwent total endograft excision, debridement, in situ reconstruction of the aorta using prosthetic grafts with omental coverage, and digestive tract reconstruction to prevent leakage. Pseudomonas aeruginosa was detected in the infected aortic sac. The patient has not experienced recurrence of infection in the 35 months since his operation.
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Affiliation(s)
- Hideki Moriyama
- Department of Thoracic, Cardiovascular and General Surgery, 12858Kanazawa University, Ishikawa, Japan
| | - Keiichi Kimura
- Department of Thoracic, Cardiovascular and General Surgery, 12858Kanazawa University, Ishikawa, Japan
| | - Shintaro Takago
- Department of Thoracic, Cardiovascular and General Surgery, 12858Kanazawa University, Ishikawa, Japan
| | - Yoji Nishida
- Department of Thoracic, Cardiovascular and General Surgery, 12858Kanazawa University, Ishikawa, Japan
| | - Mari Shimada
- Department of Thoracic, Cardiovascular and General Surgery, 12858Kanazawa University, Ishikawa, Japan
| | - Hirofumi Takemura
- Department of Thoracic, Cardiovascular and General Surgery, 12858Kanazawa University, Ishikawa, Japan
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Niaz OS, Rao A, Abidia A, Parrott R, Refson J, Somaiya P. Surgical and medical interventions for abdominal aortic graft infections. Cochrane Database Syst Rev 2020; 8:CD013469. [PMID: 32761821 PMCID: PMC8078185 DOI: 10.1002/14651858.cd013469.pub2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Abdominal aortic graft infections are a major complication following abdominal aortic aneurysm surgery, with high morbidity and mortality rates. They can be treated surgically or conservatively using medical management. The two most common surgical techniques are in situ replacement of the graft and extra-anatomical bypass. Medical management most commonly consists of a course of long-term antibiotics. There is currently no consensus on which intervention (extra-anatomical bypass, in situ replacement, or medical) is the most effective in managing abdominal aortic graft infections. Whilst in emergency or complex situations such as graft rupture surgical management is the only option, in non-emergency situations it is often personal preference that influences the clinician's decision-making. OBJECTIVES To assess and compare the effects of surgical and medical interventions for abdominal aortic graft infections. SEARCH METHODS The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase, and CINAHL databases and WHO ICTRP and ClinicalTrials.gov trials registers to 2 December 2019. We also reviewed the bibliographies of the studies identified by the search and contacted specialists in the field and study authors to request information on any possible unpublished data. SELECTION CRITERIA We aimed to include all randomised controlled trials that used surgical or medical interventions to treat abdominal aortic graft infections. The definitions of abdominal aortic graft infections were accepted as presented in the individual studies, and included secondary infection due to aortoenteric fistula. We excluded studies presenting data on prosthetic graft infections in general, unless data specific to abdominal aortic graft infections could be isolated. DATA COLLECTION AND ANALYSIS Two review authors independently assessed all studies identified by the search. We planned to independently assess risk of bias of the included trials and to evaluate the quality of the evidence using the GRADE approach. Our main outcomes were overall mortality, amputation, graft re-infection, overall graft-related complications, graft-related mortality, acute limb ischaemia, and re-intervention. MAIN RESULTS We identified no randomised controlled trials to conduct meta-analysis. AUTHORS' CONCLUSIONS There is currently insufficient evidence to draw conclusions to support any treatment over the other. Multicentre clinical trials are required to compare different treatments for the condition.
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Affiliation(s)
- Osamah S Niaz
- Department of Vascular Surgery, The Princess Alexandra Hospital, Harlow, UK
| | - Ahsan Rao
- Department of Vascular Surgery, The Princess Alexandra Hospital, Harlow, UK
| | - Ahmed Abidia
- Department of Vascular Surgery, The Princess Alexandra Hospital, Harlow, UK
| | - Rebecca Parrott
- Harlow Healthcare Library, The Princess Alexandra Hospital, Harlow, UK
| | - Jonathan Refson
- Department of Vascular Surgery, The Princess Alexandra Hospital, Harlow, UK
| | - Pranav Somaiya
- Department of Vascular Surgery, Barts Health NHS Trust, London, UK
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In situ bypass and extra-anatomic bypass procedures result in similar survival in patients with secondary aortoenteric fistulas. J Vasc Surg 2020; 73:210-221.e1. [PMID: 32445832 DOI: 10.1016/j.jvs.2020.04.515] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 04/22/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVE The optimal revascularization modality in secondary aortoenteric fistula (SAEF) remains unclear in the literature. The purpose of this investigation was to determine the revascularization approach associated with the lowest morbidity and mortality using real-world data in patients with SAEF. METHODS A retrospective, multi-institutional study of SAEF from 2002 to 2014 was performed using a standardized database. Baseline demographics, comorbidities, and operative and postoperative variables were recorded. The primary outcome was long-term mortality. Descriptive statistics, Kaplan-Meier survival analysis, and univariate and multivariate analyses were performed. RESULTS During the study period, 182 patients at 34 institutions from 11 countries presented with SAEF (median age, 72 years; 79% male). The initial aortic procedures that resulted in SAEF were 138 surgical grafts (76%) and 42 endografts (23%), with 2 unknown; 102 of the SAEFs (56%) underwent complete excision of infected aortic graft material, followed by in situ (in-line) bypass (ISB), including antibiotic-soaked prosthetic graft (53), autogenous femoral vein (neoaortoiliac surgery; 17), cryopreserved allograft (28), and untreated prosthetic grafts (4). There were 80 patients (44%) who underwent extra-anatomic bypass (EAB) with infected graft excision. Overall median Kaplan-Meier estimated survival was 319 days (interquartile range, 20-2410 days). Stratified by EAB vs ISB, there was no significant difference in Kaplan-Meier estimated survival (P = .82). In comparing EAB vs ISB, EAB patients were older (74 vs 70 years; P = .01), had less operative hemorrhage (1200 mL vs 2000 mL; P = .04), were more likely to initiate dialysis within 30 days postoperatively (15% vs 5%; P = .02), and were less likely to experience aorta-related hemorrhage within 30 days postoperatively (3% aortic stump dehiscence vs 11% anastomotic rupture; P = .03). There were otherwise no significant differences in presentation, comorbidities, and intraoperative or postoperative variables. Multivariable Cox regression showed that the duration of antibiotic use (hazard ratio, 0.92; 95% confidence interval, 0.86-0.98; P = .01) and rifampin use at time of discharge (hazard ratio, 0.20; 95% confidence interval, 0.05-0.86; P = .03) independently decreased mortality. CONCLUSIONS These data suggest that ISB does not offer a survival advantage compared with EAB and does not decrease the risk of postoperative aorta-related hemorrhage. After repair, <50% of SAEF patients survive 10 months. Each week of antibiotic use decreases mortality by 8%. Further study with risk modeling is imperative for this population.
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Alonso W, Ozdemir B, Chassin-Trubert L, Ziza V, Alric P, Canaud L. Early outcomes of native and graft-related abdominal aortic infection managed with orthotopic xenopericardial grafts. J Vasc Surg 2020; 73:222-231. [PMID: 32442610 DOI: 10.1016/j.jvs.2020.04.513] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 04/21/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Reconstruction of infected aortic cases has shifted from extra-anatomic to in situ. This study reports the surgical strategy and early outcomes of abdominal aortic reconstruction in both native and graft-related aortic infection with in situ xenopericardial grafts. METHODS Included in the analysis are 21 consecutive patients (mean age, 69 years; 20 male) who underwent abdominal xenopericardial in situ reconstruction of native aortic infection (4) and endovascular (4) or open (13) graft aortic infection between July 2017 and September 2019. All repairs were performed on an urgent basis, but none were ruptured. All patients were followed up with clinical and biologic evaluation, ultrasound at 3 months, and computed tomography scan at 6 months and 1 year. RESULTS Technical success was 100%; 8 patients were treated with xenopericardial tubes and 13 with bifurcated grafts. Thirty-day mortality was 4.7% (one death due to pneumonia with respiratory hypoxic failure in critical care.). Six patients (28%) developed acute kidney injury, four (19%) requiring temporary dialysis; five fully recovered and one died. Four patients (19%) required a return to the operating room. After a median follow-up of 14 months (range, 1-26 months), overall mortality was 19% (n = 4). Two patients presented with recurrent sepsis after reconstruction, leading to death due to multiorgan failure. Other patients (17/21) have discontinued antibiotics with no evidence of recurrence of infection clinically, radiologically, or on blood tests. Computed tomography scans at 1 year demonstrated no stenosis or graft dilation and one asymptomatic left graft branch thrombosis. Primary patency is 95%. CONCLUSIONS In situ xenopericardial aortic reconstruction is a safe and effective management strategy for both native and graft-related abdominal aortic infection with good short-term results. The graft demonstrates appropriate resistance to infection such that reliable eradication of infection in this vascular bed is possible. Longer follow-up is required in future studies to determine the durability of the reconstruction and need for reinterventions.
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Affiliation(s)
- William Alonso
- Department of Thoracic and Vascular Surgery, Hôpital A de Villeneuve, Montpellier, France.
| | - Baris Ozdemir
- Department of Thoracic and Vascular Surgery, Hôpital A de Villeneuve, Montpellier, France
| | - Lucien Chassin-Trubert
- Department of Thoracic and Vascular Surgery, Hôpital A de Villeneuve, Montpellier, France
| | - Vicent Ziza
- Department of Thoracic and Vascular Surgery, Hôpital A de Villeneuve, Montpellier, France
| | - Pierre Alric
- Department of Thoracic and Vascular Surgery, Hôpital A de Villeneuve, Montpellier, France
| | - Ludovic Canaud
- Department of Thoracic and Vascular Surgery, Hôpital A de Villeneuve, Montpellier, France
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Chakfé N, Diener H, Lejay A, Assadian O, Berard X, Caillon J, Fourneau I, Glaudemans AWJM, Koncar I, Lindholt J, Melissano G, Saleem BR, Senneville E, Slart RHJA, Szeberin Z, Venermo M, Vermassen F, Wyss TR, de Borst GJ, Bastos Gonçalves F, Kakkos SK, Kolh P, Tulamo R, Vega de Ceniga M, von Allmen RS, van den Berg JC, Debus ES, Koelemay MJW, Linares-Palomino JP, Moneta GL, Ricco JB, Wanhainen A. Editor's Choice - European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Vascular Graft and Endograft Infections. Eur J Vasc Endovasc Surg 2020; 59:339-384. [PMID: 32035742 DOI: 10.1016/j.ejvs.2019.10.016] [Citation(s) in RCA: 272] [Impact Index Per Article: 68.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Almási-Sperling V, Heger D, Meyer A, Lang W, Rother U. Treatment of aortic and peripheral prosthetic graft infections with bovine pericardium. J Vasc Surg 2020; 71:592-598. [DOI: 10.1016/j.jvs.2019.04.485] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 04/20/2019] [Indexed: 10/26/2022]
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Feo CF, Ginesu GC, Pinna A, Galotti F, Paliogiannis P, Fancellu A, Porcu A. In situ reconstruction with autologous graft in the treatment of secondary aortoenteric fistulas: A retrospective case series. Ann Med Surg (Lond) 2019; 49:53-56. [PMID: 31890198 PMCID: PMC6926104 DOI: 10.1016/j.amsu.2019.11.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 11/20/2019] [Accepted: 11/24/2019] [Indexed: 02/08/2023] Open
Abstract
Infections caused by secondary aortoenteric fistulas (SAEF) may be extremely complex and threaten patient's life. We report our surgical approach to SAEF consisting in removal of the infected graft and in situ reconstruction using an autologous venous graft. Seven consecutive patients with SAEF treated with graft removal and in situ reconstruction using an autologous venous graft from 2008 to 2017 were reviewed. Six of seven patients (86%) survived 30-day. In one case a graft thrombosis and acute lower limb ischemia occurred requiring re-operations. All patients received injective antibiotic therapy for 20 days, followed by oral therapy for 3 months. There were no major complications at long-term follow-up. Our results suggest that superficial femoral vein reconstruction of the abdominal aorta for SAEF is effective with an acceptable in-hospital mortality and low rate of major complications. We stress the importance of the deep femoral veins to create the graft because the large saphenous vein is often affected by significant intimal hyperplasia that can cause steno-occlusive complications. In situ reconstruction for secondary aortoenteric fistulas is effective. We stress the importance of the deep femoral veins to create the graft. One of the largest series of secondary aortoenteric fistulas treated with venous graft. Morbidity and mortality are acceptable at long-term follow-up.
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Affiliation(s)
- Claudio F Feo
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100, Sassari, Italy
| | - Giorgio C Ginesu
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100, Sassari, Italy
| | - Antonio Pinna
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100, Sassari, Italy
| | - Francesca Galotti
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100, Sassari, Italy
| | - Panagiotis Paliogiannis
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100, Sassari, Italy
| | - Alessando Fancellu
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100, Sassari, Italy
| | - Alberto Porcu
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100, Sassari, Italy
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Management of abdominal aortic prosthetic graft and endograft infections. A multidisciplinary update. J Infect Chemother 2019; 25:669-680. [DOI: 10.1016/j.jiac.2019.05.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 05/16/2019] [Indexed: 12/15/2022]
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Incidence, Management, and Outcomes of Aortic Graft Infection. Ann Vasc Surg 2019; 59:73-83. [DOI: 10.1016/j.avsg.2019.01.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Revised: 01/10/2019] [Accepted: 01/11/2019] [Indexed: 11/22/2022]
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Post ICJH, Vos CG. Systematic Review and Meta-Analysis on the Management of Open Abdominal Aortic Graft Infections. Eur J Vasc Endovasc Surg 2019; 58:258-281. [PMID: 31178356 DOI: 10.1016/j.ejvs.2019.03.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 03/01/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Aortic graft infection (AGI) is a disastrous complication with an incidence of 0.2-6% in operated patients. With little or no high quality evidence, the best treatment option remains unclear. Therefore, the literature on the management of open abdominal AGI was systematically reviewed to determine optimal treatment. METHODS In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic review and meta-analysis was conducted for AGI. MEDLINE, Embase, and the Cochrane Database of Systematic Reviews were searched. Methodological quality was assessed using the Methodological Index for Non-randomised Studies (MINORS) score. Primary outcomes were 30 day mortality and one year survival. Secondary outcomes were survival, infection recurrence, limb salvage, and graft patency. RESULTS Of 1574 studies identified, 32 papers were included in the study. The overall quality of the studies was moderate, with an average MINORS score of 11.9. Pooled overall 30 day mortality and one year survival were 13.5% (95% CI 10.5-16.4) and 73.6% (95% CI 68.8-78.4), respectively. The lowest 30 day mortality and highest one year survival were found for in situ repair compared with extra-anatomic repair and for prosthetic grafts compared with venous grafts or arterial allografts. The infection recurrence rate was highest for prosthetic grafts. CONCLUSIONS There is a lack of well designed, qualitative comparative studies making conclusive recommendations impossible. The current best available data suggests that partial graft removal should be avoided and the lowest 30 day mortality and best one year survival are achieved with in situ repair using prosthetic grafts. Initiatives such as the MAGIC database to collaboratively collect prospective data are an important step forward in obtaining more solid answers on this topic.
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Affiliation(s)
- Ivo C J H Post
- Department of Surgery, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | - Cornelis G Vos
- Department of Surgery, Martini Hospital, Groningen, the Netherlands.
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Cryopreserved Allograft in the Management of Native and Prosthetic Aortic Infections. Ann Vasc Surg 2019; 56:1-10. [DOI: 10.1016/j.avsg.2018.09.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 07/06/2018] [Accepted: 09/21/2018] [Indexed: 11/20/2022]
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Janko MR, Bose S, Lawrence PF. Current status of treatment for aortic graft infection: When should cryopreserved allografts be used? Semin Vasc Surg 2019; 32:81-87. [DOI: 10.1053/j.semvascsurg.2019.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Hostalrich A, Ozdemir BA, Sfeir J, Solovei L, Alric P, Canaud L. Systematic review of native and graft-related aortic infection outcome managed with orthotopic xenopericardial grafts. J Vasc Surg 2019; 69:614-618. [DOI: 10.1016/j.jvs.2018.07.072] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 07/05/2018] [Indexed: 11/16/2022]
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Batt M, Camou F, Coffy A, Feugier P, Senneville E, Caillon J, Calvet B, Chidiac C, Laurent F, Revest M, Daures JP. A meta-analysis of outcomes of in-situ reconstruction after total or partial removal of infected abdominal aortic graft. THE JOURNAL OF CARDIOVASCULAR SURGERY 2019; 61:171-182. [PMID: 30698369 DOI: 10.23736/s0021-9509.19.10669-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION There is currently a lack of evidence for the relative effectiveness of partial resection (PR) and total resection (TR) before managing abdominal aortic graft infection (AGI). Most authorities agree that TR is mandatory for intracavitary AGI in patients with favorable conditions but there is an increasing number of patients with severe comorbidities for whom this approach is not suitable, resulting in a prohibitive mortality rate. The purpose of this study was to determine the most appropriate indication for TR or PR. EVIDENCE ACQUISITION A meta-analysis was conducted on the rates of early/late mortality, amputations and reinfection. A meta-regression was performed with eight variables: patient age, male prevalence, presence of virulent or nonvirulent organisms, urgency, omentoplasty and follow-up. EVIDENCE SYNTHESIS Twenty-one studies and 1052 patients were included. For TR and PR, the rates of early mortality and reinfection were 16.8% and 10.5%, 11% and 27%, respectively. For TR urgency and male gender were associated with increased rate of early mortality and male gender, PDF and virulent organisms were associated with increased risk of reinfection. For PR no statistical correlation was analyzable except for PDF with increased risk of reinfection. CONCLUSIONS Early mortality rates are higher for TR and reinfection rates are higher for PR. For TR early mortality increases in urgent cases and it is suggested that alternative option must be discussed, reinfection decreases in the presence of nonvirulent organisms and TR seems optimal. For TR and PR reinfection increases in presence of PDF and alternative technique may be more appropriate.
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Affiliation(s)
- Michel Batt
- Department of Vascular Surgery, University Nice-Sophia Antipolis, Nice, France -
| | - Fabrice Camou
- Intensive Care Unit, Saint-Andre University Hospital, Bordeaux, France
| | - Amandine Coffy
- Laboratory of Biostatistics and Epidemiology, University Institute for Clinical Research, Montpellier, France
| | - Patrick Feugier
- Department of Vascular Surgery, University Claude Bernard Lyon 1, Hospices Civils de Lyon, Lyon, France
| | - Eric Senneville
- Infectious Diseases Department, Gustave Dron Hospital, Lille 2 University, Tourcoing, France
| | | | - Brigitte Calvet
- Anesthosiology Department, Béziers Hospital, Béziers, France
| | - Christian Chidiac
- Infectious Deseases Department, Hospices Civils de Lyon and International Center for Infectiology Research (CIRI), INSERM U1111, Lyon 1 University, Lyon, France.,Bacteriology Department, International Center for Infectiology Research (CIRI), INSERM U1111, Lyon 1 University, Lyon, France
| | - Frederic Laurent
- Infectious Diseases, and Intensive Care Unit, Pontchaillou University Hospital, CIC-INSERM 1414, Rennes 1 University, France
| | | | - Jean Pierre Daures
- Laboratory of Biostatistics and Epidemiology, University Institute for Clinical Research, Montpellier, France
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Phang D, Smeds MR, Abate M, Ali A, Long B, Rahimi M, Giglia J, Bath J. Revascularization with Obturator or Hemi-neoaortoiliac System for Partial Aortic Graft Infections. Ann Vasc Surg 2019; 54:166-175. [DOI: 10.1016/j.avsg.2018.06.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 04/28/2018] [Accepted: 06/06/2018] [Indexed: 11/24/2022]
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Fan EY, Judelson DR, Schanzer A. Explantation of infected thoracic endovascular aortic repair. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2018; 4:307-310. [PMID: 30547153 PMCID: PMC6282643 DOI: 10.1016/j.jvscit.2018.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 02/19/2018] [Indexed: 11/29/2022]
Abstract
Prosthetic graft infection is a rare and serious complication of thoracic endovascular aortic repair associated with high mortality and posing unique challenges for treatment. The prosthetic graft infection is often identified late as patients present with mild nonspecific symptoms. We describe the successful medical management and surgical explantation of an infected thoracic endograft with an aorta-bronchial fistula, using an inline reconstruction with an antibiotic-soaked synthetic graft. In this report, we provide an example of a patient with an infected thoracic endograft and how inline reconstruction combined with appropriate medical management is an acceptable treatment strategy.
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Affiliation(s)
- Emily Y Fan
- University of Massachusetts Medical School, Worcester, Mass
| | - Dejah R Judelson
- Division of Vascular and Endovascular Surgery, University of Massachusetts Medical School, Worcester, Mass
| | - Andres Schanzer
- Division of Vascular and Endovascular Surgery, University of Massachusetts Medical School, Worcester, Mass
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Janko M, Ciocca RG, Hacker RI. Vertebral Osteophyte as Possible Etiology of Aortoenteric Fistula. Ann Vasc Surg 2018; 49:313.e5-313.e7. [DOI: 10.1016/j.avsg.2017.11.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 04/29/2017] [Accepted: 11/21/2017] [Indexed: 10/18/2022]
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Weiss S, Tobler EL, von Tengg-Kobligk H, Makaloski V, Becker D, Carrel TP, Schmidli J, Wyss TR. Self Made Xeno-pericardial Aortic Tubes to Treat Native and Aortic Graft Infections. Eur J Vasc Endovasc Surg 2017; 54:646-652. [DOI: 10.1016/j.ejvs.2017.07.017] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Accepted: 07/19/2017] [Indexed: 12/13/2022]
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Pleger SP, Nink N, Böning A, Koshty A. Ascendobifemoral Bypass for the Treatment of a Thoracic Endograft Infection. Thorac Cardiovasc Surg Rep 2017; 6:e32-e34. [PMID: 29026687 PMCID: PMC5633407 DOI: 10.1055/s-0037-1607272] [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: 06/14/2017] [Accepted: 09/05/2017] [Indexed: 11/24/2022] Open
Abstract
Background
Endograft infections (EIs) are rare complications after endovascular procedures in the thoracic and abdominal aortas. The challenging treatment encloses antibiotic and surgical therapies.
Case Description
A 74-year-old male patient developed an EI after an endovascular procedure (thoracic endovascular aortic repair [TEVAR]). Despite a long-term oral antibiotic therapy, the clinical symptoms showed no falling trend. Because of the expanded infection from above the celiac trunk up to the aortic arch, we decided to remove the infected endograft and to implant an extra-anatomic ascendobifemoral bypass.
Conclusion
The implantation of an ascendobifemoral bypass was a successful treatment option for EIs after TEVAR.
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Affiliation(s)
- Sebastian Paul Pleger
- Department of Vascular and Endovascular Surgery, Jung-Stilling Hospital, Siegen, Germany
| | - Nadine Nink
- Department of Vascular and Endovascular Surgery, Jung-Stilling Hospital, Siegen, Germany
| | - Andreas Böning
- Department of Adult and Pediatric Cardiovascular Surgery and Vascular Surgery, University Hospital of Giessen, Justus Liebig University, Giessen, Germany
| | - Ahmed Koshty
- Department of Vascular and Endovascular Surgery, Jung-Stilling Hospital, Siegen, Germany
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Lejay A, Delay C, Girsowicz E, Chenesseau B, Bonnin E, Ghariani MZ, Thaveau F, Georg Y, Geny B, Chakfe N. Cryopreserved Cadaveric Arterial Allograft for Arterial Reconstruction in Patients with Prosthetic Infection. Eur J Vasc Endovasc Surg 2017; 54:636-644. [PMID: 28890027 DOI: 10.1016/j.ejvs.2017.07.016] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 07/19/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The aim of this study was to report outcomes of cryopreserved arterial allografts used as a vascular substitute in the setting of prosthetic material infection. METHODS A retrospective analysis of prospectively collected data was conducted including all consecutive interventions performed with cryopreserved arterial allografts used for vascular reconstruction in the setting of prosthetic material infection between January 2005 and December 2014. Five year outcomes included allograft related re-interventions, survival, primary patency, and limb salvage rates. RESULTS Fifty-three procedures were performed using cryopreserved allografts for vascular prosthetic infection: 25 procedures (47%) were performed at aorto-iliac level (Group 1) and 28 procedures (53%) at peripheral level (Group 2). The mean follow-up was 52 months. Five year allograft related re-intervention was 55% in Group 1 (6 allograft ruptures and 5 allograft aneurysm degenerations) and 33% in Group 2 (2 allograft ruptures and 7 allograft aneurysm degenerations). Five year survival was 40% and 68%, primary patency was 89% and 59% and limb salvage was 100% and 89% for Group 1 and 2 respectively. CONCLUSION Use of cryopreserved arterial allografts provides acceptable results but is tempered by suboptimal 5 year outcomes with high re-intervention rates.
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Affiliation(s)
- Anne Lejay
- Department of Vascular Surgery and Kidney Transplantation, University Hospital, Strasbourg, France.
| | - Charline Delay
- Department of Vascular Surgery and Kidney Transplantation, University Hospital, Strasbourg, France
| | - Elie Girsowicz
- Department of Vascular Surgery and Kidney Transplantation, University Hospital, Strasbourg, France
| | - Bettina Chenesseau
- Department of Vascular Surgery and Kidney Transplantation, University Hospital, Strasbourg, France
| | - Emilie Bonnin
- Department of Vascular Surgery and Kidney Transplantation, University Hospital, Strasbourg, France
| | - Mohamed-Zied Ghariani
- Department of Vascular Surgery and Kidney Transplantation, University Hospital, Strasbourg, France
| | - Fabien Thaveau
- Department of Vascular Surgery and Kidney Transplantation, University Hospital, Strasbourg, France
| | - Yannick Georg
- Department of Vascular Surgery and Kidney Transplantation, University Hospital, Strasbourg, France
| | - Bernard Geny
- Department of Physiology and Functional Explorations, University Hospital, Strasbourg, France
| | - Nabil Chakfe
- Department of Vascular Surgery and Kidney Transplantation, University Hospital, Strasbourg, France
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Batt M, Feugier P, Camou F, Coffy A, Senneville E, Caillon J, Calvet B, Chidiac C, Laurent F, Revest M, Daures JP. A Meta-Analysis of Outcomes After In Situ Reconstructions for Aortic Graft Infection. Angiology 2017; 69:370-379. [PMID: 28578619 DOI: 10.1177/0003319717710114] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To confirm the advantage of in situ reconstruction (ISR) over extra-anatomic reconstruction (EAR) for aortic graft infection and determine the most appropriate conduit including autogenous veins, cryopreserved allografts, and synthetic prosthesis (standard, rifampicin of silver polyesters). METHODS A meta-analysis was conducted with rate of mortality, graft occlusion, amputation, and reinfection. A meta-regression was performed with 4 factors: patients' age, presence of prosthetic-duodenal fistula (PDF), virulent organisms, or nonvirulent organisms. RESULTS In situ reconstruction over EAR seems to favor all events. For the 5 conduits used for ISR, according to operative mortality, age of the patients looks to have a positive correlation only for silver polyester and no conduit present any advantage in the presence of PDF. Reinfection seems to be not significantly different for the 5 conduits, and only autogenous veins appear to have a positive correlation with infecting organisms. CONCLUSION In situ reconstruction may be considered as first-line treatment. Our results suggest that silver polyesters appear to be most appropriate for older patients, and in order to limit reinfection, autogenous veins are probably the most suitable conduit.
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Affiliation(s)
- Michel Batt
- 1 Department of Vascular Surgery, University Nice-Sophia Antipolis, Nice, France.,2 Laboratory of Biostatistics and Epidemiology, University Institute for Clinical Research, Montpellier, France
| | - Patrick Feugier
- 2 Laboratory of Biostatistics and Epidemiology, University Institute for Clinical Research, Montpellier, France.,3 Department of Vascular Surgery, University Claude Bernard Lyon 1, Hospices Civils de Lyon, Lyon, France
| | - Fabrice Camou
- 2 Laboratory of Biostatistics and Epidemiology, University Institute for Clinical Research, Montpellier, France.,4 Intensive Care Unit, Saint-Andre University Hospital, Bordeaux, France
| | - Amandine Coffy
- 2 Laboratory of Biostatistics and Epidemiology, University Institute for Clinical Research, Montpellier, France
| | - Eric Senneville
- 2 Laboratory of Biostatistics and Epidemiology, University Institute for Clinical Research, Montpellier, France.,5 Infectious Diseases Department, Gustave Dron Hospital, Lille 2 University, Tourcoing, France
| | - Jocelyne Caillon
- 2 Laboratory of Biostatistics and Epidemiology, University Institute for Clinical Research, Montpellier, France.,6 Bactériology Department, Nantes University Hospital, Nantes, France
| | - Brigitte Calvet
- 2 Laboratory of Biostatistics and Epidemiology, University Institute for Clinical Research, Montpellier, France.,7 Anesthesiology Département, Béziers Hospital, Béziers, France
| | - Christian Chidiac
- 2 Laboratory of Biostatistics and Epidemiology, University Institute for Clinical Research, Montpellier, France.,8 Infectious Diseases Department, Hospices Civils de Lyon and Center for Infectiology Research (CIRI), INSERM U1111, Lyon 1 University, Lyon, France
| | - Frederic Laurent
- 2 Laboratory of Biostatistics and Epidemiology, University Institute for Clinical Research, Montpellier, France.,9 Bacteriology Department, International Center for Infectiology Research (CIRI), INSERM U1111, Lyon I University, Lyon, France
| | - Matthieu Revest
- 2 Laboratory of Biostatistics and Epidemiology, University Institute for Clinical Research, Montpellier, France.,10 Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, CIC-INSERM 1414, Rennes 1 University Rennes, France
| | - Jean Pierre Daures
- 2 Laboratory of Biostatistics and Epidemiology, University Institute for Clinical Research, Montpellier, France
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- 2 Laboratory of Biostatistics and Epidemiology, University Institute for Clinical Research, Montpellier, France
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Unilateral inline replacement of infected aortofemoral graft limb with femoral vein. J Vasc Surg 2017; 65:1121-1129. [DOI: 10.1016/j.jvs.2016.09.051] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 09/21/2016] [Indexed: 11/17/2022]
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Bossi M, Tozzi M, Franchin M, Ferraro S, Rivolta N, Ferrario M, Guttadauro C, Castelli P, Piffaretti G. Cryopreserved Human Allografts for the Reconstruction of Aortic and Peripheral Prosthetic Graft Infection. Ann Vasc Dis 2017. [PMID: 29515701 PMCID: PMC5835436 DOI: 10.3400/avd.oa.17-00068] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: This study aimed to present cases with cryopreserved human allografts (CHAs) for vascular reconstruction in both aortic and peripheral infected prosthetic grafts. Materials and Methods: This is a single center, observational descriptive study with retrospective analysis. In all cases, the infected prosthetic graft material was completely removed. At discharge, patients were administered anticoagulants. Follow-up examinations included clinical visits, echo-color-Doppler ultrasounds, or computed tomography angiography within 30 days and at 3, 6, and 12 months after the treatment, and then twice per year. Results: We treated 21 patients (90% men, n=19) with the mean age of 71±12 years and mean interval between the initial operation and replacement with CHA of 30 months [range, 1–216; interquartile range (IQR), 2–36]. In-hospital mortality was 14% (n=3); no CHA-related complication led to death. Limb salvage was 100%. No patient was lost at the median follow-up of 14 months (range, 2–61; IQR, 6–39). No rupture, aneurysmal degeneration, or re-infection occurred. Estimated freedom from CHA-related adverse events (95% confidence interval, 43–63) was 95% at 3 years. Conclusion: In our experience, CHAs are a viable option for prosthetic graft infections and provide satisfactory clinical results and favorable stability because of a very low rate of CHA-related adverse events during follow-up.
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Affiliation(s)
- Matteo Bossi
- Vascular Surgery, Department of Medicine and Surgery, Circolo University Teaching Hospital, University of Insubria School of Medicine, Varese, Italy
| | - Matteo Tozzi
- Vascular Surgery, Department of Medicine and Surgery, Circolo University Teaching Hospital, University of Insubria School of Medicine, Varese, Italy
| | - Marco Franchin
- Vascular Surgery, Department of Medicine and Surgery, Circolo University Teaching Hospital, University of Insubria School of Medicine, Varese, Italy
| | - Stefania Ferraro
- Vascular Surgery, Department of Medicine and Surgery, Circolo University Teaching Hospital, University of Insubria School of Medicine, Varese, Italy
| | - Nicola Rivolta
- Vascular Surgery, Department of Medicine and Surgery, Circolo University Teaching Hospital, University of Insubria School of Medicine, Varese, Italy
| | - Massimo Ferrario
- Vascular Surgery, Department of Medicine and Surgery, Circolo University Teaching Hospital, University of Insubria School of Medicine, Varese, Italy
| | - Chiara Guttadauro
- Vascular Surgery, Department of Medicine and Surgery, Circolo University Teaching Hospital, University of Insubria School of Medicine, Varese, Italy
| | - Patrizio Castelli
- Vascular Surgery, Department of Medicine and Surgery, Circolo University Teaching Hospital, University of Insubria School of Medicine, Varese, Italy
| | - Gabriele Piffaretti
- Vascular Surgery, Department of Medicine and Surgery, Circolo University Teaching Hospital, University of Insubria School of Medicine, Varese, Italy
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