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Wu SJ, Sun S, Tan YH, Chien CY. Analysis of antibiotic strategies to prevent vascular graft or endograft infection after surgical treatment for infective native aortic aneurysms: a systematic review. Antimicrob Resist Infect Control 2024; 13:116. [PMID: 39354648 DOI: 10.1186/s13756-024-01477-3] [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: 05/01/2024] [Accepted: 09/27/2024] [Indexed: 10/03/2024] Open
Abstract
INTRODUCTION Some patients with an infective native aortic aneurysm (INAA) develop an aortic vascular graft or endograft infection (VGEI) even after successful open surgical repair or endovascular intervention. The aim of the systematic review and meta-analysis performed herein was to compare the clinical outcomes of different surgical and antibiotic treatment strategies. METHODS We systematically searched PubMed, MEDLINE, EMBASE and Web of Science. The keywords used for the search were "mycotic aortic aneurysm", "infected aortic aneurysm", "infective native aortic aneurysm", "antibiotics", "surgery", and "endovascular". The search was limited to articles written in English and to studies involving humans. Articles published before 2000 were excluded. Case reports and review articles were excluded. RESULTS Of the 524 studies retrieved from our search of the databases, 47 articles were included in this study. Among the 47 articles (1546 patients, 72.8% of whom were male) retrieved, five articles were excluded from the subgroup analysis because the data concerning open surgical repair and endovascular intervention could not be separated. The remaining 42 articles included a total of 1179 patients who underwent open surgical repair (622 patients) or endovascular intervention (557 patients) for INAA. There was a statistically significant difference (p = 0.001) in the pooled in-hospital mortality rate between the open surgical repair group (13.2%, 82/622) and the endovascular intervention group (7.2%, 40/557). However, there was a statistically significant difference (p < 0.001) in the aortic VGEI rate between the open surgical repair group (5.4%). 29/540) and endovascular intervention (13.3%, 69/517) group. For patients who underwent open surgical repair, a lower rate of aortic vascular graft infection was associated with long-term antibiotic use (p = 0.005). For patients who underwent endovascular intervention, there was a trend of association (p = 0.071) between the lower rate of aortic endograft infection and lifelong antibiotic use. CONCLUSION Infective native aortic aneurysms are life-threatening. The pooled in-hospital mortality rate of the open surgical repair group was significantly higher than that of the endovascular intervention group, whereas the rate of the aortic VGEI in the open surgical repair group was significantly lower than that in the endovascular intervention group. Regardless of whether open surgical repair or endovascular intervention is performed, better long-term outcomes can be achieved with aggressive antibiotic treatment, which is especially important for patients who undergo endovascular intervention.
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Affiliation(s)
- Shye-Jao Wu
- Division of Cardiovascular Surgery, Departments of Surgery, MacKay Memorial Hospital, Taipei, Taiwan.
- MacKay Medical College, New Taipei, Taiwan.
| | - Shen Sun
- Division of Cardiovascular Surgery, Departments of Surgery, MacKay Memorial Hospital, Taipei, Taiwan
- MacKay Medical College, New Taipei, Taiwan
| | - Yu-Hern Tan
- Division of Cardiovascular Surgery, Departments of Surgery, MacKay Memorial Hospital, Taipei, Taiwan
| | - Chen-Yen Chien
- Division of Cardiovascular Surgery, Departments of Surgery, MacKay Memorial Hospital, Taipei, Taiwan
- MacKay Medical College, New Taipei, Taiwan
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2
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Deniz E, Bobylev D, Krüger H, Salman J, Zubarevich A, Martens A, Kaufeld T, Schmack B, Weymann A, Ruhparwar A, Popov AF, Helms F. The Fate of the Aorta after Coarctation Repair: Open Surgical Replacement of Descending Aorta in a High-Volume Unit. J Clin Med 2024; 13:5345. [PMID: 39336832 PMCID: PMC11432251 DOI: 10.3390/jcm13185345] [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: 08/14/2024] [Revised: 09/05/2024] [Accepted: 09/09/2024] [Indexed: 09/30/2024] Open
Abstract
Objectives: Complications after aortic coarctation repair are associated with high mortality and require surgical or endovascular reintervention. For patients unsuitable for endovascular therapies, reoperation remains the only therapeutic option. However, surgical experience and up-to-date follow-up data concerning this overall rare entity in the spectrum of aortic reoperations are still highly limited. Thus, the aim of this study was to analyze the short-term outcomes and long-term survival of patients undergoing surgical descending aorta repair after previous coarctation repair in a high-volume unit. Methods: We present a retrospective single-center analysis of 25 patients who underwent open descending aorta replacement after initial coarctation repair. The surgical history, concomitant cardiovascular malformations, and preoperative characteristics as well as postoperative complications and long-term survival were analyzed. Results: The mean age at operation was 45.4 ± 12.8 years. A proportion of 68% (n = 17) of the patients were male. The most common complication necessitating reoperation after coarctation repair was aneurysm formation (68%) and re-stenosis (16%). The average time between initial repair and reoperation was 26.3 ± 9.9 years. Technical success was achieved in all the operations, while recurrent nerve damage (24%) and bleeding requiring rethoracotomy (20%) were identified as the most common perioperative complications. The one-year mortality was 0% and the overall long-term survival was 88% at 15 years. Conclusions: Open surgical descending aorta replacement can be performed safely and with excellent survival outcomes even in the challenging subgroup of patients after previous coarctation repair. Thus, reoperation should be considered a feasible approach for patients who are unsuitable for endovascular therapies. Nonetheless, concomitant cardiovascular anomalies and frequent preoperations may complicate the redo operation in this patient population.
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Affiliation(s)
- Ezin Deniz
- Division for Cardiothoracic-, Transplantation- and Vascular Surgery, Hannover Medical School, 30625 Hannover, Germany
| | - Dmitry Bobylev
- Division for Cardiothoracic-, Transplantation- and Vascular Surgery, Hannover Medical School, 30625 Hannover, Germany
| | - Heike Krüger
- Division for Cardiothoracic-, Transplantation- and Vascular Surgery, Hannover Medical School, 30625 Hannover, Germany
| | - Jawad Salman
- Division for Cardiothoracic-, Transplantation- and Vascular Surgery, Hannover Medical School, 30625 Hannover, Germany
| | - Alina Zubarevich
- Division for Cardiothoracic-, Transplantation- and Vascular Surgery, Hannover Medical School, 30625 Hannover, Germany
| | - Andreas Martens
- Clinic for Cardiac Surgery, University Clinic Oldenburg, 26133 Oldenburg, Germany
| | - Tim Kaufeld
- Division for Cardiothoracic-, Transplantation- and Vascular Surgery, Hannover Medical School, 30625 Hannover, Germany
| | - Bastian Schmack
- Division for Cardiothoracic-, Transplantation- and Vascular Surgery, Hannover Medical School, 30625 Hannover, Germany
| | - Alexander Weymann
- Division for Cardiothoracic-, Transplantation- and Vascular Surgery, Hannover Medical School, 30625 Hannover, Germany
| | - Arjang Ruhparwar
- Division for Cardiothoracic-, Transplantation- and Vascular Surgery, Hannover Medical School, 30625 Hannover, Germany
| | - Aron-Frederik Popov
- Division for Cardiothoracic-, Transplantation- and Vascular Surgery, Hannover Medical School, 30625 Hannover, Germany
| | - Florian Helms
- Division for Cardiothoracic-, Transplantation- and Vascular Surgery, Hannover Medical School, 30625 Hannover, Germany
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3
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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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4
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Sanin GD, Negmadjanov U, Patterson JW, Hamid RN, Torosian T, Stafford JM, Sheehan MK, Goldman MP, Hurie J, Edwards MS, Velazquez G. Contemporary outcomes for arterial reconstruction with non-saphenous vein cryo-preserved conduits. J Vasc Surg 2024; 79:1457-1465. [PMID: 38286153 DOI: 10.1016/j.jvs.2024.01.201] [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: 10/16/2023] [Revised: 12/06/2023] [Accepted: 01/21/2024] [Indexed: 01/31/2024]
Abstract
OBJECTIVE Cryopreserved (CP) products are utilized during challenging cases when autogenous or prosthetic conduit use is not feasible. Despite decades of experience with cadaveric greater saphenous vein (GSV), there is limited available data regarding the outcomes and patency of other CP products, specifically arterial and deep venous grafts. This study was designed to evaluate outcomes of non-GSV CP conduits in patients undergoing urgent, emergent, and elective arterial reconstruction at our institution. We hypothesized that non-GSV CP allografts have adequate patency and outcomes and are therefore a feasible alternative to GSV in settings where autologous graft is unavailable or prosthetic grafts are contraindicated. METHODS This study was approved by the Institutional Review Board at our institution. We retrospectively reviewed charts of patients undergoing arterial reconstructions using CP conduits from 2010 to 2022. Data collected included demographics, comorbidities, smoking status, indications for surgery, indication for CP conduit use, anatomic reconstruction, urgency of procedure, and blood loss. Time-to-event outcomes included primary and secondary graft patency rates, follow-up amputations, and mortality; other complications included follow-up infection/reinfection and 30-day complications, including return to the operating room and perioperative mortality. Time-to-event analyses were evaluated using product-limit survival estimates. RESULTS Of 96 identified patients receiving CP conduits, 56 patients received non-GSV conduits for 66 arterial reconstructions. The most common type of non-GSV CP product used was femoral artery (31 patients), followed by aorto-iliac artery (22 patients), and femoral vein (19 patients), with some patients receiving more than one reconstruction or CP product. Patients were mostly male (75%), with a mean age of 63.1 years and a mean body mass index of 26.7 kg/m2. Indications for CP conduit use included infection in 53 patients, hostile environment in 36 patients, contaminated field in 30 patients, tissue coverage concerns in 30 patients, inadequate conduit in nine patients, and patient preference in one patient. Notably, multiple patients had more than one indication. Most surgeries (95%) were performed in urgent or emergent settings. Supra-inguinal reconstructions were most common (53%), followed by extra-anatomic bypasses (47%). Thirty-day mortality occurred in 10 patients (19%). Fifteen patients (27%) required return to the operating room for indications related to the vascular reconstructions, with 10 (18%) cases being unplanned and five (9%) cases planned/staged. Overall survival at 6, 12, and 24 months was 80%, 68%, and 59%, respectively. Primary patency at 6, 12, and 24 months was 86%, 70%, and 62%, respectively. Amputation freedom at 6 months, 12 months, and 24 months was 98%, 95%, and 86%, respectively for non-traumatic indications. CONCLUSIONS Non-GSV CP products may be used in complex arterial reconstructions when autogenous or prosthetic options are not feasible or available.
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Affiliation(s)
- Gloria D Sanin
- Department of Vascular and Endovascular Surgery, Atrium Health Wake Forest Baptist, Winston-Salem, NC.
| | - Ulugbek Negmadjanov
- Department of Vascular and Endovascular Surgery, Atrium Health Wake Forest Baptist, Winston-Salem, NC
| | - James W Patterson
- Department of Vascular and Endovascular Surgery, Atrium Health Wake Forest Baptist, Winston-Salem, NC
| | - Rasikh N Hamid
- Department of Vascular and Endovascular Surgery, Atrium Health Wake Forest Baptist, Winston-Salem, NC
| | - Taron Torosian
- Department of Vascular and Endovascular Surgery, Atrium Health Wake Forest Baptist, Winston-Salem, NC
| | - Jeanette M Stafford
- Atrium Health Wake Forest Baptist Department of Biostatical Analysis, Winston-Salem, NC
| | - Maureen K Sheehan
- Department of Vascular and Endovascular Surgery, Atrium Health Wake Forest Baptist, Winston-Salem, NC
| | - Matthew P Goldman
- Department of Vascular and Endovascular Surgery, Atrium Health Wake Forest Baptist, Winston-Salem, NC
| | - Justin Hurie
- Department of Vascular and Endovascular Surgery, Atrium Health Wake Forest Baptist, Winston-Salem, NC
| | - Matthew S Edwards
- Department of Vascular and Endovascular Surgery, Atrium Health Wake Forest Baptist, Winston-Salem, NC
| | - Gabriela Velazquez
- Department of Vascular and Endovascular Surgery, Atrium Health Wake Forest Baptist, Winston-Salem, NC
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5
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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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6
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Frankel WC, Green SY, Amarasekara HS, Orozco-Sevilla V, Preventza O, LeMaire SA, Coselli JS. Early and late outcomes of surgical repair of mycotic aortic aneurysms: A 30-year experience. J Thorac Cardiovasc Surg 2024; 167:578-587. [PMID: 35643768 DOI: 10.1016/j.jtcvs.2022.03.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 02/17/2022] [Accepted: 03/16/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Mycotic aortic aneurysm and its associated complications are often catastrophic. In this study, we examined the early and late outcomes of surgical repair of mycotic aortic aneurysm at our center over the last 3 decades. METHODS We retrospectively reviewed our prospectively maintained aortic surgery database with supplemental adjudication of medical records. Aortic infection was confirmed through clinical, radiological, intraoperative, pathological, and treatment evidence. RESULTS Seventy-five patients (median age, 68 years; interquartile range, 62-74) who underwent surgical repair of a mycotic aortic aneurysm between 1992 and 2021 were included. Almost all patients (n = 72; 96%) presented with symptoms, including 26 patients (35%) with rupture, and many underwent urgent or emergency repair (n = 64; 85%). Sixty-one patients underwent open repair, and 14 patients underwent hybrid or endovascular repair. Infection-specific adjunct techniques included rifampin-soaked grafts (n = 16), omental pedicle flaps (n = 21), and antibiotic irrigation catheters (n = 8). There were 15 early deaths (20%), including 10 of the 26 patients (38%) who presented with rupture; however, persistent stroke, paraplegia or paraparesis, and renal failure necessitating dialysis were uncommon (each <5%). Almost all early survivors (52/60; 87%) were discharged with long-term antibiotic therapy. Estimated survival at 2, 6, and 10 years was 55.7% ± 5.8%, 39.0% ± 5.7%, and 26.9% ± 5.5%, respectively. CONCLUSIONS A substantial proportion of patients with mycotic aortic aneurysm present with rupture and generally require urgent or emergency repair. Operative mortality and complications are common, especially for patients who present with rupture, and late survival is poor.
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Affiliation(s)
- William C Frankel
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
| | - Susan Y Green
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
| | - Hiruni S Amarasekara
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
| | - Vicente Orozco-Sevilla
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex; Section of Adult Cardiac Surgery, Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Tex; CHI St Luke's Health-Baylor St Luke's Medical Center, Houston, Tex
| | - Ourania Preventza
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex; Section of Adult Cardiac Surgery, Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Tex; CHI St Luke's Health-Baylor St Luke's Medical Center, Houston, Tex
| | - Scott A LeMaire
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex; Section of Adult Cardiac Surgery, Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Tex; CHI St Luke's Health-Baylor St Luke's Medical Center, Houston, Tex; Cardiovascular Research Institute, Baylor College of Medicine, Houston, Tex.
| | - Joseph S Coselli
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex; Section of Adult Cardiac Surgery, Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Tex; CHI St Luke's Health-Baylor St Luke's Medical Center, Houston, Tex; Cardiovascular Research Institute, Baylor College of Medicine, Houston, Tex
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7
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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: 1] [Impact Index Per Article: 1.0] [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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Reinders Folmer EI, Verhofstad N, Zeebregts CJ, van Sambeek MRHM, Saleem BR. Performance of the BioIntegral Bovine Pericardial Graft in Vascular Infections: VASCular No-REact Graft Against INfection Study. Ann Vasc Surg 2023; 95:116-124. [PMID: 37295670 DOI: 10.1016/j.avsg.2023.06.001] [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: 03/26/2023] [Revised: 05/26/2023] [Accepted: 06/01/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Vascular graft and endograft infections (VGEI) and native vessel infections (NVI) remain considerable challenges in vascular surgery, leading to high mortality and morbidity rates. Although in situ reconstruction is the preferred treatment, the material of choice is still a source of debate. Autologous veins are considered the first choice; however, xenografts may be an acceptable alternative. The performance of a biomodified bovine pericardial graft is assessed when implemented in an infected vascular area. METHODS This is a prospective multicenter cohort study. Patients who underwent reconstruction for VGEI or NVI with a biomodified bovine pericardial bifurcated or straight tube graft were included from December 2017 until June 2021. The primary outcome measure was reinfection at mid-term follow-up. Secondary outcome measures included mortality, patency, and amputation rate. RESULTS Thirty-four patients with vascular infections were included, of which 23 (68%) had an infected Dacron prosthesis after primary open repair and 8 (24%) had an infected endovascular graft. The remaining 3 (9%) had infected native vessels. At secondary repair, 3 (7%) patients had an in situ aortic tube reconstruction, 29 (66%) had an aortic bifurcated reconstruction, and 2 (5%) had an iliac-femoral reconstruction. At 1-year follow-up after the BioIntegral bovine pericardial graft reconstruction, the reinfection rate was 9%. The 1-year infection-related and procedure-related mortality rate was 16%. The occlusion rate was 6% and in total 3 patients underwent a lower limb amputation during the 1-year follow-up period. CONCLUSIONS In situ reconstruction as treatment of (endo)graft and native vessel infections remains a challenge and reinfection looms as a potential consequence. In cases where time is of essence or when autologous venous repair is not feasible, a swift available solution is needed. The BioIntegral biomodified bovine pericardial graft may be an option as it shows reasonable results in terms of reinfection, in aortic tube and bifurcated grafts.
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Affiliation(s)
- Eline I Reinders Folmer
- Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - Nicole Verhofstad
- Division of Vascular Surgery, Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - Clark J Zeebregts
- Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marc R H M van Sambeek
- Division of Vascular Surgery, Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - Ben R Saleem
- Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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9
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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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Golemovic M, Skific M, Haluzan D, Pavic P, Golubic Cepulic B. Ten-year experience with cryopreserved vascular allografts in the Croatian Cardiovascular Tissue Bank. Cell Tissue Bank 2022; 23:807-824. [PMID: 35129755 PMCID: PMC8818844 DOI: 10.1007/s10561-022-09992-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 01/10/2022] [Indexed: 11/28/2022]
Abstract
The Croatian Cardiovascular Tissue Bank (CTB) was established in June 2011. Activities managed by CTB are processing of heart valves and blood vessels, as well as quality control, storage, medical release and distribution of allografts. The aim of this report is to present CTB's vascular tissue activities and retrospectively evaluate the outcomes of their use in the University Hospital Centre Zagreb. Between June 2011 and July 2021, 90 vascular allografts (VAs) from 55 donors after brain death were referred to CTB. Only 54% of VAs met the tissue quality requirements while 46% of tissues were discarded. The most frequent reasons for discard were unacceptable morphology and initial microbiological contamination. Altogether 42 VAs were released for transplantation and 37 of them were used in 27 surgical procedures. The most common indication for surgery was prosthetic graft or stent infection. According to the anatomic position of vascular reconstruction, patients were divided in the aortic and peripheral reconstruction group. A total of 23 patients were treated. In the aortic reconstruction group 58% of patients did not experience any graft-related complications. In the group of patients who underwent peripheral reconstruction significant incidence of reinfection was observed highlighting it as a major graft-related complication. Despite the small patient groups and limited duration of follow-up, presented clinical outcomes provide valuable information on the efficacy of vascular allografts. Additional clinical results collected on a larger patient groups and comparison to other reconstructive treatment options are necessary.
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Affiliation(s)
- M Golemovic
- Department of Transfusion Medicine and Transplantation Biology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - M Skific
- Department of Transfusion Medicine and Transplantation Biology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - D Haluzan
- Department of Surgery, Division for Vascular Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
| | - P Pavic
- Department of Surgery, Division for Vascular Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
| | - B Golubic Cepulic
- Department of Transfusion Medicine and Transplantation Biology, University Hospital Centre Zagreb, Zagreb, Croatia
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11
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Aortoenteric fistula following endovascular abdominal aortic aneurysm repair. J Vasc Surg Cases Innov Tech 2022; 8:438-440. [PMID: 35996728 PMCID: PMC9391504 DOI: 10.1016/j.jvscit.2022.06.003] [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: 02/23/2022] [Accepted: 06/10/2022] [Indexed: 11/23/2022] Open
Abstract
Aortoenteric fistula is a rare complication after endovascular stent grafting. In the present report, we have described the case of a 69-year-old man 3 years after endovascular repair of an abdominal aortic aneurysm who had presented with worsening back pain and fever. Computed tomography had demonstrated dilated bowel and a thickened aortic wall, with air foci within the native aneurysm sac. He underwent emergent right axillary–bifemoral bypass with explantation of the aortic endograft and primary repair of the duodenal fistula. Tissue cultures grew Streptococcus anginosus, Prevotella denticola, and Parvimonas micra, and he was discharged home with 6 weeks of intravenous ceftriaxone and oral metronidazole after an 18-day hospital admission.
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12
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Molacek J, Treska V, Houdek K, Opatrný V, Certik B, Baxa J. Use of a Silver-Impregnated Vascular Graft: Single-Center Experience. Antibiotics (Basel) 2022; 11:386. [PMID: 35326849 PMCID: PMC8944627 DOI: 10.3390/antibiotics11030386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 02/27/2022] [Accepted: 03/04/2022] [Indexed: 12/10/2022] Open
Abstract
INTRODUCTION Vascular graft infection is a life threatening situation with significant morbidity and mortality. Bacterial graft infection can lead to false aneurysms, bleeding and sepsis. There are a lot of risky situations where grafts can become infected. It is therefore highly desirable to have a vascular graft that is resistant to infection. In this retrospective clinical study, a silver-impregnated vascular graft was evaluated in various indications. METHODS Our study included a total of 71 patients who received a silver-impregnated vascular graft during the period from 2013 to 2018. Patients had an aortoiliac localization of vascular graft in 61 cases (86%), and a peripheral localization on the lower limbs in 10 cases (14%). Indications for the use of these special vascular grafts were trophic lesions or gangrene in the lower limbs in 24 cases (34%), suspicious mycotic abdominal aortic aneurysm (mAAA) in 4 cases (5.5%), salmonela aortitis or aneurysms in 4 cases (5.5%), infection of the previous vascular graft in 11 cases (15.5%), other infections in 12 cases (17%), AAA rupture in 10 cases (14%) and other reasons (pre-transplant condition, multiple trauma, graft-enteric fistula) in 6 cases (8.5%). Thirty-day mortality, morbidity, the need for reintervention and amputation, primary and secondary graft patency, and finally the presence of a proven vascular graft infection were evaluated. RESULTS The 30-day mortality was 19.7%, and morbidity was 42.2%. The primary patency of the vascular graft was 91.5%. Reoperation was necessary in 10 cases (14%) and amputation was necessary in 10 cases (14%). The median length of hospital stay was 13 days and the mean follow-up period was 48 ± 9 months. During the follow-up period, six patients (8.5%) died from reasons unrelated to surgery or without any relation to the vascular graft. Secondary patency after one year was 88%. Infection of the silver graft was observed in three patients (4.2%). CONCLUSIONS Based on our results, the silver graft is a very suitable alternative for solving infectious, or potentially infectious, situations in vascular surgery. In particular, in urgent or acute cases, a silver graft is often the only option.
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Affiliation(s)
- Jiri Molacek
- Vascular Surgery Department, University Hospital in Pilsen, Faculty of Medicine in Pilsen, Charles University, Husova 3, 301 00 Plzeň, Czech Republic; (V.T.); (K.H.); (V.O.); (B.C.)
| | - Vladislav Treska
- Vascular Surgery Department, University Hospital in Pilsen, Faculty of Medicine in Pilsen, Charles University, Husova 3, 301 00 Plzeň, Czech Republic; (V.T.); (K.H.); (V.O.); (B.C.)
| | - Karel Houdek
- Vascular Surgery Department, University Hospital in Pilsen, Faculty of Medicine in Pilsen, Charles University, Husova 3, 301 00 Plzeň, Czech Republic; (V.T.); (K.H.); (V.O.); (B.C.)
| | - Václav Opatrný
- Vascular Surgery Department, University Hospital in Pilsen, Faculty of Medicine in Pilsen, Charles University, Husova 3, 301 00 Plzeň, Czech Republic; (V.T.); (K.H.); (V.O.); (B.C.)
| | - Bohuslav Certik
- Vascular Surgery Department, University Hospital in Pilsen, Faculty of Medicine in Pilsen, Charles University, Husova 3, 301 00 Plzeň, Czech Republic; (V.T.); (K.H.); (V.O.); (B.C.)
| | - Jan Baxa
- Department of Imagine Methods, University Hospital in Pilsen, Faculty of Medicine in Pilsen, Charles University, Husova 3, 301 00 Plzeň, Czech Republic;
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Cryopreserved venous allograft in the treatment of a mycotic abdominal aortic aneurysm caused by group B Streptococcus. J Vasc Surg Cases Innov Tech 2022; 8:9-12. [PMID: 35024523 PMCID: PMC8731693 DOI: 10.1016/j.jvscit.2021.10.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 10/29/2021] [Indexed: 11/22/2022] Open
Abstract
We report a case of a mycotic abdominal aortic aneurysm caused by invasive group B streptococcus. Given the anatomical suitability with healthy segments of aortoiliac vessels, in situ repair was performed. A cryopreserved femoral vein graft was chosen because of risks of graft reinfection and negated the need for bilateral femoral vein harvest. The patient remained clinically well and the graft patent with no concerns at 6 months of follow-up. A review of literature on group B Streptococcus aortitis was performed.
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14
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Chatzigakis PK, Barmparessos EM, Katsikas VC. Variant Neo-Aortoiliac System Operation Using a Composite Conduit of Silver-Coated Dacron Graft and Autologous Femoral Veins: A Report of Two Cases. Vasc Specialist Int 2021; 37:20. [PMID: 34238771 PMCID: PMC8267534 DOI: 10.5758/vsi.210022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/13/2021] [Accepted: 06/28/2021] [Indexed: 11/20/2022] Open
Abstract
Aortic prosthesis infection is associated with significant morbidity and mortality rates. The introduction of the neo-aortoiliac system (NAIS) technique offers a new perspective, as a venous conduit is considered an optimal graft in aortic prosthesis infection because it is autogenous, durable, inexpensive and has low infection rates. Occasionally, the anatomical characteristics of available autologous venous conduits may limit the applicability of this technique. Herein, we present two cases in which a variant NAIS technique was used to confront an aortic graft infection. To expand the usefulness of the NAIS technique and avoid the use of prosthetic material in a potentially contaminated area as much as possible, we combined an autologous femoral vein with a short segment of a silver-coated Dacron graft. The combination of a silver-impregnated graft and the NAIS is a feasible bailout technique should the NAIS vein appears inadequate upon exploration.
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Affiliation(s)
- Petros K Chatzigakis
- Vascular Surgery Department, General Hospital of Athens "Georgios Gennimatas", Athens, Greece
| | | | - Vasileios C Katsikas
- Vascular Surgery Department, General Hospital of Athens "Georgios Gennimatas", Athens, Greece
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15
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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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Rajendra N, Sebastian J, Reddy A, Kumar A, Ayappan MK, Mathur K, Raju R. Mycotic aortic aneurysm caused by Acinetobacter baumannii complex: A rare case. INDIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2021. [DOI: 10.4103/ijves.ijves_8_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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17
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Aortic Reconstruction with Cryopreserved Human Allograft in a Hemodialysis Patient with Abdominal Aortic Aneurysm after Surgical Treatment of Liver Abscess. COR ET VASA 2020. [DOI: 10.33678/cor.2020.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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18
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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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Systematic Review and Meta: Analysis of Aortic Graft Infections following Abdominal Aortic Aneurysm Repair. Int J Vasc Med 2020; 2020:9574734. [PMID: 32206352 PMCID: PMC7013324 DOI: 10.1155/2020/9574734] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 12/23/2019] [Accepted: 01/07/2020] [Indexed: 12/02/2022] Open
Abstract
Introduction. Aortic graft infection (AGI) is a rare complication following AAA repair and is associated with high morbidity and mortality. Management is variable, and there are no evidence-based guidelines. The aim of this study was to systematically review and analyse management options for AGI.
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20
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Tubular Reconstruction with Bovine Pericardium Xenografts to Treat Native Aortic Infections. Ann Vasc Surg 2020; 64:27-32. [PMID: 31931127 DOI: 10.1016/j.avsg.2019.10.104] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 10/15/2019] [Accepted: 10/23/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND The treatment of aortic infections is complex, and the material of reconstruction remains discussed. Several alternatives were suggested in the literature. The current consensus is the use of biological material. The aim of this study was to evaluate the short-term results of bovine pericardium xenografts. METHODS Between November 2016 and June 2019, we included consecutively all the patients presenting with native aortic infections in which arterial reconstruction was carried out with tubular bovine pericardium grafts sutured longitudinally. We collected the preoperative, peroperative, and postoperative clinical, radiological, biological, and bacteriological characteristics. The recurrence of infection, the graft failures, and the morbimortality were analyzed. RESULTS Twelve patients including three women were treated. Their mean age was 68.4 ± 9 years. They presented 2 thoracic, 4 thoracoabdominal, 4 abdominal, and 2 aortoiliac aneurysms. The diagnosis was made using angio-CT in all the cases and was confirmed by positron emission tomography (PET) scan in 7 cases and blood cultures in 9 cases. Peroperative cultures were positive in 11 cases. Antibiotics were given in 9 patients before operation for a median duration of 9 (3-19) days and in all the patients postoperatively for a median duration of 42 (1-540) days. The median follow-up was 355 (98-839) days. Six medical complications occurred, including 2 (16.6%) leading to death in the immediate postoperative period. No reoperation was needed. The PET scan returned positive in 1/10 cases (10%) during the follow-up. The diameter of the grafts was preserved, without any defect observed on the angio-CT. CONCLUSIONS Short-term results showed a mechanical resistance to infection of the bovine pericardium. This biological material offers a promising alternative with multiple advantages including availability, simplicity of preparation, and adaptability to the various locations of the aortic infection.
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Mestres CA, Quintana E, Kopjar T, Ambrosioni J, Almela M, Fuster D, Ninot S, Miró JM. Twenty-year experience with cryopreserved arterial allografts for vascular infections. Eur J Cardiothorac Surg 2019; 55:358-365. [PMID: 30084901 DOI: 10.1093/ejcts/ezy263] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 06/12/2018] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES The aim of this study was to analyse outcomes over 2 decades using cryopreserved vascular allografts to treat vascular infection. METHODS We conducted a retrospective study of patients identified from our institutional database who were treated for primary or secondary vascular infection using implanted allografts. RESULTS Between October 1992 and May 2014, 54 patients underwent surgery for vascular infection out of 118 patients implanted with cryopreserved vascular allografts. The 52 patients for whom we had full information form the basis of the study with a 96% follow-up. The average age was 64 ± 11 years; 87% were men; 65% had previous vascular surgery; 19% had emergency operations. A total of 75% of the patients had aortoiliofemoral infections. Five patients underwent surgery with cardiopulmonary bypass. Fifty percent required more than 1 allograft and 15% had concomitant procedures. Seventy-three percent (38/52) of specimen cultures yielded positive results with polymicrobial flora in 29%. Surgical specimens most frequently grew coagulase-negative staphylococci. The early postoperative reoperation rate was 15% for allograft-related complications. There were 20 (38%) early deaths, including deaths of acute myocardial infarction, anastomosis rupture and persistent sepsis and shock. Uncontrolled infection leading to septic shock and multiple organ failure was the cause of death in 50% of the cases. The mean duration of freedom from allograft reintervention was 12.2 years. The mean duration of freedom from allograft occlusion or limb loss was 12.1 years [95% confidence interval (CI) 9.9-14.4]. Of the 32 surviving patients, we had patency information for 66% obtained by angiography or computed tomography. The mean survival for the cohort was 5.9 years (95% CI 3.9-7.8). Mean freedom from cardiovascular infection-related death was 9.3 years (95% CI 7.2-11.4). CONCLUSIONS Allografts can be indicated for treatment of primary/secondary infection and have remarkable results in multimorbid patients. Patients with vascular infection have a high-risk profile, around 40% mortality during the first 6 months, with reduction in overall mortality thereafter. We believe that allografts may play a role in the surgical treatment of vascular infection.
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Affiliation(s)
- Carlos A Mestres
- Department of Cardiovascular Surgery, Hospital Clínic, Barcelona, Spain.,Department of Cardiovascular Surgery, University Hospital Zürich, Zürich, Switzerland
| | - Eduard Quintana
- Department of Cardiovascular Surgery, Hospital Clínic, Barcelona, Spain
| | - Tomislav Kopjar
- Department of Cardiac Surgery, University Hospital Centre, Zagreb, Croatia
| | - Juan Ambrosioni
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Manuel Almela
- Microbiology Service, Hospital Clinic, Barcelona, Spain
| | - David Fuster
- Nuclear Medicine Service, Hospital Clinic, Barcelona, Spain
| | - Salvador Ninot
- Department of Cardiovascular Surgery, Hospital Clínic, Barcelona, Spain
| | - José M Miró
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
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22
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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. Hippokratia 2019. [DOI: 10.1002/14651858.cd013469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Osamah S Niaz
- The Princess Alexandra Hospital; Department of Vascular Surgery; Harlow UK CM20 1QX
| | - Ahsan Rao
- The Princess Alexandra Hospital; Department of Vascular Surgery; Harlow UK CM20 1QX
| | - Ahmed Abidia
- The Princess Alexandra Hospital; Department of Vascular Surgery; Harlow UK CM20 1QX
| | - Rebecca Parrott
- The Princess Alexandra Hospital; Harlow Healthcare Library; Harlow UK
| | - Jonathan Refson
- The Princess Alexandra Hospital; Department of Vascular Surgery; Harlow UK CM20 1QX
| | - Pranav Somaiya
- The Princess Alexandra Hospital; Department of Vascular Surgery; Harlow UK CM20 1QX
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23
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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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24
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Antonopoulos CN, Papakonstantinou NA, Hardy D, Lyden SP. Editor's Choice - Cryopreserved Allografts for Arterial Reconstruction after Aorto-Iliac Infection: A Systematic Review and Meta-Analysis. Eur J Vasc Endovasc Surg 2019; 58:120-128. [PMID: 31202580 DOI: 10.1016/j.ejvs.2019.03.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 03/01/2019] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Native and aortic graft infections are rare, but they represent one of the most life threatening complications of vascular surgery. Several materials and surgical approaches have been developed so far. Among them, cryopreserved allografts have been proposed as a treatment option. A systematic review and meta-analysis was conducted to investigate the role of cryopreserved allografts for arterial reconstruction after aorto-iliac infection. METHODS The current meta-analysis was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Patient baseline characteristics were investigated, along with 30 outcomes after use of cryopreserved arterial allografts for reconstruction after aorto-iliac infection. Pooled proportions with 95% CIs of outcome rates were calculated. RESULTS A total of 31 studies, including 1,377 patients, finally participated in the meta-analysis. Among the early outcomes, 30 day mortality was 14.91% (95% CI 11.78-18.31). Peri-anastomotic rupture/allograft disruption rate was 5.90% (95% CI 2.77-9.88), while pooled aneurysmal degeneration/allograft dilatation was 4.99% (95% CI 1.60-9.68). A pooled rate of 3.11% (95% CI 1.60-4.98) was estimated for pseudoaneurysm formation after the use of cryopreserved arterial allografts, while the allograft thrombotic/stenotic complication rate and peri-anastomotic infection were 12.19% (95% CI 7.90-17.15) and 3.32% (95% CI 1.90-5.03), respectively. Mortality during follow up was 19.24% (95% CI 11.97-27.58), while allograft related mortality during follow up was 3.58% (95% CI 1.56-6.15). A pooled allograft related re-operation rate was estimated at 24.87% (95% CI 17.89-32.51). CONCLUSIONS The use of cryopreserved allograft seems to be a safe and durable option with acceptable outcomes for treatment of aorto-iliac infection.
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Affiliation(s)
- Constantine N Antonopoulos
- Cardiothoracic and Vascular Surgery Department, "Evangelismos" General Hospital, Athens, Greece; Department of Vascular Surgery, Cleveland Clinic, Cleveland, OH, USA.
| | | | - David Hardy
- Department of Vascular Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Sean P Lyden
- Department of Vascular Surgery, Cleveland Clinic, Cleveland, OH, USA
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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: 23] [Impact Index Per Article: 4.6] [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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28
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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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29
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Outcomes of Surgical Explantation of Infected Aortic Grafts After Endovascular and Open Abdominal Aneurysm Repair. Eur J Vasc Endovasc Surg 2019; 57:130-136. [DOI: 10.1016/j.ejvs.2018.07.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Accepted: 07/17/2018] [Indexed: 12/31/2022]
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30
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Petrunić M, Perkov D, Meštrović T, Halužan D, Tomić Mahečić T. Endovascular Treatment of a Late False Aneurysm Complicating Open Suprarenal Mycotic Aneurysm Repair with a Cryopreserved Aortic Homograft. Ann Vasc Surg 2018; 56:350.e5-350.e8. [PMID: 30287286 DOI: 10.1016/j.avsg.2018.07.055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 07/06/2018] [Accepted: 07/07/2018] [Indexed: 11/25/2022]
Abstract
We report a patient who was initially treated for a suprarenal mycotic aortic aneurysm. The aneurysm repair was performed using a cryopreserved arterial homograft and debranching of visceral arteries. Five years later, the patient was referred due to a large symptomatic false aneurysm at the distal homograft anastomosis. Endovascular repair was indicated and performed using a bifurcated Medtronic composite stent graft. The procedure was uneventful, while control angiography showed complete exclusion of the false aneurysm. Within 6 months of follow-up, the endograft showed favorable position and maintained patency with no signs of endoleaks. We discuss the role of the cryopreserved homografts for in situ repair of mycotic aortic aneurysms and comment on possible late complications after placing those grafts.
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Affiliation(s)
- Mladen Petrunić
- Department of Surgery, University Hospital Center Zagreb - "Rebro", Zagreb, Croatia
| | - Dražen Perkov
- Department of Radiology, University Hospital Center Zagreb - "Rebro", Zagreb, Croatia
| | - Tomislav Meštrović
- Department of Surgery, University Hospital Center Zagreb - "Rebro", Zagreb, Croatia.
| | - Damir Halužan
- Department of Surgery, University Hospital Center Zagreb - "Rebro", Zagreb, Croatia
| | - Tina Tomić Mahečić
- Department of Anesthesiology, University Hospital Center Zagreb - "Rebro", Zagreb, Croatia
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Abrard S, Cousin B, Reydel T, Ammi M, Beydon L. Pneumococcal urinary antigen test: A tool for pneumococcal aortitis diagnosis? IDCases 2018; 14:e00415. [PMID: 29998060 PMCID: PMC6037901 DOI: 10.1016/j.idcr.2018.e00415] [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: 03/26/2018] [Revised: 05/18/2018] [Accepted: 06/26/2018] [Indexed: 11/30/2022] Open
Abstract
Introduction Aortitis is rare. The etiological diagnosis is difficult but essential for treatment. Even with appropriate treatment mortality remains high. We present a case of pneumococcal aortitis followed by a brief review of the literature. Presentation of Case In this case, the aortic disease was characterized by multiple inflammatory aneurysms. Blood cultures were negative but urine was tested for the presence of pneumococcal urinary antigen postoperatively was positive. Treatment consisted of antibacterial therapy and both surgical and endovascular procedures. The patient was discharged and is well. Discussion Preoperative determination of etiology is crucial in implementing a specific treatment. Pneumococcus is a common bacterium in infectious aortitis. Identification of the causative microbe is necessary to guide antimicrobial therapy. Blood cultures are frequently sterile. The pneumococcal urinary antigen test may be more sensitive than blood cultures, as is the case in pneumococcal pneumonia. Conclusions The pneumococcal urinary antigen test may was a useful diagnostic tool in establishing the cause for aortitis in this case. Its potential value should be assessed in furthers studies.
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Affiliation(s)
- Stanislas Abrard
- Département d’Anesthésie Réanimation, Anesthesiology and Intensive Care Department, Centre Hospitalier Universitaire d’Angers, Angers University Hospital, 4 Rue Larrey, 49100 Angers, France
| | - Benoit Cousin
- Département d’Anesthésie Réanimation, Anesthesiology and Intensive Care Department, Centre Hospitalier Universitaire d’Angers, Angers University Hospital, 4 Rue Larrey, 49100 Angers, France
| | - Thomas Reydel
- Département d’Anesthésie Réanimation, Anesthesiology and Intensive Care Department, Centre Hospitalier Universitaire d’Angers, Angers University Hospital, 4 Rue Larrey, 49100 Angers, France
| | - Myriam Ammi
- Département de Chirurgie Vasculaire et Thoracique, Department of Vascular and Thoracic Surgery, Centre Hospitalier Universitaire d’Angers, Angers University Hospital, 4 Rue Larrey, 49100 Angers, France
| | - Laurent Beydon
- Département d’Anesthésie Réanimation, Anesthesiology and Intensive Care Department, Centre Hospitalier Universitaire d’Angers, Angers University Hospital, 4 Rue Larrey, 49100 Angers, France
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Heinola I, Sörelius K, Wyss TR, Eldrup N, Settembre N, Setacci C, Mani K, Kantonen I, Venermo M. Open Repair of Mycotic Abdominal Aortic Aneurysms With Biological Grafts: An International Multicenter Study. J Am Heart Assoc 2018; 7:e008104. [PMID: 29886419 PMCID: PMC6220543 DOI: 10.1161/jaha.117.008104] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 04/25/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND The treatment of mycotic abdominal aortic aneurysm requires surgery and antimicrobial therapy. Since prosthetic reconstructions carry a considerable risk of reinfection, biological grafts are noteworthy alternatives. The current study evaluated the durability, infection resistance, and midterm outcome of biological grafts in treatment of mycotic abdominal aortic aneurysm. METHODS AND RESULTS All patients treated with biological graft in 6 countries between 2006 and 2016 were included. Primary outcome measures were 30- and 90-day survival, treatment-related mortality, and reinfection rate. Secondary outcome measures were overall mortality and graft patency. Fifty-six patients (46 males) with median age of 69 years (range 35-85) were included. Sixteen patients were immunocompromised (29%), 24 (43%) had concomitant infection, and 12 (21%) presented with rupture. Bacterial culture was isolated from 43 (77%). In-situ aortic reconstruction was performed using autologous femoral veins in 30 patients (54%), xenopericardial tube-grafts in 12 (21%), cryopreserved arterial/venous allografts in 9 (16%), and fresh arterial allografts in 5 (9%) patients. During a median follow-up of 26 months (range 3 weeks-172 months) there were no reinfections and only 3 patients (5%) required assistance with graft patency. Thirty-day survival was 95% (n=53) and 90-day survival was 91% (n=51). Treatment-related mortality was 9% (n=5). Kaplan-Meier estimation of survival at 1 year was 83% (95% confidence interval, 73%-94%) and at 5 years was 71% (52%-89%). CONCLUSIONS Mycotic abdominal aortic aneurysm repair with biological grafts is a durable option for patients fit for surgery presenting an excellent infection resistance and good overall survival.
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Affiliation(s)
- Ivika Heinola
- Department of Vascular Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Karl Sörelius
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden
| | - Thomas R Wyss
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Nikolaj Eldrup
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Nicla Settembre
- Department of Vascular Surgery, Nancy University Hospital, Nancy, France
| | - Carlo Setacci
- Department of Medical, Surgical and Neurosciences, University of Siena, Italy
| | - Kevin Mani
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden
| | - Ilkka Kantonen
- Department of Vascular Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Maarit Venermo
- Department of Vascular Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Cryopreserved arterial allografts for in situ reconstruction of abdominal aortic native or secondary graft infection. J Vasc Surg 2018; 67:468-477. [DOI: 10.1016/j.jvs.2017.06.088] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 06/07/2017] [Indexed: 11/23/2022]
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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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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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Lutz B, Reeps C, Biro G, Knappich C, Zimmermann A, Eckstein HH. Bovine Pericardium as New Technical Option for In Situ Reconstruction of Aortic Graft Infection. Ann Vasc Surg 2016; 41:118-126. [PMID: 27903471 DOI: 10.1016/j.avsg.2016.07.098] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Revised: 07/05/2016] [Accepted: 07/21/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Alloplastic aortic graft infection is a devastating complication following aortic surgery. It is associated with excessively high mortality and morbidity caused by anastomotic rupture or septicemia. Many authors consider in situ replacement after complete surgical graft removal as the method of choice. However, there is an ongoing debate about the most suitable material for reconstruction. We present our first experiences with replacing the descending and infrarenal aorta using custom-made bovine pericardium grafts. MATERIAL AND METHODS From January 2013 to 2015, 13 patients (10 male, median age 70 years, range 53-84) were treated for 5 early-graft infections after open reconstructions and 7 late graft infections (1 TEVAR, 2 EVAR, and 4 open reconstructions), and 1 patient was treated for mycotic aneurysm. Septicemia was evident in 8 patients, whereas 5 patients were presented with low-grade infection. In all cases, graft infection was proven by a synopsis of clinical findings, laboratory tests, imaging, and microbiologic tests (positive pathogen detection in 11 patients). Cutaneous and aortoenteric fistulae were present in 3 and 4 patients, respectively. All patients received an in situ replacement using a hand-sewn xenoprosthesis or patch made from a bovine pericardium sheet. Follow-up was routinely performed 3, 12, and 24 months after discharge. RESULTS For reconstruction, 4 pericardium tubes, 7 bifurcated grafts, and 2 large patches were implanted in situ. Technical success was 100%. Median length of hospital stay was 44 days (range, 20-136 days), with an in-hospital mortality rate of 7.7% (n = 1). Major procedure- and disease-related complications were temporary (n = 2) and permanent dialysis (n = 1), limb loss (n = 1), and long-term ventilation (n = 5). Complete infection control and initial healing could be achieved in 75% (n = 10). During the follow-up (median 9 months, range: 1-27 months), primary graft patency was 100%, and mortality was 41.7%. We observed 2 secondary ruptures due to reinfection at 4 and 7 months. CONCLUSIONS Custom-made bovine pericardium grafts provide a good option for in situ replacement following early or late aortic graft infection. Despite of its high biocompatibility, pericardium provides not an absolute protection against ongoing retroperitoneal infection. For the treatment, the principles of septic surgery need to be applied and close follow-up is mandatory.
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Affiliation(s)
- Brigitta Lutz
- Department of Visceral, Thoracic, and Vascular Surgery, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany; Department of Vascular Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Christian Reeps
- Department of Visceral, Thoracic, and Vascular Surgery, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany; Department of Vascular Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Gabor Biro
- Department of Vascular Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Christoph Knappich
- Department of Vascular Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Alexander Zimmermann
- Department of Vascular Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Hans-Henning Eckstein
- Department of Vascular Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany.
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Wilson WR, Bower TC, Creager MA, Amin-Hanjani S, O’Gara PT, Lockhart PB, Darouiche RO, Ramlawi B, Derdeyn CP, Bolger AF, Levison ME, Taubert KA, Baltimore RS, Baddour LM. Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: A Scientific Statement From the American Heart Association. Circulation 2016; 134:e412-e460. [DOI: 10.1161/cir.0000000000000457] [Citation(s) in RCA: 215] [Impact Index Per Article: 26.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Kakkos SK, Bicknell CD, Tsolakis IA, Bergqvist D. Editor's Choice - Management of Secondary Aorto-enteric and Other Abdominal Arterio-enteric Fistulas: A Review and Pooled Data Analysis. Eur J Vasc Endovasc Surg 2016; 52:770-786. [PMID: 27838156 DOI: 10.1016/j.ejvs.2016.09.014] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 09/25/2016] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To compare management strategies for secondary abdominal arterio-enteric fistulas (AEFs). METHODS This study is a review and pooled data analysis. Medline and Scopus databases were searched for studies published between 1999 and 2015. Particular emphasis was given to short- and long-term outcomes in relation to AEF repair type. RESULTS Two hundred and sixteen publications were retrieved, reporting on 823 patients. In-hospital mortality was 30.7%. Open surgery had higher in-hospital mortality (246/725, 33.9%), than endovascular methods (7/98, 7.1%, p < .001, OR 6.7, 95% CI 3-14.7, including staged endovascular to open surgery, 0/13, 0%). In-hospital mortality after graft removal/extra-anatomical bypass grafting was 31.2% (66/226), graft removal/in situ repair 34% (137/403), primary closure of the arterial defect 62.5% (10/16), and for miscellaneous open procedures 41.3% (33/80), p = .019. Among the subgroups of in situ repair, homografts were associated with a higher mortality than impregnated prosthetic grafts (p = .047). There was no difference in recurrent AEF-free rates between open and endovascular procedures. Extra-anatomical bypass/graft removal and in situ repair had a lower AEF recurrence rate than primary closure and homografts. Late sepsis occurred more often after endovascular surgery (2-year rates 42% vs. 19% for open, p = .001). The early survival benefit of endovascular surgery was blunted during follow-up, although it remained significant (p < .001). Within the in situ repair group, impregnated prosthetic grafts were associated with the worst overall and AEF related mortality free rates and vein grafts with the best. No recurrence, sepsis, or mortality was reported following staged endograft placement to open repair after a mean follow-up of 16.8 months (p = .18, p = .22, and p = .006, respectively, compared with patients in other groups). CONCLUSIONS Endovascular surgery, where appropriate, is associated with better early survival than open surgery for secondary AEFs. Most of this benefit is lost during long-term follow-up, implying that a staged approach with early conversion to in situ vein grafting may achieve the best results in selected patients.
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Affiliation(s)
- S K Kakkos
- Department of Vascular Surgery, University Hospital of Patras, Greece; Department of Surgery and Cancer, Imperial College London, St. Mary's Hospital, London, UK.
| | - C D Bicknell
- Department of Surgery and Cancer, Imperial College London, St. Mary's Hospital, London, UK
| | - I A Tsolakis
- Department of Vascular Surgery, University Hospital of Patras, Greece
| | - D Bergqvist
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden
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Koganti D, Ryan SP, Kwon J, Abai B, Dimuzio PJ, Salvatore DM. Atypical Mycotic Aortic Aneurysms. Ann Vasc Surg 2016; 36:296.e13-296.e18. [DOI: 10.1016/j.avsg.2016.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 03/15/2016] [Accepted: 04/04/2016] [Indexed: 12/21/2022]
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41
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Yoon WJ, Conley A, Herrera S, Van Dorp D, Lorelli DR. Ruptured Mycotic Abdominal Aortic Pseudoaneurysm in a Patient on Hemodialysis Complicated with Oxacillin-Resistant Staphylococcus aureus Bacteremia. Ann Vasc Surg 2016; 35:204.e1-4. [DOI: 10.1016/j.avsg.2016.01.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 01/16/2016] [Accepted: 01/16/2016] [Indexed: 11/28/2022]
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Jayet J, Raux M, Allaire E, Desgranges P, Cochennec F. Treatment of an Abdominal Aortic Aneurysm Infected by Coxiella Burnetii Using a Cryopreserved Allograft. Ann Vasc Surg 2016; 33:227.e9-227.e12. [DOI: 10.1016/j.avsg.2015.09.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 09/22/2015] [Accepted: 09/27/2015] [Indexed: 11/28/2022]
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Zientara A, Schwegler I, Dzemali O, Bruijnen H, Peters AS, Attigah N. Xenopericardial self-made tube grafts in infectious vascular reconstructions: Preliminary results of an easy and ready to use surgical approach. Vascular 2016; 24:621-627. [PMID: 27059764 DOI: 10.1177/1708538116644361] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE Infections are a major setback of vascular reconstruction and associated with considerable morbidity and mortality. We evaluated retrospectively our results with self-made bovine pericardial grafts in infected vessel revascularization versus standard graft material. BASIC METHODS Retrospective analysis of 9 patients with bovine reconstruction and 10 patients with miscellaneous grafts (vein, homograft) for vascular infections. PRINCIPAL FINDINGS Infection-free rate of the pericardial group was 100% in 17 months. For patients after reconstructions with miscellaneous grafts, the infection-free rate was 82% in 45 months. Overall in-hospital mortality was 10.5%. There were no in-hospital deaths in the pericardial group. Graft patency of the whole cohort was 100%. The median follow up was 11.74 months. CONCLUSION Self-made bovine pericardial tube grafts can be crafted to almost any size and adjusted to complex anatomic requirements. The use was feasible in various situations and was associated with good preliminary results concerning patency and reinfection.
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Affiliation(s)
- Alicja Zientara
- Department of Cardiac Surgery, Triemli Hospital, Zürich, Switzerland
| | - Igor Schwegler
- Department of Vascular Surgery, Triemli Hospital, Zürich, Switzerland
| | - Omer Dzemali
- Department of Cardiac Surgery, Triemli Hospital, Zürich, Switzerland
| | - Hans Bruijnen
- Department of Vascular Surgery, Augsburg City Hospital, Augsburg, Germany
| | | | - Nicolas Attigah
- Department of Vascular Surgery, Triemli Hospital, Zürich, Switzerland
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Blanco Amil CL, Vidal Rey J, López Arquillo I, Pérez Rodríguez MT, Encisa de Sá JM. Mycotic Abdominal Aortic Aneurysm Secondary to Septic Embolism of a Thoracic Aorta Graft Infection. Ann Vasc Surg 2016; 33:227.e13-20. [PMID: 26965799 DOI: 10.1016/j.avsg.2015.11.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Revised: 11/19/2015] [Accepted: 11/21/2015] [Indexed: 11/19/2022]
Abstract
Mycotic aneurysms account for 1% of abdominal aortic aneurysms. There are very few cases published that describe the formation of mycotic aneurysms after septic embolism due to graft infection. We present the first case to our knowledge to be described in the literature of a mycotic aneurysm caused by septic embolism derived from a thoracic aorta graft infection, treated with conventional surgery leading to a successful outcome and evolution.
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Affiliation(s)
- Carla Lorena Blanco Amil
- Department of Vascular and Endovascular Surgery, Complejo Hospitalario Universitario de Vigo (CHUVI), Vigo, Spain.
| | - Jorge Vidal Rey
- Department of Vascular and Endovascular Surgery, Complejo Hospitalario Universitario de Vigo (CHUVI), Vigo, Spain
| | - Irene López Arquillo
- Department of Vascular and Endovascular Surgery, Complejo Hospitalario Universitario de Vigo (CHUVI), Vigo, Spain
| | | | - José Manuel Encisa de Sá
- Department of Vascular and Endovascular Surgery, Complejo Hospitalario Universitario de Vigo (CHUVI), Vigo, Spain
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Heinola I, Kantonen I, Jaroma M, Albäck A, Vikatmaa P, Aho P, Venermo M. Editor's Choice – Treatment of Aortic Prosthesis Infections by Graft Removal and In Situ Replacement with Autologous Femoral Veins and Fascial Strengthening. Eur J Vasc Endovasc Surg 2016; 51:232-9. [DOI: 10.1016/j.ejvs.2015.09.015] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 09/19/2015] [Indexed: 10/22/2022]
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Gewartowska M, Olszewski WL, Buyanowskaya O, Frontczak-Baniewicz M. A novel method for long-lasting preservation of arterial grafts. J Surg Res 2015; 200:374-86. [PMID: 26323366 DOI: 10.1016/j.jss.2015.07.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 07/30/2015] [Accepted: 07/31/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Autologous venous grafts generally give best results for arterial bypass grafting in cases of arterial stenosis. When no suitable venous graft can be found, synthetic prosthetic graft may be an alternative. Prostheses are easily accessible but susceptible to infection. In these cases, the replacement of infected prosthesis by the human arterial allograft is the best treatment option. The question arises whether we could prepare a graft meeting mechanical conditions of an artery immunologically inert and resistant to bacterial infection. MATERIALS AND METHODS LEW and BN rat aortic segments were placed in dehydrated sodium chloride and stored for 1 to 12 mo. Then, they were transplanted orthotopically as aortic grafts for 3 to 15 mo in syngenic and allogenic combination. No immunosuppression was used. Patency, pulsation, and frequency of development of aneurysms were studied. The tensile strength and maximum intraluminal pressures were measured. Morphology of grafts was evaluated on histology and electron microscopy. The endothelial and infiltrating cells were identified. RESULTS Transplanted allogeneic aortic grafts preserved in anhydrous sodium chloride up to 12 mo remained patent for 15 mo. Hypertrophy of intima with endothelial cells lining the inner surface and single muscle cells between elastic fibers were seen. Normal structure of collagen and elastic fibers was maintained. Only minor-host mononuclear infiltrates were seen around the preserved allografts. CONCLUSIONS Rat aortas preserved in anhydrous sodium chloride retain patency and function even 15 mo after transplantation. Such grafts retain their wall structure and evoke only minor recipient reaction. Our results confirm that anhydrous sodium chloride may be used for arterial grafts preservation. Low immunogenicity is additional advantage.
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Affiliation(s)
- Magdalena Gewartowska
- Department of Surgical Research and Transplantology, Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland; Department of Human Epigenetics, Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland.
| | - Waldemar L Olszewski
- Department of Surgical Research and Transplantology, Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland; Department of Human Epigenetics, Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland; Department of Gastrointestinal and Transplantation Surgery and Clinical Laboratory, Central Clinical Hospital, Ministry of Internal Affairs, Warsaw, Poland
| | - Olga Buyanowskaya
- Department of Surgical Research and Transplantology, Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland; Department of Human Epigenetics, Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland
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Lau C, Gaudino M, de Biasi AR, Munjal M, Girardi LN. Outcomes of Open Repair of Mycotic Descending Thoracic and Thoracoabdominal Aortic Aneurysms. Ann Thorac Surg 2015; 100:1712-7. [PMID: 26277557 DOI: 10.1016/j.athoracsur.2015.05.067] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 04/24/2015] [Accepted: 05/14/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate the short- and intermediate-term outcomes of open repair of mycotic thoracic and thoracoabdominal aneurysms. Contemporary surgical and perioperative techniques were utilized. METHODS From November 1997 to May 2014, 14 consecutive patients underwent open repair of descending thoracic (n = 9, 64.3%) and thoracoabdominal (n = 5, 35.7%) mycotic aortic aneurysms. All procedures were performed through the left side of the chest. Infected tissue was completely debrided and excised. Aortic continuity was restored in situ with a Dacron prosthesis (Macquet Corp, Oakland, NJ). Soft tissue coverage of the prosthesis was performed when anatomy and patient condition permitted. Perioperative outcomes, intermediate-term survival, and reinfection rates were examined. RESULTS All patients presented with either aneurysm-related symptoms or a clinical picture of sepsis. Diagnosis was confirmed utilizing computed tomography imaging. Mean age was 66 ± 13 years, 8 patients (57.1%) were male, and mean aneurysm size was 5.9 ± 1.3 cm. All patients were hypertensive, 3 (21.4%) had prior coronary revascularization, 7 (50%) had chronic pulmonary disease, 5 (35.7%) had diabetes mellitus, and 2 (14.3%) had end-stage renal disease requiring dialysis. Twelve patients (85.7%) had aneurysm-related pain, and 9 (64.3%) of them had contained rupture. Mean time from onset of illness to surgery was 36 days (range, 0 to 153). On preoperative blood cultures, 4 (28.6%) grew Staphylococcus aureus, 4 (28.6%) grew gram negative organisms, 2 (14.3%) grew mycobacterium, and 4 cultures (28.6%) had negative results. Empiric broad-spectrum antibiotics were initiated on all patients and adjusted based on final cultures. A majority of patients underwent repair utilizing a clamp-and-sew technique (n = 10, 71.4%); the remainder (n = 4, 28.6%) required repair under profound hypothermic circulatory arrest. After radical debridement of the infected tissue, grafts were placed in the normal anatomic position; 6 (42.9%) patients had additional soft tissue coverage, 5 (35.7%) utilizing an omental flap and 1 (7.1%), a serratus muscle flap. There was 1 in-hospital death (7.1%) secondary to ischemic bowel. Four patients (28.6%) required tracheostomy, and 1 (7.1%) had recurrent nerve injury. None of the patients incurred spinal cord injury, stroke, or new onset renal failure requiring dialysis. After surgery, all patients were given 6 weeks of intravenous antibiotics. Lifelong suppression therapy was maintained with oral antibiotics. There were no episodes of prosthetic graft infection on follow-up. Univariate analysis revealed that New York Heart Association functional class, diabetes, and preoperative renal dysfunction were preoperative risk factors for major adverse events. Mean follow-up time was 26.5 months (median 8.2; range, 1 to 142). Actuarial 5-year survival was 71%. CONCLUSIONS Open repair of mycotic descending thoracic and thoracoabdominal aortic aneurysms remains the gold standard of therapy. Aggressive intraoperative debridement with in situ prosthetic reconstruction permits a high rate of success in this very high risk cohort of patients. Lifelong antibiotic suppression therapy may prevent late prosthetic graft infection.
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Affiliation(s)
- Christopher Lau
- Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York, New York.
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York, New York
| | - Andreas R de Biasi
- Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York, New York
| | - Monica Munjal
- Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York, New York
| | - Leonard N Girardi
- Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York, New York
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Muñoz-García R, González-González S, Rubio-Lobato L, Sarria-García E, Valderrama-Marcos JF, Gutiérrez-de-Loma J. Circulación extracorpórea para proteger el riñón trasplantado en un paciente con una infección de una endoprótesis de aorta abdominal. CIRUGIA CARDIOVASCULAR 2015. [DOI: 10.1016/j.circv.2014.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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49
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Setacci C, Chisci E, Setacci F, Ercolini L, de Donato G, Troisi N, Galzerano G, Michelagnoli S. How To Diagnose and Manage Infected Endografts after Endovascular Aneurysm Repair. AORTA : OFFICIAL JOURNAL OF THE AORTIC INSTITUTE AT YALE-NEW HAVEN HOSPITAL 2014; 2:255-64. [PMID: 26798744 DOI: 10.12945/j.aorta.2014.14-036] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 10/03/2014] [Indexed: 12/14/2022]
Abstract
The prevalence of endograft infections (EI) after endovascular abdominal aortic aneurysm repair is below 1%. With the growing number of patients with aortic endografts and the aging population, the number of patients with EI might also increase. The diagnosis is based on an association of clinical symptoms, imaging, and microbial cultures. Angio-computed tomography is currently the gold-standard technique for diagnosis. Low-grade infection sometimes requires nuclear medicine imaging to make a correct diagnosis. There is no good evidence to guide management so far. In the case of active gastrointestinal bleeding, pseudoaneurysm, or extensive perigraft purulence involving adjacent organs, an invasive treatment should always be attempted. In the other cases (the majority), when there is not an immediate danger to the patient's life, a conservative management is started with a proper antimicrobial therapy. Any infectious cavity can be percutaneously drained. Management depends on the patient's condition and a tailored approach should always be offered. In the case of a patient who is young, has a good life expectancy, or in whom there is absence of significant comorbidities, a surgical attempt can be proposed. Surgical techniques favor, in terms of mortality, patency, and reinfection rate, the in situ reconstruction. Choice of technique relies on the center and the operator's experience. Long-term antibiotic therapy is always required in all cases, with close monitoring of the C-reactive protein.
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Affiliation(s)
- Carlo Setacci
- Vascular and Endovascular Surgery Unit, University of Siena, Siena, Italy
| | - Emiliano Chisci
- Department of Surgery, Vascular and Endovascular Surgery Unit, "San Giovanni di Dio" Hospital, Florence, Italy; and
| | - Francesco Setacci
- P. Valdoni Department of Surgery, La Sapienza University, Rome, Italy
| | - Leonardo Ercolini
- Department of Surgery, Vascular and Endovascular Surgery Unit, "San Giovanni di Dio" Hospital, Florence, Italy; and
| | | | - Nicola Troisi
- Department of Surgery, Vascular and Endovascular Surgery Unit, "San Giovanni di Dio" Hospital, Florence, Italy; and
| | - Giuseppe Galzerano
- Vascular and Endovascular Surgery Unit, University of Siena, Siena, Italy
| | - Stefano Michelagnoli
- Department of Surgery, Vascular and Endovascular Surgery Unit, "San Giovanni di Dio" Hospital, Florence, Italy; and
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Oberhuber A, Lohr B, Orend KH, Schelzig H, Muehling B. Outcome of Infrainguinal Prosthetic Graft Infections Depending on the Surgical Management. Surg Infect (Larchmt) 2014; 15:606-12. [DOI: 10.1089/sur.2013.099] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Alexander Oberhuber
- University of Duesseldorf, Department of Vascular and Endovascular Surgery, Duesseldorf, Germany
| | - Bernard Lohr
- University of Ulm, Department of Cardiothoracic and Vascular Surgery, Duesseldorf, Germany
| | - Karl-Heinz Orend
- University of Ulm, Department of Cardiothoracic and Vascular Surgery, Duesseldorf, Germany
| | - Hubert Schelzig
- University of Duesseldorf, Department of Vascular and Endovascular Surgery, Duesseldorf, Germany
| | - Bernd Muehling
- University of Ulm, Department of Cardiothoracic and Vascular Surgery, Duesseldorf, Germany
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