1
|
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
| |
Collapse
|
2
|
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
| |
Collapse
|
3
|
Mestres C, Van Hemelrijck M, Quintana E, Smit FE. Significance and current approaches to vascular graft infection. Indian J Thorac Cardiovasc Surg 2023; 39:333-340. [PMID: 38093914 PMCID: PMC10713901 DOI: 10.1007/s12055-023-01638-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 10/23/2023] [Accepted: 10/24/2023] [Indexed: 12/17/2023] Open
Abstract
Vascular graft/endograft infection (VGEI) is a constant in cardiovascular surgery with published rates between 1 and 5%. Every graft type and anatomical location is a potential target for infectious complications. These patients are sick patients with high frailty burden. Management of VGEI entails a multidisciplinary and multimodality approach. Here we review some aspects of the problem of VGEI including prevention, diagnosis, and surgical therapy with focus on recent developments in the field.
Collapse
Affiliation(s)
- Carlos–Alberto Mestres
- Department of Cardiothoracic Surgery, Faculty of Health Sciences and The Robert WM Frater Cardiovascular Research Centre, The University of the Free State, PO Box 339 (Internal Box G32), Bloemfontein, 9300 South Africa
| | | | - Eduard Quintana
- Department of Cardiovascular Surgery, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Francis Edwin Smit
- Department of Cardiothoracic Surgery, Faculty of Health Sciences and The Robert WM Frater Cardiovascular Research Centre, The University of the Free State, PO Box 339 (Internal Box G32), Bloemfontein, 9300 South Africa
| |
Collapse
|
4
|
Ogino H, Iida O, Akutsu K, Chiba Y, Hayashi H, Ishibashi-Ueda H, Kaji S, Kato M, Komori K, Matsuda H, Minatoya K, Morisaki H, Ohki T, Saiki Y, Shigematsu K, Shiiya N, Shimizu H, Azuma N, Higami H, Ichihashi S, Iwahashi T, Kamiya K, Katsumata T, Kawaharada N, Kinoshita Y, Matsumoto T, Miyamoto S, Morisaki T, Morota T, Nanto K, Nishibe T, Okada K, Orihashi K, Tazaki J, Toma M, Tsukube T, Uchida K, Ueda T, Usui A, Yamanaka K, Yamauchi H, Yoshioka K, Kimura T, Miyata T, Okita Y, Ono M, Ueda Y. JCS/JSCVS/JATS/JSVS 2020 Guideline on Diagnosis and Treatment of Aortic Aneurysm and Aortic Dissection. Circ J 2023; 87:1410-1621. [PMID: 37661428 DOI: 10.1253/circj.cj-22-0794] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Affiliation(s)
- Hitoshi Ogino
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Osamu Iida
- Cardiovascular Center, Kansai Rosai Hospital
| | - Koichi Akutsu
- Cardiovascular Medicine, Nippon Medical School Hospital
| | - Yoshiro Chiba
- Department of Cardiology, Mito Saiseikai General Hospital
| | | | | | - Shuichiro Kaji
- Department of Cardiovascular Medicine, Kansai Electric Power Hospital
| | - Masaaki Kato
- Department of Cardiovascular Surgery, Morinomiya Hospital
| | - Kimihiro Komori
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine
| | - Hitoshi Matsuda
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University
| | | | - Takao Ohki
- Division of Vascular Surgery, Department of Surgery, The Jikei University School of Medicine
| | - Yoshikatsu Saiki
- Division of Cardiovascular Surgery, Graduate School of Medicine, Tohoku University
| | - Kunihiro Shigematsu
- Department of Vascular Surgery, International University of Health and Welfare Mita Hospital
| | - Norihiko Shiiya
- First Department of Surgery, Hamamatsu University School of Medicine
| | | | - Nobuyoshi Azuma
- Department of Vascular Surgery, Asahikawa Medical University
| | - Hirooki Higami
- Department of Cardiology, Japanese Red Cross Otsu Hospital
| | | | - Toru Iwahashi
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Kentaro Kamiya
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Takahiro Katsumata
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College
| | - Nobuyoshi Kawaharada
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine
| | | | - Takuya Matsumoto
- Department of Vascular Surgery, International University of Health and Welfare
| | | | - Takayuki Morisaki
- Department of General Medicine, IMSUT Hospital, the Institute of Medical Science, the University of Tokyo
| | - Tetsuro Morota
- Department of Cardiovascular Surgery, Nippon Medical School Hospital
| | | | - Toshiya Nishibe
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Kenji Okada
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine
| | | | - Junichi Tazaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Masanao Toma
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center
| | - Takuro Tsukube
- Department of Cardiovascular Surgery, Japanese Red Cross Kobe Hospital
| | - Keiji Uchida
- Cardiovascular Center, Yokohama City University Medical Center
| | - Tatsuo Ueda
- Department of Radiology, Nippon Medical School
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine
| | - Kazuo Yamanaka
- Cardiovascular Center, Nara Prefecture General Medical Center
| | - Haruo Yamauchi
- Department of Cardiac Surgery, The University of Tokyo Hospital
| | | | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | | | - Yutaka Okita
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine
| | - Minoru Ono
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
| | | |
Collapse
|
5
|
Yoshida S, Manerikar A, Zhu M, Mehta C. Successful surgical treatment of Stanford type A aortic dissection due to Salmonella aortitis. J Cardiothorac Surg 2023; 18:233. [PMID: 37452382 PMCID: PMC10349517 DOI: 10.1186/s13019-023-02318-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 06/28/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Salmonella spp. cause infectious aortitis through the hematogenous spread of an intestinal Salmonella infection. Salmonella aortitis can result in extensive tissue damage in the aorta leading to complications including dissection, abscess formation, pseudoaneurysms, and rupture, which require early diagnosis and treatment with both surgery and antibiotic therapy. CASE PRESENTATION We report a case of Salmonella aortitis complicated by Stanford type A aortic dissection. A 62-year-old man with a history of heroin use presented with chest pain, epigastric pain and vomiting. The computed tomography scan showed Stanford type A aortic dissection without malperfusion. At the time of surgery, an aortic dissection with purulent fluid and contained rupture was noted in the ascending aorta. Fluid culture was consistent with Salmonella. A composite valve-graft conduit aortic root replacement with ascending aorta and hemiarch replacement was performed. The patient recovered well and was discharged on long-term antibiotics. CONCLUSIONS This rare case of a Stanford type A aortic dissection with contained rupture due to Salmonella aortitis was successfully treated with emergent surgery and antibiotic therapy.
Collapse
Affiliation(s)
- Shohei Yoshida
- Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine and Northwestern Memorial Hospital, 676 North St. Clair, Suite 7-300, Chicago, IL, 60611, USA
| | - Adwaiy Manerikar
- Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine and Northwestern Memorial Hospital, 676 North St. Clair, Suite 7-300, Chicago, IL, 60611, USA
| | - Mengou Zhu
- Division of Internal Medicine, Northwestern University Feinberg School of Medicine and Northwestern Memorial Hospital, Chicago, IL, USA
| | - Christopher Mehta
- Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine and Northwestern Memorial Hospital, 676 North St. Clair, Suite 7-300, Chicago, IL, 60611, USA.
| |
Collapse
|
6
|
Lin CH, Hsia K, Lu JH, Ma H. Cryopreserved allogenic vascular graft in free-flap reconstructive microsurgery: case report. J Surg Case Rep 2021; 2021:rjab375. [PMID: 34457239 PMCID: PMC8390391 DOI: 10.1093/jscr/rjab375] [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: 07/27/2021] [Accepted: 08/04/2021] [Indexed: 11/13/2022] Open
Abstract
The use of cryopreserved allogenic vascular graft in reconstructive microsurgery has rarely been reported. Here, we report a case of lower extremity reconstruction using cryopreserved hepatic artery as the vein conduit. Postoperative flap perfusion was uneventful with satisfactory wound healing, and graft patency was observed on follow-up color Doppler. Thus, cryopreserved allogenic vascular graft could be a source of vascular conduit in microsurgery.
Collapse
Affiliation(s)
- Chih-Hsun Lin
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei 11217, Taiwan
| | - Kai Hsia
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei 11217, Taiwan
| | - Jen-Her Lu
- Section of pediatric cardiology, department of pediatrics, Taipei medical university hospital, Taipei11031, Taiwan
| | - Hsu Ma
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei 11217, Taiwan
| |
Collapse
|
7
|
Infections of the aorta. Indian J Thorac Cardiovasc Surg 2021; 38:101-114. [PMID: 35463716 PMCID: PMC8980989 DOI: 10.1007/s12055-021-01173-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 02/21/2021] [Accepted: 02/23/2021] [Indexed: 10/21/2022] Open
Abstract
Infection of the aorta continues to be a clinical challenge with high morbidity and mortality. The incidence varies between 0.6 and 2.6%. There has been a steady increase in graft infections, especially endograft infections, due to increased procedures (0.2 to 5%). Staphylococcus species remains the most common organism; however, gram-negative and rare causative agents are also reported. The clinical presentation can be very diverse and a high degree of suspicion is necessary to diagnose them. Sometimes, they may present as an emergency with rupture or fistulation. Diagnosis is based on a triad of clinical features, microbial cultures and imaging. Culture-specific antibiotics are mandatory during the entire course, but seldom cure alone. Surgical management remains the standard of care and involves an integrated approach involving debridement, reconstruction and use of adjuncts. Various aortic substitutes have been described with advantages and limitations. Pericardial tube grafts have emerged as a good option. Endo-vascular options are practiced mostly as a bridge to definitive surgery. A small role for conservative management is described. Aortic fistulation to the gut and airway carries a very high mortality. There are no large series in the literature to define guideline-directed treatment and most often it is a customized solution. The 30-day mortality remains close to 30%. Outcomes depend on multiple factors including patient's age, the timing of presentation, diagnosis, causative organism, host status and the treatment strategy adopted.
Collapse
|
8
|
Kalinin RE, Solanik NA, Pshennikov AS, Suchkov IA, Egorov AA, Kaprov VV. [The place of arterial allograft in reconstructive surgery of the main arteries of the lower extremities]. Khirurgiia (Mosk) 2020:69-74. [PMID: 33030004 DOI: 10.17116/hirurgia202009169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Critical limb ischemia, especially in the absence of autologous vein, prosthetic and native vascular infections are isolated diseases for which there currently doesn't have best surgical treatment. Vascular allografts may be the treatment of choice for these patients. In this analysis, we tried to reflect the directions of development of vascular allotransplantation, global trends related to indications for their use, methods of conservation, degradation and endothelial dysfunction. At the present time there doesn't have meta-analyzes on the efficiency of using arterial allografts or other options for implantation (synthetic graft, xenografts) for critical limb ischemia and graft and native infections. Now it is wrong to recommend using them always. Further studies of their performance are necessary. In addition, development of graft control techniques is also needed when rejection develops. Currently, there are no special diagnostic markers, the assessment of which could save patients with immune-mediated dilatation and dysfunction of allografts.
Collapse
Affiliation(s)
- R E Kalinin
- Ryazan State Medical University, Ryazan, Russia
| | - N A Solanik
- Ryazan State Medical University, Ryazan, Russia
| | - A S Pshennikov
- Ryazan State Medical University, Ryazan, Russia.,Ryazan State Clinical Hospital, Ryazan, Russia
| | - I A Suchkov
- Ryazan State Medical University, Ryazan, Russia
| | - A A Egorov
- Ryazan State Clinical Hospital, Ryazan, Russia
| | - V V Kaprov
- Ryazan State Clinical Hospital, Ryazan, Russia
| |
Collapse
|
9
|
Arasu R, Campbell I, Cartmill A, Cohen T, Hansen P, Muller J, Dave R, McGahan T. Management of primary mycotic aneurysms and prosthetic graft infections: an 8-year experience with in-situ cryopreserved allograft reconstruction. ANZ J Surg 2020; 90:1716-1720. [PMID: 32783268 DOI: 10.1111/ans.16218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 07/16/2020] [Accepted: 07/19/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Primary mycotic aneurysms and prosthetic graft infections are traditionally managed by resection of infected vascular tissue and revascularisation with an extra-anatomical bypass. Long-term patency for this method has been reported to be poor with associated high reinfection and limb amputation rates. The aim of this study was to analyse the outcomes of those patients in our department between 2010 and 2018 whom had revascularisation with in-situ arterial reconstruction using cryopreserved allograft as a conduit. METHODS The data were retrospectively reviewed and 13 patients were identified. There were five patients with primary mycotic aneurysms and eight patients with prosthetic graft infections, three of which were complicated by aortoenteric fistulae (AEF). RESULTS There were three peri-operative mortalities (23%) with all three mortalities related to graft re-infection and post-implantation haemorrhage; two of these from uncontrolled bile leaks related to the original AEF with persistent graft contamination. The 10 surviving patients were followed up for a mean duration of 15.8 months with an overall primary graft patency of 89% and no incidence of graft re-infection or aneurysmal degeneration. CONCLUSION Patients that survived the peri-operative period demonstrated acceptable medium-term allograft durability, with the most favourable outcomes observed in those patients who had arterial infections uncomplicated by AEF. The main barrier to more wide-spread use in our state remains inadequate supply of banked cryopreserved tissue.
Collapse
Affiliation(s)
- Rohan Arasu
- Department of Vascular Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Ian Campbell
- Department of Vascular Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Andrew Cartmill
- Department of Vascular Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Toby Cohen
- Department of Vascular Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Peter Hansen
- Department of Vascular Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Juanita Muller
- Department of Vascular Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Richa Dave
- Department of Vascular Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Timothy McGahan
- Department of Vascular Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| |
Collapse
|
10
|
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.
Collapse
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
| |
Collapse
|
11
|
Wang X, Li Y, Chen Y. Successful surgical management of coarctation of the aorta with infective endaortitis and splenic abscess: a case report. J Int Med Res 2020; 48:300060520910655. [PMID: 32270732 PMCID: PMC7153188 DOI: 10.1177/0300060520910655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Infective endaortitis with a splenic abscess is an extremely rare and fatal complication of coarctation of the aorta. We herein describe a 19-year-old female patient with a 2-month history of intermittent fever with progressive abdominal and leg pain. Aortic computed tomography angiography showed a rapidly progressive poststenotic saccular aneurysm immediately distal to the coarctation. Enhanced abdominal computed tomography showed a severe splenic abscess. During the operation, the infected spleen was resected first. We subsequently removed all of the diseased aorta and performed in situ aortic reconstruction with an artificial tube graft and without extracorporeal circulation. The patient had an uneventful postoperative clinical course and recovered very well during the 4-year follow-up. In summary, our case report details the successful surgical treatment of coarctation of the aorta with infective endaortitis and a splenic abscess and thoroughly discusses the indications and key notes for surgery without extracorporeal circulation in this complex disease.
Collapse
Affiliation(s)
- Xuebin Wang
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yongjun Li
- Department of Vascular Surgery, Beijing Hospital, National Center of Gerontology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuexin Chen
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Yuexin Chen, Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, #1 Shuai-Fu-Yuan, Wang-Fu-Jing, Beijing 100730, China.
| |
Collapse
|
12
|
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.
Collapse
|
13
|
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.
Collapse
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
| | | |
Collapse
|
14
|
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
| |
Collapse
|
15
|
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.
Collapse
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
| |
Collapse
|
16
|
Furlough CL, Jain AK, Ho KJ, Rodriguez HE, Tomita TM, Eskandari MK. Peripheral artery reconstructions using cryopreserved arterial allografts in infected fields. J Vasc Surg 2019; 70:562-568. [PMID: 30737000 DOI: 10.1016/j.jvs.2018.10.111] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 10/13/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Cryopreserved human arterial allografts are a recognized acceptable alternative for vascular reconstruction when other traditional conduits are either unavailable or contraindicated. We reviewed our experience using cryopreserved arterial allografts for peripheral artery reconstructions in contaminated and infected surgical fields. METHODS A single-center, retrospective review was conducted of 57 patients who underwent a peripheral vascular reconstruction using a cryopreserved arterial allograft from January 2002 through July 2017. Indications for repair included removal of infected prosthetic bypass (n = 29), revascularizations in contaminated fields (n = 11), primary arterial repair in the setting of infection (n = 10), and infected vascular closure devices (n = 7). Aorta-based repairs were excluded. Demographics, index procedural details, postoperative complications, and conduit patency were analyzed. Primary end points included conduit-related mortality and graft failure as measured by reinfection, hemorrhage, or aneurysmal degeneration. Mean follow-up for the study is 27.8 months (range, 2-125 months). RESULTS A total of 57 peripheral vascular reconstructions using cryopreserved arterial allografts were performed during the 15-year period. Among the 22 women and 35 men treated, the mean age was 61 years. The vascular beds involved included iliofemoral (n = 39), femoropopliteal or femoral-distal (n = 10), axillosubclavian or brachial (n = 2), mesenteric (n = 3), and carotid (n = 3) arteries. Adjunctive muscle flap coverage of the allograft conduit was performed in the majority of cases (61%; n = 35). The 30-day mortality was 9%; one death was directly related to conduit insertion. The 30-day conduit-related complication rate was 14% and included hemorrhage from the graft requiring return to the operating room (n = 4) and graft infection (n = 4). The late conduit-related complication rate was 15.8% and included graft infection (n = 1), graft thrombosis (n = 3), major amputation resulting from conduit failure (n = 1), pseudoaneurysm degeneration requiring repair (n = 2), graft hemorrhage (n = 1), and symptomatic graft stenosis (n = 1). CONCLUSIONS A cryopreserved arterial allograft is a useful alternative conduit for peripheral vascular reconstruction in infected or contaminated surgical fields when other autologous or prosthetic conduits are either unavailable or contraindicated. In the immediate postoperative period, these repairs demonstrate acceptable resistance to graft failure and reinfection, particularly in conjunction with adjunctive rotational muscle flap coverage. Late conduit-related complications appear to be infrequent.
Collapse
Affiliation(s)
- Courtney L Furlough
- Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Ashish K Jain
- Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Karen J Ho
- Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Heron E Rodriguez
- Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Tadaki M Tomita
- Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Mark K Eskandari
- Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill.
| |
Collapse
|
17
|
Repair of Thoracic and Thoracoabdominal Mycotic Aneurysms and Infected Aortic Grafts Using Allograft. Ann Thorac Surg 2018; 106:1129-1135. [DOI: 10.1016/j.athoracsur.2018.04.050] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 03/16/2018] [Accepted: 04/17/2018] [Indexed: 12/25/2022]
|
18
|
Abstract
Vascular graft infection is a devastating complication of vascular reconstructive surgery. The infection can occur early in the postoperative period and is largely due to intraoperative contamination or by contiguous extension from a nearby infection. It can also occur years after implantation. Staphylococci remain the most common organisms and biofilm production makes eradication difficult. Factors commonly reported to predispose to vascular graft infection are periodontal disease, nasal colonization with Staphylococcus aureus, bacteremia, certain graft characteristics, diabetes mellitus, postoperative hyperglycemia, location of the incision, wound infection, and emergency procedure. Management consists of antibiotic and surgical therapy. Preventive methods are described.
Collapse
Affiliation(s)
- Amal Gharamti
- Division of Infectious Diseases, Department of Internal Medicine, American University of Beirut, Cairo Street, Riad El Solh, Beirut 1107 2020, Lebanon
| | - Zeina A Kanafani
- Division of Infectious Diseases, Department of Internal Medicine, American University of Beirut, Cairo Street, Riad El Solh, Beirut 1107 2020, Lebanon; Division of Infectious Diseases, Department of Internal Medicine, American University of Beirut Medical Center, Cairo Street, PO Box 11-0236/11D, Riad El Solh, Beirut 1107 2020, Lebanon.
| |
Collapse
|
19
|
Deipolyi AR, Czaplicki CD, Oklu R. Inflammatory and infectious aortic diseases. Cardiovasc Diagn Ther 2018; 8:S61-S70. [PMID: 29850419 PMCID: PMC5949581 DOI: 10.21037/cdt.2017.09.03] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 09/01/2017] [Indexed: 12/15/2022]
Abstract
Aortitis is aortic inflammation, which can be due to inflammatory or infectious diseases. Left undiagnosed, aortitis can lead to aneurysm formation and rupture, in addition to ischemic compromise of major organs. Infectious aortic diseases include mycotic aneurysm and graft infection; the most common inflammatory diseases are Takayasu's and giant cell arteritis. We review the epidemiology, etiology, presentation and diagnosis, and treatment of these entities.
Collapse
Affiliation(s)
- Amy R. Deipolyi
- Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Rahmi Oklu
- Division of Vascular & Interventional Radiology, Mayo Clinic, Phoenix, AZ, USA
| |
Collapse
|
20
|
Špaček M, Měřička P, Janoušek L, Štádler P, Adamec M, Vlachovský R, Guňka I, Navrátil P, Thieme F, Mitáš P, Špunda R, Špatenka J, Staffa R, Němec P, Lindner J. Organization model for allotransplantations of cryopreserved vascular grafts in Czech Republic. Cell Tissue Bank 2018; 19:437-445. [PMID: 29502254 DOI: 10.1007/s10561-018-9691-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 03/01/2018] [Indexed: 11/30/2022]
Abstract
The transplantation of fresh or cryopreserved vascular allografts in patients with a prosthetic graft infection or critical limb ischemia is necessary for their limb salvage and, in many cases, represents a lifesaving procedure. While transplantation of fresh allografts has a long history in the Czech Republic, the standard use of cryopreserved vascular allografts was introduced into the clinical practice in 2011 as a result of the implementation of EU Directive 2004/23/EC into national legislation (Human Cell and Tissue Act No. 296/2008 Coll.). The authors present an organizational model based on cooperation between the majority of Czech Transplant Centers with a tissue establishment licensed by the national competent authority. In various points, we are addressing individual aspects of experimental and clinical studies which affect clinical practice. Based on experimental and clinical work, the first validation of cryopreserved arterial and venous grafts for clinical use was performed between 2011 and 2013. The growing number of centers participating in this programme led to a growing number of patients who underwent transplantation of vascular allografts. In 2015 the numbers of transplanted fresh versus cryopreserved allografts in the Czech Republic were almost equal. Cooperation of the participating centers in the Czech Republic with the licensed Tissue Establishment made it possible to achieve a full compliance with the European Union Directives, and harmonized national legal norms and assured a high quality of cryopreserved vascular allografts.
Collapse
Affiliation(s)
- Miroslav Špaček
- 2nd Department of Surgery - Department of Cardiovascular Surgery, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic.
| | - Pavel Měřička
- Tissue Bank, University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | - Libor Janoušek
- Department of Transplant Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Petr Štádler
- Department of Vascular Surgery, Na Homolce Hospital, Prague, Czech Republic
| | - Miloš Adamec
- Transplants Coordinating Centre, Prague, Czech Republic
| | - Robert Vlachovský
- 2nd Department of Surgery, St. Anne's University Hospital, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Igor Guňka
- Department of Surgery, University Hospital and Faculty of Medicine Hradec Kralove, Charles University in Prague, Hradec Kralove, Czech Republic.,Transplant Center, University Hospital and Faculty of Medicine Hradec Kralove, Charles University in Prague, Hradec Kralove, Czech Republic
| | - Pavel Navrátil
- Transplant Center, University Hospital and Faculty of Medicine Hradec Kralove, Charles University in Prague, Hradec Kralove, Czech Republic
| | - Filip Thieme
- Department of Transplant Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Petr Mitáš
- 2nd Department of Surgery - Department of Cardiovascular Surgery, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
| | - Rudolf Špunda
- 2nd Department of Surgery - Department of Cardiovascular Surgery, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
| | - Jaroslav Špatenka
- Department of Transplantation and Tissue Bank, University Hospital Motol, Prague, Czech Republic
| | - Robert Staffa
- 2nd Department of Surgery, St. Anne's University Hospital, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Petr Němec
- Center of Cardiovascular Surgery and Transplantations Brno, Brno, Czech Republic
| | - Jaroslav Lindner
- 2nd Department of Surgery - Department of Cardiovascular Surgery, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
| |
Collapse
|
21
|
Glebova NO, Black JH. Current management of infected aortic grafts in patients with connective tissue disorders. Semin Vasc Surg 2017; 30:75-79. [PMID: 29248123 DOI: 10.1053/j.semvascsurg.2017.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Patients with connective tissue disorder present a particular clinical challenge in the treatment of aortic graft infections. Specific complexities arise in patients with connective tissue disorders when reoperation for aortic graft infection is required. Herein we describe current management of infected aortic grafts in patients with connective tissue disorders using homograft and rifampin-coated graft replacements using in situ replacement therapy, which is associated with improved outcome compared to graft excision and extra-anatomic bypass.
Collapse
Affiliation(s)
- Natalia O Glebova
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Colorado, Anschutz Medical Campus, 12631 East 17(th) Avenue, Room 5409, Mail Stop C312, Aurora, CO 80045.
| | - James H Black
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Johns Hopkins Medical Institutes, Baltimore, MD
| |
Collapse
|
22
|
Ito F, Inokuchi R, Matsumoto A, Kumada Y, Yokoyama H, Ishida T, Hashimoto K, Narita M, Shinohara K. Presence of periaortic gas in Clostridium septicum-infected aortic aneurysm aids in early diagnosis: a case report and systematic review of the literature. J Med Case Rep 2017; 11:268. [PMID: 28931420 PMCID: PMC5607595 DOI: 10.1186/s13256-017-1422-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 08/08/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clostridium septicum-infected aortic aneurysm is a fatal and rare disease. We present a fatal case of C. septicum-infected aortic aneurysm and a pertinent literature review with treatment suggestions for reducing mortality rates. CASE PRESENTATION A 58-year-old Japanese man with an unremarkable medical history presented with a 3-day history of mild weakness in both legs, and experienced paraplegia and paresthesia a day before admission. Upon recognition of signs of an abdominal aortic aneurysm and paraplegia, we suspected an occluded Adamkiewicz artery and performed a contrast-enhanced computed tomography scan, which revealed an aortic aneurysm with periaortic gas extending from his chest to his abdomen and both kidneys. Antibiotics were initiated followed by emergency surgery for source control of the infection. However, owing to his poor condition and septic shock, aortic repair was not possible. We performed bilateral nephrectomy as a possible source control, after which we initiated mechanical ventilation, continuous hemodialysis, and hemoperfusion. A culture of the samples taken from the infected region and four consecutive blood cultures yielded C. septicum. His condition gradually improved postoperatively; however, on postoperative day 10, massive hemorrhage due to aortic rupture resulted in his death. CONCLUSIONS In this patient, C. septicum was thought to have entered his blood through a gastrointestinal tumor, infected the aorta, and spread to his kidneys. However, we were uncertain whether there was an associated malignancy. A literature review of C. septicum-related aneurysms revealed the following: 6-month mortality, 79.5%; periaortic gas present in 92.6% of cases; no standard operative procedure and no guidelines for antimicrobial administration established; and C. septicum was associated with cancer in 82.5% of cases. Thus, we advocate for early diagnosis via the identification of periaortic gas, as an aortic aneurysm progresses rapidly. To reduce the risk of reinfection as well as infection of other sites, there is the need for concurrent surgical management of the aneurysm and any associated malignancy. We recommend debridement of the infectious focus and in situ vascular graft with omental coverage. Postoperatively, orally administered antibiotics must be continued indefinitely (chronic suppression therapy). We believe that these treatments will decrease mortality due to C. septicum-infected aortic aneurysms.
Collapse
Affiliation(s)
- Fumihito Ito
- Department of Emergency and Critical Care Medicine, Ohta Nishinouchi Hospital, 2-5-20 Nishinouchi, Koriyama, Fukushima, 963-8558, Japan.
| | - Ryota Inokuchi
- Department of Emergency and Critical Care Medicine, JR General Hospital, 2-1-3 Yoyogi, Shibuya-ku, Tokyo, 151-8528, Japan.,Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Akinori Matsumoto
- Department of Emergency and Critical Care Medicine, Ohta Nishinouchi Hospital, 2-5-20 Nishinouchi, Koriyama, Fukushima, 963-8558, Japan
| | - Yoshibumi Kumada
- Department of Emergency and Critical Care Medicine, Ohta Nishinouchi Hospital, 2-5-20 Nishinouchi, Koriyama, Fukushima, 963-8558, Japan
| | - Hideyuki Yokoyama
- Department of Emergency and Critical Care Medicine, Ohta Nishinouchi Hospital, 2-5-20 Nishinouchi, Koriyama, Fukushima, 963-8558, Japan
| | - Tokiya Ishida
- Department of Emergency and Critical Care Medicine, Ohta Nishinouchi Hospital, 2-5-20 Nishinouchi, Koriyama, Fukushima, 963-8558, Japan
| | - Katsuhiko Hashimoto
- Department of Emergency and Critical Care Medicine, Ohta Nishinouchi Hospital, 2-5-20 Nishinouchi, Koriyama, Fukushima, 963-8558, Japan
| | - Masashi Narita
- Department of Infectious Diseases, Okinawa Chubu Hospital, 281 Miyazato, Uruma, Okinawa, 904-2293, Japan
| | - Kazuaki Shinohara
- Department of Emergency and Critical Care Medicine, Ohta Nishinouchi Hospital, 2-5-20 Nishinouchi, Koriyama, Fukushima, 963-8558, Japan
| |
Collapse
|
23
|
Theodoridis K, Müller J, Ramm R, Findeisen K, Andrée B, Korossis S, Haverich A, Hilfiker A. Effects of combined cryopreservation and decellularization on the biomechanical, structural and biochemical properties of porcine pulmonary heart valves. Acta Biomater 2016; 43:71-77. [PMID: 27422199 DOI: 10.1016/j.actbio.2016.07.013] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 06/30/2016] [Accepted: 07/11/2016] [Indexed: 12/24/2022]
Abstract
UNLABELLED Non-fixed, decellularized allogeneic heart valve scaffolds seem to be the best choice for heart valve replacement, their availability, however, is quite limited. Cryopreservation could prolong their shelf-life, allowing for their ideal match to a recipient. In this study, porcine pulmonary valves were decellularized using detergents, either prior or after cryopreservation, and analyzed. Mechanical integrity was analyzed by uniaxial tensile testing, histoarchitecture by histological staining, and composition by DNA, collagen (hydroxyproline) and GAG (chondroitin sulfate) quantification. Residual sodium dodecyl sulfate (SDS) in the scaffold was quantified by applying a methylene blue activation assay (MBAS). Cryopreserved decellularized scaffolds (DC) and scaffolds that were decellularized after cryopreservation (CD) were compared to fresh valves (F), cryopreserved native valves (C), and decellularized only scaffolds (D). The E-modulus and tensile strength of decellularized (D) tissue showed no significant difference compared to DC and CD. The decellularization resulted in an overall reduction of DNA and GAG, with DC containing the lowest amount of GAGs. The DNA content in the valvular wall of the CD group was higher than in the D and DC groups. CD valves showed slightly more residual SDS than DC valves, which might be harmful to recipient cells. In conclusion, cryopreservation after decellularization was shown to be preferable over cryopreservation before decellularization. However, in vivo testing would be necessary to determine whether these differences are significant in biocompatibility or immunogenicity of the scaffolds. STATEMENT OF SIGNIFICANCE Absence of adverse effects on biomechanical stability of acellular heart valve grafts by cryopreservation, neither before nor after decellularization, allows the identification of best matching patients in a less time pressure dictated process, and therefore to an optimized use of a very limited, but best-suited heart valve prosthesis.
Collapse
|
24
|
Minga Lowampa E, Holemans C, Stiennon L, Van Damme H, Defraigne JO. Late Fate of Cryopreserved Arterial Allografts. Eur J Vasc Endovasc Surg 2016; 52:696-702. [PMID: 27614553 DOI: 10.1016/j.ejvs.2016.08.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 08/09/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Initial enthusiasm for use of cryopreserved arterial allografts was subsequently tempered by suboptimal long-term outcome. Thrombosis, anastomotic pseudo-aneurysm, allograft disruption, aneurysmal degeneration, recurrent intestinal fistulization, and persistent infection are commonly reported in series with long-term follow-up. The authors reviewed their experience over the past 15 years with the use of cryopreserved arterial allografts as a vascular substitute for vascular prosthetic infection or for primary arterial infection, to investigate allograft-related complications. MATERIAL AND METHODS A retrospective analysis of prospectively collected data was conducted for 103 cryopreserved arterial allografts inserted in 96 patients between July 2000 and July 2015. There were 78 patients with infected vascular prosthesis (IVP), nine patients with an aorto-enteric fistula (AEF), and nine patients with primary arterial infection (PAI). RESULTS The in-hospital mortality was eight out of 78 (9%) IVP patients, three out of nine AEF patients, and zero out of nine PAI patients. Median follow-up was 49 months. Allograft-related re-interventions were necessary in 29% of the patients with IVP and four of the patients with AEF, but none of the patients with PAI. Five-year survival for the IVP, AEF, and PAI patients was 53%, 44%, and 90%, respectively. CONCLUSION This series highlights some shortcomings of cryopreserved arterial allografts in the long term, including suboptimal outcome-results and shortage of material. The authors discuss the allograft-related complications and suggest some tricks to minimize their risk.
Collapse
Affiliation(s)
- E Minga Lowampa
- Department of Cardiovascular Surgery, University Hospital Sart Tilman, Liège, Belgium
| | - Ch Holemans
- Department of Cardiovascular Surgery, University Hospital Sart Tilman, Liège, Belgium
| | - L Stiennon
- Department of Cardiovascular Surgery, University Hospital Sart Tilman, Liège, Belgium
| | - H Van Damme
- Department of Cardiovascular Surgery, University Hospital Sart Tilman, Liège, Belgium.
| | - J O Defraigne
- Department of Cardiovascular Surgery, University Hospital Sart Tilman, Liège, Belgium
| |
Collapse
|
25
|
|
26
|
Deipolyi AR, Rho J, Khademhosseini A, Oklu R. Diagnosis and management of mycotic aneurysms. Clin Imaging 2016; 40:256-62. [DOI: 10.1016/j.clinimag.2015.11.011] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 11/04/2015] [Accepted: 11/23/2015] [Indexed: 02/06/2023]
|
27
|
Revest M, Camou F, Senneville E, Caillon J, Laurent F, Calvet B, Feugier P, Batt M, Chidiac C. Medical treatment of prosthetic vascular graft infections: Review of the literature and proposals of a Working Group. Int J Antimicrob Agents 2015; 46:254-65. [PMID: 26163735 DOI: 10.1016/j.ijantimicag.2015.04.014] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 04/07/2015] [Accepted: 04/21/2015] [Indexed: 02/07/2023]
Abstract
More than 400000 vascular grafts are inserted annually in the USA. Graft insertion is complicated by infection in 0.5-4% of cases. Vascular graft infections (VGIs) are becoming one of the most frequent prosthesis-related infections and are associated with considerable mortality, ranging from 10 to 25% within 30 days following the diagnosis. Treatment of VGI is based on urgent surgical removal of the infected graft followed by prolonged antibiotherapy. Data regarding the best antibiotherapy to use are lacking since no well designed trial to study antimicrobial treatment of VGI exists. Moreover, since VGIs demonstrate very specific pathophysiology, guidelines on other material-related infections or infective endocarditis treatment cannot be entirely applied to VGI. A French multidisciplinary group gathering infectious diseases specialists, anaesthesiologists, intensivists, microbiologists, radiologists and vascular surgeons was created to review the literature dealing with VGI and to make some proposals regarding empirical and documented antibiotic therapy for these infections. This article reveals these proposals.
Collapse
Affiliation(s)
- M Revest
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France; CIC Inserm 1414, Rennes 1 University, Rennes, France
| | - F Camou
- Intensive Care Unit, Saint-André University Hospital, Bordeaux, France
| | - E Senneville
- Infectious Diseases Department, Gustave Dron Hospital, Tourcoing, Lille 2 University, France
| | - J Caillon
- Bacteriology Department, EA 3826 Nantes University, Hôtel Dieu University Hospital, Nantes, France
| | - F Laurent
- Bacteriology Department, International Center for Infectiology Research (CIRI) - INSERM U1111, CNRS UMR5308, Lyon 1 University, ENS de Lyon, Hospices Civils de Lyon, Lyon, France
| | - B Calvet
- Anesthesiology Department, Beziers, France
| | - P Feugier
- Department of Vascular Surgery, University Claude Bernard Lyon 1, Hospices Civils de Lyon, Lyon, France
| | - M Batt
- Department of Vascular Surgery, University of Nice-Sophia Antipolis, Nice, France
| | - C Chidiac
- Infectious Diseases Department, University Claude Bernard Lyon 1, Hospices Civils de Lyon, Inserm U1111, Lyon 1 University, Lyon, France.
| | | |
Collapse
|
28
|
Setacci C, Chisci E, Setacci F, Ercolini L, de Donato G, Troisi N, Galzerano G, Michelagnoli S. How To Diagnose and Manage Infected Endografts after Endovascular Aneurysm Repair. AORTA : OFFICIAL JOURNAL OF THE AORTIC INSTITUTE AT YALE-NEW HAVEN HOSPITAL 2014; 2:255-64. [PMID: 26798744 DOI: 10.12945/j.aorta.2014.14-036] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 10/03/2014] [Indexed: 12/14/2022]
Abstract
The prevalence of endograft infections (EI) after endovascular abdominal aortic aneurysm repair is below 1%. With the growing number of patients with aortic endografts and the aging population, the number of patients with EI might also increase. The diagnosis is based on an association of clinical symptoms, imaging, and microbial cultures. Angio-computed tomography is currently the gold-standard technique for diagnosis. Low-grade infection sometimes requires nuclear medicine imaging to make a correct diagnosis. There is no good evidence to guide management so far. In the case of active gastrointestinal bleeding, pseudoaneurysm, or extensive perigraft purulence involving adjacent organs, an invasive treatment should always be attempted. In the other cases (the majority), when there is not an immediate danger to the patient's life, a conservative management is started with a proper antimicrobial therapy. Any infectious cavity can be percutaneously drained. Management depends on the patient's condition and a tailored approach should always be offered. In the case of a patient who is young, has a good life expectancy, or in whom there is absence of significant comorbidities, a surgical attempt can be proposed. Surgical techniques favor, in terms of mortality, patency, and reinfection rate, the in situ reconstruction. Choice of technique relies on the center and the operator's experience. Long-term antibiotic therapy is always required in all cases, with close monitoring of the C-reactive protein.
Collapse
Affiliation(s)
- Carlo Setacci
- Vascular and Endovascular Surgery Unit, University of Siena, Siena, Italy
| | - Emiliano Chisci
- Department of Surgery, Vascular and Endovascular Surgery Unit, "San Giovanni di Dio" Hospital, Florence, Italy; and
| | - Francesco Setacci
- P. Valdoni Department of Surgery, La Sapienza University, Rome, Italy
| | - Leonardo Ercolini
- Department of Surgery, Vascular and Endovascular Surgery Unit, "San Giovanni di Dio" Hospital, Florence, Italy; and
| | | | - Nicola Troisi
- Department of Surgery, Vascular and Endovascular Surgery Unit, "San Giovanni di Dio" Hospital, Florence, Italy; and
| | - Giuseppe Galzerano
- Vascular and Endovascular Surgery Unit, University of Siena, Siena, Italy
| | - Stefano Michelagnoli
- Department of Surgery, Vascular and Endovascular Surgery Unit, "San Giovanni di Dio" Hospital, Florence, Italy; and
| |
Collapse
|
29
|
Infectious Aortitis with Multiple Mycotic Aneurysms Caused by Streptococcus agalactiae. Ann Vasc Surg 2013; 27:975.e7-975.e13. [DOI: 10.1016/j.avsg.2012.10.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2012] [Revised: 10/11/2012] [Accepted: 10/23/2012] [Indexed: 11/17/2022]
|
30
|
Lyons O, Patel A, Saha P, Clough R, Price N, Taylor P. A 14-year Experience with Aortic Endograft Infection: Management and Results. Eur J Vasc Endovasc Surg 2013; 46:306-13. [DOI: 10.1016/j.ejvs.2013.04.021] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 04/10/2013] [Indexed: 02/05/2023]
|
31
|
Jashari R, Van Hoeck B, Ngakam R, Goffin Y, Fan Y. Banking of cryopreserved arterial allografts in Europe: 20 years of operation in the European Homograft Bank (EHB) in Brussels. Cell Tissue Bank 2013; 14:589-99. [DOI: 10.1007/s10561-012-9359-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Accepted: 12/17/2012] [Indexed: 12/20/2022]
|
32
|
Yamashiro S, Arakaki R, Kise Y, Inafuku H, Kuniyoshi Y. Potential role of omental wrapping to prevent infection after treatment for infectious thoracic aortic aneurysms. Eur J Cardiothorac Surg 2012; 43:1177-82. [DOI: 10.1093/ejcts/ezs600] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
33
|
Johnson JJ, Alex Jacocks M, Gauthier SC, Irwin DA, Wolf RF, Garwe T, Lerner MR, Lees JS. Establishing a swine model to compare vascular prostheses in a contaminated field. J Surg Res 2012; 181:355-8. [PMID: 22795350 DOI: 10.1016/j.jss.2012.06.056] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Revised: 06/14/2012] [Accepted: 06/21/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Patch arteriotomies are performed during many vascular procedures. Whereas synthetic materials are generally felt to be inappropriate for infected environments, the suitability of glutaraldehyde-treated bovine pericardium (GBP), a biologic material, in such instances is unknown. Our main objectives were to develop an animal model to study vascular prostheses while comparing the infectability of polyester (Dacron) and GBP in a topically infected environment. METHODS Twenty-three pigs underwent transabdominal patch arteriotomy of the infrarenal aorta with either Dacron or GBP. The patches were inoculated with sterile saline (1 per group), Staphylococcus aureus 10(4) colony-forming units (CFUs) (4 per group), or S. aureus 10(5) CFUs (6 per group). At 3 wk, the animals were euthanized, and the patches were removed via a left retroperitoneal approach. Specimens were collected for microbiologic and histologic analysis. RESULTS One animal from each group inoculated with 10(5) CFUs died during the study period, and another died immediately postoperatively of an airway complication. All aortas were patent and without evidence of pseudoaneurysm formation. Gross abscesses were found in 4/6 Dacron and 5/6 GBP animals receiving 10(5) CFUs. Similarly, 4/6 animals implanted with Dacron and 5/6 animals implanted with GBP had positive tissue cultures. A histologic grading system of inflammation substantiated the culture results. CONCLUSIONS No significant difference exists between Dacron and GBP to resist bacterial infection at 3 wk. We have established a reproducible in vivo model to study arterial patch materials in a topically infected environment.
Collapse
Affiliation(s)
- Jeremy J Johnson
- Department of Surgery, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma, USA
| | | | | | | | | | | | | | | |
Collapse
|
34
|
Reslan OM, Ebaugh JL, Gupta N, Brecher SM, Itani KM, Raffetto JD. Acute Expansion of a Hospital-Acquired Methicillin-Resistant Staphylococcus aureus–Infected Abdominal Aortic Aneurysm. Ann Vasc Surg 2012; 26:732.e1-6. [DOI: 10.1016/j.avsg.2011.08.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Revised: 07/31/2011] [Accepted: 08/07/2011] [Indexed: 11/15/2022]
|
35
|
Yamada A, Takahashi R, Toyama R, Okita Y. Acute regeneration and chronic acellular transformation of rabbit cryopreserved aortic allografts. Acta Histochem Cytochem 2012; 45:177-86. [PMID: 22829711 PMCID: PMC3395303 DOI: 10.1267/ahc.11060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Accepted: 03/14/2012] [Indexed: 11/22/2022] Open
Abstract
An analysis of rabbit cryopreserved aortic allografts excised on postoperative days (POD) 2, 5, 11, 60, 210, 360, and 720, as well as controls that were untransplanted native aortas and cryopreserved aortas, was performed. On POD2, the number of medial smooth muscle cells in the allografts was reduced to approximately 50%. Ki-67 analysis revealed that medial smooth muscle cells in the allografts proliferated from the 2nd day. By the 11th day, their proliferation ceased and the number of medial smooth muscle cells was restored to almost at the same level as in the controls. Polymorphic microsatellite DNA marker analysis disclosed that the restored medial smooth muscle cells were of donor origin. From 7 months through 2 years, the media of cryopreserved aortic allografts were transformed into acellular structures, in which the elastic fibers were preserved. On the other hand, newly accumulated smooth muscle cells were observed in the adventitia just outside of acellular media after 7 months. In some cases, scattered lamellar calcium deposition was observed in the same regions. This study presents a comprehensive documentation of regeneration and acellular transformation in cryopreserved aortic allografts based on short and long-term analysis.
Collapse
Affiliation(s)
- Akitoshi Yamada
- Departments of Surgery, Division of Cardiovascular Surgery, Kobe University, Graduate School of Medicine
- Departments of Surgery, Division of Cardiovascular Surgery, Kobe University, Graduate School of Medicine
| | - Rei Takahashi
- Department of Pharmacotherapeutics, Faculty of Pharmaceutical Sciences, Doshisha Women’s College of Liberal Arts
- Department of Diagnostic Pathology, Kyoto University Hospital
- Department of Pharmacotherapeutics, Faculty of Pharmaceutical Sciences, Doshisha Women’s College of Liberal Arts
- Department of Diagnostic Pathology, Kyoto University Hospital
| | - Reiko Toyama
- Departments of Surgery, Division of Cardiovascular Surgery, Kobe University, Graduate School of Medicine
- Departments of Surgery, Division of Cardiovascular Surgery, Kobe University, Graduate School of Medicine
| | - Yutaka Okita
- Departments of Surgery, Division of Cardiovascular Surgery, Kobe University, Graduate School of Medicine
- Departments of Surgery, Division of Cardiovascular Surgery, Kobe University, Graduate School of Medicine
| |
Collapse
|
36
|
Vascular Reconstruction Using Allogeneic Homografts in a Renal Transplant Patient With Pseudoaneurysm and Infected Vascular Prosthesis. Transplantation 2012; 93:e15-6. [DOI: 10.1097/tp.0b013e31824198b5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
|
37
|
Vogt PR. Arterial Allografts in Treating Aortic Graft Infections: Something Old, Something New. Semin Vasc Surg 2011; 24:227-33. [DOI: 10.1053/j.semvascsurg.2011.10.008] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
38
|
Czerny M, von Allmen R, Opfermann P, Sodeck G, Dick F, Stellmes A, Makaloski V, Bühlmann R, Derungs U, Widmer MK, Carrel T, Schmidli J. Self-Made Pericardial Tube Graft: A New Surgical Concept for Treatment of Graft Infections After Thoracic and Abdominal Aortic Procedures. Ann Thorac Surg 2011; 92:1657-62. [DOI: 10.1016/j.athoracsur.2011.06.073] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2011] [Revised: 06/18/2011] [Accepted: 06/22/2011] [Indexed: 01/22/2023]
|
39
|
Dahl SL, Blum JL, Niklason LE. Bioengineered Vascular Grafts: Can We Make Them Off-the-Shelf? Trends Cardiovasc Med 2011; 21:83-9. [DOI: 10.1016/j.tcm.2012.03.004] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
40
|
Carrel T, Schmidli J. Management of vascular graft and endoprosthetic infection of the thoracic and thoraco-abdominal aorta. Multimed Man Cardiothorac Surg 2011; 2011:mmcts.2010.004705. [PMID: 24413747 DOI: 10.1510/mmcts.2010.004705] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Infection of a vascular prosthesis or endovascular stent-graft is probably the most serious complication that may occur after implantation and dramatically affects the patient's outcome. Surgical treatment is almost always required but even after surgery, morbidity can be significant. Several approaches have been described with some advantages and/or some limitations. Complete resection of the infected foreign material with debridement of the surrounding tissue gives most probably the better results. Orthotopic reconstruction is the best option for all thoracic and thoraco-abdominal pathologies and the use of coated prostheses, homografts or self-made vascular tubes from xenopericardial tissue has to be discussed from case to case. In some exceptional situations, endovascular stent-graft can be performed as bridging to a more complete treatment if general condition of the patient has to be stabilized.
Collapse
Affiliation(s)
- Thierry Carrel
- Clinic for Cardiovascular Surgery, University Hospital Berne, Berne, Switzerland
| | | |
Collapse
|
41
|
Dubois M, Daenens K, Houthoofd S, Peetermans W, Fourneau I. Treatment of Mycotic Aneurysms with Involvement of the Abdominal Aorta: Single-centre Experience in 44 Consecutive Cases. Eur J Vasc Endovasc Surg 2010; 40:450-6. [DOI: 10.1016/j.ejvs.2010.07.017] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Accepted: 07/24/2010] [Indexed: 02/06/2023]
|
42
|
Nagano N, Yamamoto T, Amano A, Kikuchi K. Infected aneurysm of the aortic arch with purulent pericarditis caused by Streptococcus pneumoniae. Interact Cardiovasc Thorac Surg 2009; 10:459-61. [PMID: 20007205 DOI: 10.1510/icvts.2009.224980] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 76-year-old woman had a chest pain and high fever, and was admitted to the intensive care unit diagnosed as acute pericarditis. Enhanced CT-scan showed a 47-mm aneurysm in the aortic arch which seemed to be impending rupture and the part of the aorta looked like a pseudoaneurysm. Emergent total aortic arch replacement with a rifampicin-bonded Dacron graft was performed. Pericardial effusion was purulent and the aorta was infected with pus discharge in the aortic wall. There were some ulcerations on the surface of the luminal wall of the aorta. One of them was penetrating into the pericardial space causing a pseudoaneurysm. Both pericardial effusion and excised aortic wall were sent to culture study and resulted in positive for Streptococcus pneumoniae. The infection of the aorta, with erosion into the pericardial space, seemed to be the cause of purulent pericarditis. Antibiotic therapy was commenced immediately after surgery and continued for four weeks. Though she had neurological deficit after surgery, her infection was well controlled and there was no recurrence of infection 11 months after surgery.
Collapse
Affiliation(s)
- Naoko Nagano
- Department of Cardiovascular Surgery, Kobari General Hospital, Noda, Chiba, Japan.
| | | | | | | |
Collapse
|
43
|
Bustamante M, Gomez-Dermit V, García I, Pontón A, Revuelta J, Gonzalez-Tutor A. Endoluminal Repair of a Pseudoaneurysm in a Patient with Cryopreserved Arterial Allograft of the Iliac Vessel. Ann Vasc Surg 2009; 23:410.e17-20. [DOI: 10.1016/j.avsg.2008.02.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2007] [Revised: 01/05/2008] [Accepted: 02/28/2008] [Indexed: 11/25/2022]
|
44
|
Chenu C, Marcheix B, Barcelo C, Rousseau H. Aorto-enteric Fistula After Endovascular Abdominal Aortic Aneurysm Repair: Case Report and Review. Eur J Vasc Endovasc Surg 2009; 37:401-6. [DOI: 10.1016/j.ejvs.2008.11.037] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2008] [Accepted: 11/24/2008] [Indexed: 11/28/2022]
|
45
|
Is Endovascular Repair of Mycotic Aortic Aneurysms a Durable Treatment Option? Eur J Vasc Endovasc Surg 2009; 37:407-12. [DOI: 10.1016/j.ejvs.2008.11.025] [Citation(s) in RCA: 99] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2008] [Accepted: 11/25/2008] [Indexed: 02/06/2023]
|
46
|
Brown KE, Heyer K, Rodriguez H, Eskandari MK, Pearce WH, Morasch MD. Arterial reconstruction with cryopreserved human allografts in the setting of infection: A single-center experience with midterm follow-up. J Vasc Surg 2009; 49:660-6. [DOI: 10.1016/j.jvs.2008.10.026] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2008] [Revised: 10/01/2008] [Accepted: 10/08/2008] [Indexed: 10/21/2022]
|
47
|
Popov AF, Baryalei MM, Schmitto JD, Hinz J, Wiese CH, Raab B, Kolat P, Schoendube FA, Seipelt R. Acute aortic dissection type A discloses Corpus alienum. J Cardiothorac Surg 2009; 4:1. [PMID: 19121214 PMCID: PMC2628653 DOI: 10.1186/1749-8090-4-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2008] [Accepted: 01/02/2009] [Indexed: 11/16/2022] Open
Abstract
We report an unusual case of an aortic type A dissection with a corpus alienum which compresses the right ventricle. The patient successfully underwent an aortic root replacement in deep hypothermia with re-implantation of the coronary arteries using a modified Bentall procedure and the resection of the corpus alienum. Intraoperative finding reveals 3 greatly adhered gauze compresses, which were most likely forgotten in the operation 34 years ago.
Collapse
Affiliation(s)
- Aron Frederik Popov
- Department of Thoracic and Cardiovascular Surgery, University of Göttingen, Germany.
| | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Tamazashvili T, Yushkov Y, Roca M. Modified technique for recovering aortoiliac homografts. Prog Transplant 2008. [DOI: 10.7182/prtr.18.3.571k268225922001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
49
|
Modified Technique for Recovering Aortoiliac Homografts. Prog Transplant 2008; 18:162-5. [DOI: 10.1177/152692480801800303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Infection of the prosthetic aortic graft bypass remains one of the most serious complications of aortoiliac bypass grafts. Use of an aortoiliac allograft as a replacement for an infected prosthetic graft is an effective treatment for this problem. However, the availability of aortoiliac grafts is affected by the high rate of procurement errors experienced during recovery. This overall error rate nationally averaged 32.5% in 2006, of which nearly a third (9.6%) were related to tears of the intima at or below the bifurcation of the abdominal aorta. Objective To analyze the potential of a new aortoiliac graft recovery method in reducing the error rate. Method A modified technique of aortoiliac graft recovery was used to minimize the possibility of intimal tears. The essence of this technique is to change the sequence of mobilization of the graft, starting from the zone of low resistance, which is at the iliac arteries, and continuing upward to the abdominal aorta, which has higher resistance because of the greater thickness of the aortic wall. An additional modification of the standard technique is to use a tourniquet to raise the aortic edges. Conclusion The aortoiliac graft has various resistances to tearing owing to the different wall thicknesses of the aorta and the iliac arteries. Mobilization of the abdominal aorta before dissection of the iliac arteries creates a high risk of tears at and around the bifurcation of the aorta and the iliac arteries.
Collapse
|
50
|
Girdauskas E, Falk V, Kuntze T, Borger MA, Schmidt A, Scheinert D, Mohr FW. Secondary surgical procedures after endovascular stent grafting of the thoracic aorta: successful approaches to a challenging clinical problem. J Thorac Cardiovasc Surg 2008; 136:1289-94. [PMID: 19026818 DOI: 10.1016/j.jtcvs.2008.05.053] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2008] [Revised: 04/07/2008] [Accepted: 05/19/2008] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To evaluate the results of open surgical repair for complications after endovascular thoracic aorta stenting. METHODS A total of 14 patients (8 male, mean age 59.8 +/- 14.8 years) underwent conventional surgical therapy at our institution over a 5-year period after previous thoracic aortic stent implantation. The indications for surgery, intraoperative strategy, and perioperative and follow-up results were analyzed. RESULTS The indication for stent implantation was type B aortic dissection in 10 patients, expanding degenerative thoracic aneurysm in 3 patients, and pseudoaneurysm in 1 patient. The median interval to conventional surgery after stent implantation was 4.5 months (range 0.1-49 months). The indication for surgery was persistent type I endoleak with progressive aneurysm enlargement in 7 patients, aortoesophageal fistula in 2 patients, retrograde type A dissection in 2 patients, infection of the endoprosthesis in 2 patients, and aortic valve insufficiency caused by perforation of noncoronary and right coronary cusps in 1 patient. The endograft had to be removed in 9 (64%) patients, and 5 (36%) patients required replacement of the thoracoabdominal aorta. In-hospital mortality was 7% (1 patient). No patients had a postoperative stroke or paraparesis. Eleven (79%) patients are alive after a mean follow-up of 13.5 +/- 10.1 months (range 1-36 months). CONCLUSIONS Secondary surgical procedures after stenting of the thoracic aorta can be performed with very good results, despite the challenging clinical scenarios. Identification of successful surgical strategies for this difficult clinical problem is important in the era of increasing endovascular therapy.
Collapse
|