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Ge J, Weng C, Zhao J, Yuan D, Huang B, Wang T. Management and Clinical Outcome of Aortic Graft Infections: A Single-Center Retrospective Study. J Clin Med 2022; 11:6588. [PMID: 36362816 PMCID: PMC9656002 DOI: 10.3390/jcm11216588] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 10/27/2022] [Accepted: 11/04/2022] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND This study aimed to evaluate the outcome of various treatment options for aortic graft infection (AGI) patients and identify factors affecting their prognosis. METHODS The data of AGI patients from January 2008 to December 2019 were retrospectively collected and analyzed. The primary endpoints were 30-day mortality and perioperative complication-related morbidity; the secondary endpoints were re-infection (RI) rates, primary and secondary graft patency, overall mortality, duration of antibiotic therapy, and the number of antibiotic types used in treatment. RESULTS There was no significant difference in the 30-day mortality and perioperative-related complications between the conservative treatment, in-situ reconstruction (ISR), and extra-anatomic reconstruction (EAR) groups. The ISR group had lower re-infection rates and better overall survival rates than the EAR and conservative treatment groups. Different bypass graft conduits had no significant influence on the RI rate or primary and secondary graft patency. AGI patients infected with high-virulence pathogens had higher RI and overall mortality rates than those infected with low virulence pathogens, but this was not statistically significant. Initial procedures prior to the AGI also had no influence on the prognosis of AGI patients. Patients undergoing ISR or EAR surgery received antibiotic therapy for a longer duration than patients undergoing conservative treatment. Patients without RI received more types of antibiotics than patients with RI. CONCLUSIONS ISR had lower RI rates and better overall survival rates than EAR and conservative treatment and may be a better choice for patients with AGI. Several factors were found to have no influence on patients' prognosis however, further studies are required.
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Affiliation(s)
| | | | | | | | | | - Tiehao Wang
- Department of Vascular Surgery, West China Hospital, Sichuan University, 37 Guo Xue Alley, Chengdu 610041, China
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2
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Matsubayashi Y, Takashima N, Kondo Y, Wakisaka H, Suzuki T. Infected Aortic Aneurysm Caused by Streptococcus zooepidemicus: A Case Report and Literature Review. Ann Vasc Dis 2021; 14:71-74. [PMID: 33786105 PMCID: PMC7991697 DOI: 10.3400/avd.cr.20-00133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
A 66-year-old Japanese male working at a stable developed abdominal pain and fever and was brought to the emergency department. The computed tomography scan revealed an aneurysm of approximately 70 mm in diameter, with an irregular border, at the infrarenal abdominal aorta. Emergency surgery was performed with a bifurcated Dacron graft. Streptococcus zooepidemicus was observed on the aneurysm wall. He was discharged in good condition and was prescribed oral amoxicillin/clavulanic acid for 4 months. He has remained well and did not develop inflammation. Evaluation of patient history and data, including the consumption of unpasteurized dairy food, occupation, and direct contact with animals, is important for an early diagnosis, a prompt surgery, and an appropriate antibiotic therapy.
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Affiliation(s)
- Yuji Matsubayashi
- Division of Cardiovascular Surgery, Department of Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Noriyuki Takashima
- Division of Cardiovascular Surgery, Department of Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Yasuo Kondo
- Division of Cardiovascular Surgery, Department of Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Hodaka Wakisaka
- Division of Cardiovascular Surgery, Department of Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Tomoaki Suzuki
- Division of Cardiovascular Surgery, Department of Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan
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3
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Chen CL, Kuo TT, Chen IM, Chen TW, Chen PL, Huang CY, Shih CC. Mid-Term Outcome of Infected Abdominal Aortic Stent Graft Dismantlement with Reconstruction of Bilateral Axillofemoral Bypass. Surg Infect (Larchmt) 2020; 22:680-683. [PMID: 33337972 DOI: 10.1089/sur.2020.332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Abdominal aortic stent graft infection (AAGI) is a severe complication. The optimal management of AAGI remains unclear. This study provides updated results of bilateral axillofemoral bypasses (AFBs) for patients with AAGI. Patients and Methods: In total, 31 patients (25 men; mean age, 67.1 years) with AAGI treated using AFB between January 2006 and April 2020 were included. Overall, the mean follow-up duration was 24 months (range, 1-72). In the 23 patients who survived the post-operative period, the mean follow-up duration was 32 months (range, 12-72). Results: Thirty-day and in-hospital mortality rates was 16% and 26%, respectively. The 12-month primary and secondary patency rates for the AFB graft were both 91%. In total, seven (30%) patients received re-interventions such as thrombectomy and balloon angioplasty. No amputation was required during follow-up. Culture results were positive in 87% of pre-operative cultures and 84% of intra-operative cultures. Staphylococcus aureus was the most prevalent pathogen, with four cases of methicillin-resistant Staphylococcus aureus and one each of vancomycin-resistant enterococci, carbapenem-resistant Klebsiella pneumoniae, and carbapenem-resistant Enterobacteriaceae. In-hospital mortality rate was 57% in patients with drug-resistant pathogens. Conclusions: Reconstruction with bilateral AFB and stent graft removal in patients with AAGI is a feasible treatment modality and provided an acceptable patency rate and low amputation rate. Additional studies investigating long-term results and the optimal treatment of AAGI are required.
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Affiliation(s)
- Ching-Li Chen
- Department of Medical Education, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, School of Medicine, School of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Tzu-Ting Kuo
- Department of Medicine, School of Medicine, School of Medicine, National Yang Ming University, Taipei, Taiwan
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - I-Ming Chen
- Department of Medicine, School of Medicine, School of Medicine, National Yang Ming University, Taipei, Taiwan
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Tai-Wei Chen
- Department of Medicine, School of Medicine, School of Medicine, National Yang Ming University, Taipei, Taiwan
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Po-Lin Chen
- Department of Medicine, School of Medicine, School of Medicine, National Yang Ming University, Taipei, Taiwan
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chun-Yang Huang
- Department of Medicine, School of Medicine, School of Medicine, National Yang Ming University, Taipei, Taiwan
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chun-Che Shih
- Institute of Clinical Medicine, School of Medicine, National Yang Ming University, Taipei, Taiwan
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Chakfé N, Diener H, Lejay A, Assadian O, Berard X, Caillon J, Fourneau I, Glaudemans AWJM, Koncar I, Lindholt J, Melissano G, Saleem BR, Senneville E, Slart RHJA, Szeberin Z, Venermo M, Vermassen F, Wyss TR, de Borst GJ, Bastos Gonçalves F, Kakkos SK, Kolh P, Tulamo R, Vega de Ceniga M, von Allmen RS, van den Berg JC, Debus ES, Koelemay MJW, Linares-Palomino JP, Moneta GL, Ricco JB, Wanhainen A. Editor's Choice - European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Vascular Graft and Endograft Infections. Eur J Vasc Endovasc Surg 2020; 59:339-384. [PMID: 32035742 DOI: 10.1016/j.ejvs.2019.10.016] [Citation(s) in RCA: 272] [Impact Index Per Article: 68.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Copes F, Pien N, Van Vlierberghe S, Boccafoschi F, Mantovani D. Collagen-Based Tissue Engineering Strategies for Vascular Medicine. Front Bioeng Biotechnol 2019; 7:166. [PMID: 31355194 PMCID: PMC6639767 DOI: 10.3389/fbioe.2019.00166] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 06/24/2019] [Indexed: 12/21/2022] Open
Abstract
Cardiovascular diseases (CVDs) account for the 31% of total death per year, making them the first cause of death in the world. Atherosclerosis is at the root of the most life-threatening CVDs. Vascular bypass/replacement surgery is the primary therapy for patients with atherosclerosis. The use of polymeric grafts for this application is still burdened by high-rate failure, mostly caused by thrombosis and neointima hyperplasia at the implantation site. As a solution for these problems, the fast re-establishment of a functional endothelial cell (EC) layer has been proposed, representing a strategy of crucial importance to reduce these adverse outcomes. Implant modifications using molecules and growth factors with the aim of speeding up the re-endothelialization process has been proposed over the last years. Collagen, by virtue of several favorable properties, has been widely studied for its application in vascular graft enrichment, mainly as a coating for vascular graft luminal surface and as a drug delivery system for the release of pro-endothelialization factors. Collagen coatings provide receptor-ligand binding sites for ECs on the graft surface and, at the same time, act as biological sealants, effectively reducing graft porosity. The development of collagen-based drug delivery systems, in which small-molecule and protein-based drugs are immobilized within a collagen scaffold in order to control their release for biomedical applications, has been widely explored. These systems help in protecting the biological activity of the loaded molecules while slowing their diffusion from collagen scaffolds, providing optimal effects on the targeted vascular cells. Moreover, collagen-based vascular tissue engineering substitutes, despite not showing yet optimal mechanical properties for their use in the therapy, have shown a high potential as physiologically relevant models for the study of cardiovascular therapeutic drugs and diseases. In this review, the current state of the art about the use of collagen-based strategies, mainly as a coating material for the functionalization of vascular graft luminal surface, as a drug delivery system for the release of pro-endothelialization factors, and as physiologically relevant in vitro vascular models, and the future trend in this field of research will be presented and discussed.
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Affiliation(s)
- Francesco Copes
- Laboratory for Biomaterials and Bioengineering, Canada Research Chair Tier I for the Innovation in Surgery, Department of Min-Met-Materials Engineering & Regenerative Medicine, CHU de Quebec Research Center, Laval University, Quebec City, QC, Canada
- Laboratory of Human Anatomy, Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | - Nele Pien
- Laboratory for Biomaterials and Bioengineering, Canada Research Chair Tier I for the Innovation in Surgery, Department of Min-Met-Materials Engineering & Regenerative Medicine, CHU de Quebec Research Center, Laval University, Quebec City, QC, Canada
- Polymer Chemistry & Biomaterials Group, Department of Organic and Macromolecular Chemistry, Centre of Macromolecular Chemistry, Ghent University, Ghent, Belgium
| | - Sandra Van Vlierberghe
- Polymer Chemistry & Biomaterials Group, Department of Organic and Macromolecular Chemistry, Centre of Macromolecular Chemistry, Ghent University, Ghent, Belgium
| | - Francesca Boccafoschi
- Laboratory for Biomaterials and Bioengineering, Canada Research Chair Tier I for the Innovation in Surgery, Department of Min-Met-Materials Engineering & Regenerative Medicine, CHU de Quebec Research Center, Laval University, Quebec City, QC, Canada
- Laboratory of Human Anatomy, Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | - Diego Mantovani
- Laboratory for Biomaterials and Bioengineering, Canada Research Chair Tier I for the Innovation in Surgery, Department of Min-Met-Materials Engineering & Regenerative Medicine, CHU de Quebec Research Center, Laval University, Quebec City, QC, Canada
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Cryopreserved Allograft in the Management of Native and Prosthetic Aortic Infections. Ann Vasc Surg 2019; 56:1-10. [DOI: 10.1016/j.avsg.2018.09.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 07/06/2018] [Accepted: 09/21/2018] [Indexed: 11/20/2022]
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Batt M, Camou F, Coffy A, Feugier P, Senneville E, Caillon J, Calvet B, Chidiac C, Laurent F, Revest M, Daures JP. A meta-analysis of outcomes of in-situ reconstruction after total or partial removal of infected abdominal aortic graft. THE JOURNAL OF CARDIOVASCULAR SURGERY 2019; 61:171-182. [PMID: 30698369 DOI: 10.23736/s0021-9509.19.10669-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION There is currently a lack of evidence for the relative effectiveness of partial resection (PR) and total resection (TR) before managing abdominal aortic graft infection (AGI). Most authorities agree that TR is mandatory for intracavitary AGI in patients with favorable conditions but there is an increasing number of patients with severe comorbidities for whom this approach is not suitable, resulting in a prohibitive mortality rate. The purpose of this study was to determine the most appropriate indication for TR or PR. EVIDENCE ACQUISITION A meta-analysis was conducted on the rates of early/late mortality, amputations and reinfection. A meta-regression was performed with eight variables: patient age, male prevalence, presence of virulent or nonvirulent organisms, urgency, omentoplasty and follow-up. EVIDENCE SYNTHESIS Twenty-one studies and 1052 patients were included. For TR and PR, the rates of early mortality and reinfection were 16.8% and 10.5%, 11% and 27%, respectively. For TR urgency and male gender were associated with increased rate of early mortality and male gender, PDF and virulent organisms were associated with increased risk of reinfection. For PR no statistical correlation was analyzable except for PDF with increased risk of reinfection. CONCLUSIONS Early mortality rates are higher for TR and reinfection rates are higher for PR. For TR early mortality increases in urgent cases and it is suggested that alternative option must be discussed, reinfection decreases in the presence of nonvirulent organisms and TR seems optimal. For TR and PR reinfection increases in presence of PDF and alternative technique may be more appropriate.
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Affiliation(s)
- Michel Batt
- Department of Vascular Surgery, University Nice-Sophia Antipolis, Nice, France -
| | - Fabrice Camou
- Intensive Care Unit, Saint-Andre University Hospital, Bordeaux, France
| | - Amandine Coffy
- Laboratory of Biostatistics and Epidemiology, University Institute for Clinical Research, Montpellier, France
| | - Patrick Feugier
- Department of Vascular Surgery, University Claude Bernard Lyon 1, Hospices Civils de Lyon, Lyon, France
| | - Eric Senneville
- Infectious Diseases Department, Gustave Dron Hospital, Lille 2 University, Tourcoing, France
| | | | - Brigitte Calvet
- Anesthosiology Department, Béziers Hospital, Béziers, France
| | - Christian Chidiac
- Infectious Deseases Department, Hospices Civils de Lyon and International Center for Infectiology Research (CIRI), INSERM U1111, Lyon 1 University, Lyon, France.,Bacteriology Department, International Center for Infectiology Research (CIRI), INSERM U1111, Lyon 1 University, Lyon, France
| | - Frederic Laurent
- Infectious Diseases, and Intensive Care Unit, Pontchaillou University Hospital, CIC-INSERM 1414, Rennes 1 University, France
| | | | - Jean Pierre Daures
- Laboratory of Biostatistics and Epidemiology, University Institute for Clinical Research, Montpellier, France
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Affiliation(s)
- Jayer Chung
- Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, One Baylor Plaza, MS 390, Houston, TX 77030, USA.
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Li HL, Chan YC, Cheng SW. Current Evidence on Management of Aortic Stent-graft Infection: A Systematic Review and Meta-Analysis. Ann Vasc Surg 2018; 51:306-313. [PMID: 29772328 DOI: 10.1016/j.avsg.2018.02.038] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Revised: 08/26/2017] [Accepted: 02/19/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Aortic stent-graft infection (SGI) is rare but remains one of the most challenging and threatening complications. This systematic review aimed to identify the clinical features, treatment, and outcomes of endograft infection after abdominal endovascular aortic repair (EVAR) and thoracic endovascular aortic repair (TEVAR). METHODS A systematic literature review of all published literature from January 1991 to September 2016 on SGI was performed under the instruction of Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Aorta, aneurysm, endovascular, stent-graft, endograft and infection were the keywords used in our comprehensive search in PubMed and MEDLINE databases. Data analysis was performed using SPSS, V 22.0. RESULTS A total of 185 potential relevant articles were identified, but only 11 studies with 402 patients met the inclusion criteria. Majority of the patients were male (308/402, 77%), with a mean age ranging from 65 to 73 years. Most of the endografts were implanted for EVAR (351/402, 87%), while the other 51 (13%) endografts were infected following TEVAR. Among the 402 patients, 39 (9.7%) patients presented with aortic rupture. Ninety-two of 380 (24.2%) patients with available data had aortoenteric fistula (AEF). Sixty-nine patients (17%) died in hospital or within 30 days after operation. One hundred fourteen patients (28%) died during follow-up. The most commonly used stent grafts were Zenith (Cook Inc, Bloomington, IN) (22%) and Excluder (W.L. Gore, Flagstaff, AZ) (20%). Of the 402 patients in this series, 108 patients (27%) had negative culture, and multiple microorganisms were identified in 103 patients (26%). The most frequently isolated microorganisms were Staphylcoccus species (30.1%), Streptococcus (14.8%), and fungus (9.2%). Forty-two patients (42/401, 10%) received conservative treatment, whereas 359 (90%) patients underwent surgical treatment, including stent graft removal with in situ reconstruction or extra-anatomical bypass, and secondary endovascular procedure. Patients in the surgical group had a higher survival rate compared with conservative group (58% vs. 33%, P = 0.002). The survival rate was higher in the patients with infected EVAR than TEVAR (58% vs. 27%, P = 0.000). Patient with AEF had a worse prognosis (survival rate 72% vs. 33%, P = 0.002). CONCLUSIONS Current evidence suggests that surgical treatment is a better option compared with conservative management in selected patients with aortic endograft infection. The outcome was worse in patients with infected TEVAR and AEF.
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Affiliation(s)
- Hai Lei Li
- Division of Vascular Surgery, Department of Surgery, University of Hong Kong Shenzhen hospital, Guangdong, China
| | - Yiu Che Chan
- Division of Vascular & Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, South Wing, 14th Floor K Block, Queen Mary Hospital, Hong Kong, China.
| | - Stephen W Cheng
- Division of Vascular & Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, South Wing, 14th Floor K Block, Queen Mary Hospital, Hong Kong, China
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Megaloikonomos PD, Antoniadou T, Dimopoulos L, Liontos M, Igoumenou V, Panagopoulos GN, Giannitsioti E, Lazaris A, Mavrogenis AF. Spondylitis transmitted from infected aortic grafts: a review. J Bone Jt Infect 2017; 2:96-103. [PMID: 28540144 PMCID: PMC5441139 DOI: 10.7150/jbji.17703] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Graft infection following aortic aneurysms repair is an uncommon but devastating complication; its incidence ranges from <1% to 6% (mean 4%), with an associated perioperative and overall mortality of 12% and 17.5-20%, respectively. The most common causative organisms are Staphylococcus aureus and Escherichia coli; causative bacteria typically arise from the skin or gastrointestinal tract. The pathogenetic mechanisms of aortic graft infections are mainly breaks in sterile technique during its implantation, superinfection during bacteremia from a variety of sources, severe intraperitoneal or retroperitoneal inflammation, inoculation of bacteria during postoperative percutaneous interventions to manage various types of endoleaks, and external injury of the vascular graft. Mechanical forces in direct relation to the device were implicated in fistula formation in 35% of cases of graft infection. Partial rupture and graft migration leading to gradual erosion of the bowel wall and aortoenteric fistulas have been reported in 30.8% of cases. Rarely, infection via continuous tissues may affect the spine, resulting in spondylitis. Even though graft explantation and surgical debridement is usually the preferred course of action, comorbidities and increased perioperative risk may preclude patients from surgery and endorse a conservative approach as the treatment of choice. In contrast, conservative treatment is the treatment of choice for spondylitis; surgery may be indicated in approximately 8.5% of patients with neural compression or excessive spinal infection. To enhance the literature, we searched the related literature for published studies on continuous spondylitis from infected endovascular grafts aiming to summarize the pathogenesis and diagnosis, and to discuss the treatment and outcome of the patients with these rare and complex infections.
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Affiliation(s)
- Panayiotis D Megaloikonomos
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, ATTIKON University Hospital, Athens, Greece
| | - Thekla Antoniadou
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, ATTIKON University Hospital, Athens, Greece
| | - Leonidas Dimopoulos
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, ATTIKON University Hospital, Athens, Greece
| | - Marcos Liontos
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, ATTIKON University Hospital, Athens, Greece
| | - Vasilios Igoumenou
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, ATTIKON University Hospital, Athens, Greece
| | - Georgios N Panagopoulos
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, ATTIKON University Hospital, Athens, Greece
| | - Efthymia Giannitsioti
- Fourth Department of Internal Medicine, National and Kapodistrian University of Athens, School of Medicine, ATTIKON University Hospital, Athens, Greece
| | - Andreas Lazaris
- Department of Vascular Surgery, National and Kapodistrian University of Athens, School of Medicine, ATTIKON University Hospital, Athens, Greece
| | - Andreas F Mavrogenis
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, ATTIKON University Hospital, Athens, Greece
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Lutz B, Reeps C, Biro G, Knappich C, Zimmermann A, Eckstein HH. Bovine Pericardium as New Technical Option for In Situ Reconstruction of Aortic Graft Infection. Ann Vasc Surg 2016; 41:118-126. [PMID: 27903471 DOI: 10.1016/j.avsg.2016.07.098] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Revised: 07/05/2016] [Accepted: 07/21/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Alloplastic aortic graft infection is a devastating complication following aortic surgery. It is associated with excessively high mortality and morbidity caused by anastomotic rupture or septicemia. Many authors consider in situ replacement after complete surgical graft removal as the method of choice. However, there is an ongoing debate about the most suitable material for reconstruction. We present our first experiences with replacing the descending and infrarenal aorta using custom-made bovine pericardium grafts. MATERIAL AND METHODS From January 2013 to 2015, 13 patients (10 male, median age 70 years, range 53-84) were treated for 5 early-graft infections after open reconstructions and 7 late graft infections (1 TEVAR, 2 EVAR, and 4 open reconstructions), and 1 patient was treated for mycotic aneurysm. Septicemia was evident in 8 patients, whereas 5 patients were presented with low-grade infection. In all cases, graft infection was proven by a synopsis of clinical findings, laboratory tests, imaging, and microbiologic tests (positive pathogen detection in 11 patients). Cutaneous and aortoenteric fistulae were present in 3 and 4 patients, respectively. All patients received an in situ replacement using a hand-sewn xenoprosthesis or patch made from a bovine pericardium sheet. Follow-up was routinely performed 3, 12, and 24 months after discharge. RESULTS For reconstruction, 4 pericardium tubes, 7 bifurcated grafts, and 2 large patches were implanted in situ. Technical success was 100%. Median length of hospital stay was 44 days (range, 20-136 days), with an in-hospital mortality rate of 7.7% (n = 1). Major procedure- and disease-related complications were temporary (n = 2) and permanent dialysis (n = 1), limb loss (n = 1), and long-term ventilation (n = 5). Complete infection control and initial healing could be achieved in 75% (n = 10). During the follow-up (median 9 months, range: 1-27 months), primary graft patency was 100%, and mortality was 41.7%. We observed 2 secondary ruptures due to reinfection at 4 and 7 months. CONCLUSIONS Custom-made bovine pericardium grafts provide a good option for in situ replacement following early or late aortic graft infection. Despite of its high biocompatibility, pericardium provides not an absolute protection against ongoing retroperitoneal infection. For the treatment, the principles of septic surgery need to be applied and close follow-up is mandatory.
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Affiliation(s)
- Brigitta Lutz
- Department of Visceral, Thoracic, and Vascular Surgery, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany; Department of Vascular Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Christian Reeps
- Department of Visceral, Thoracic, and Vascular Surgery, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany; Department of Vascular Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Gabor Biro
- Department of Vascular Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Christoph Knappich
- Department of Vascular Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Alexander Zimmermann
- Department of Vascular Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Hans-Henning Eckstein
- Department of Vascular Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany.
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Wilson WR, Bower TC, Creager MA, Amin-Hanjani S, O’Gara PT, Lockhart PB, Darouiche RO, Ramlawi B, Derdeyn CP, Bolger AF, Levison ME, Taubert KA, Baltimore RS, Baddour LM. Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: A Scientific Statement From the American Heart Association. Circulation 2016; 134:e412-e460. [DOI: 10.1161/cir.0000000000000457] [Citation(s) in RCA: 215] [Impact Index Per Article: 26.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Chisci E, de Donato G, Setacci F, Stella A, Setacci C. Recurrent Aortoenteric Fistula: Two Different Bridge Solutions. Vascular 2016; 15:235-7. [PMID: 17714642 DOI: 10.2310/6670.2007.00033] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A “recurrent” aortoenteric fistula (AEF) is very rare and in literature anecdotic. Currently, graft excision and extra-anatomic bypass are considered the treatments of choice, but are associated with significant mortality and morbidity. Herein, we describe the case of a “recurrent” AEF treated before definitive extra-anatomic bypass, by two different, staged bridge solutions: allograft in situ replacement and endovascular grafting. At 1, 3 and 6-month follow-up, the patient was asymptomatic and normally active.
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Affiliation(s)
- Emiliano Chisci
- Vascular and Endovascular Surgery Unit, Department of Surgery, University of Siena, Siena, Italy.
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14
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Results from the Multicenter Study on Aortoenteric Fistulization After Stent Grafting of the Abdominal Aorta (MAEFISTO). J Vasc Surg 2016; 64:313-320.e1. [PMID: 27289529 DOI: 10.1016/j.jvs.2016.04.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 04/10/2016] [Indexed: 01/18/2023]
Abstract
OBJECTIVE This study investigated the frequency, clinical features, therapeutic options, and results of aortoenteric fistulas (AEFs) developing after endovascular abdominal aortic repair (EVAR). METHODS Eight Italian centers with an EVAR program participated in this retrospective multicenter study and collected data on AEFs that developed after a previous EVAR. RESULTS A total of 3932 patients underwent EVAR between 1997 and 2013 at the participating centers. During the same period, 32 patients presented with an AEF during EVAR follow-up, 21 with original EVAR performed for atherosclerotic aneurysmal disease (ATS group) and 11 with the original EVAR performed for a postsurgical pseudoaneurysm (PSA group). The incidence of AEF development after EVAR was 0.46% in the ATS group and 3.9% in the PSA group. Anastomotic PSA as the indication to EVAR (P < .0001) and urgent/emergency EVAR (P = .01) were significantly associated with AEF development. Median time between EVAR and the AEF diagnosis was 32 months (interquartile range, 11-75 months) for the ATS group and 14 months (interquartile range, 10.5-21.5 months) for the PSA group. Among five AEF patients treated conservatively, two (40%) died, at 7 and 15 months, and the remaining three were alive at a median follow-up of 12 months. The AEF was treated surgically in 27 patients, including aortic stent graft explantation in all cases, in situ aortic reconstruction in 14 (52%), and extra-anatomic bypass in 13 (48%). Perioperative mortality was 37% (10 of 27). No additional aortic-related death was recorded in operated-on patients at a median follow-up of 28 months. CONCLUSIONS Late AEFs rarely occur during EVAR follow-up, but the risk is significantly increased when EVAR is performed for PSA after previous aortic surgery and EVAR is performed as an emergency. Conservative and surgical treatment of post-EVAR AEF are both associated with high mortality. However, beyond the perioperative period, surgical correction of AEFs appears to be durable at midterm follow-up.
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The role of axillofemoral bypass in current vascular surgery practice. Am J Surg 2016; 211:968-71. [DOI: 10.1016/j.amjsurg.2016.02.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 01/31/2016] [Accepted: 02/01/2016] [Indexed: 11/19/2022]
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Keunen B, Houthoofd S, Daenens K, Hendriks J, Fourneau I. A Case of Primary Aortoenteric Fistula: Review of Therapeutic Challenges. Ann Vasc Surg 2016; 33:230.e5-230.e13. [PMID: 26965800 DOI: 10.1016/j.avsg.2015.11.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 11/17/2015] [Accepted: 11/24/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUNDS Primary aortoenteric fistula (PAEF) is a lethal cause of gastrointestinal bleeding. They mainly originate from eroding abdominal aortic aneurysms into the intestinal wall. Other known causes involve malignancies, infection, corpora aliena, or radiation therapy. Traditional treatment consists of resection of the fistula and extra-anatomic reconstruction. In situ repair and endovascular stenting have offered new therapeutic options in managing this complex entity. CASE REPORT A 79-year-old woman presented with a PAEF. She was known with a 3.9-cm abdominal aortic aneurysm and polymyalgia rheumatica. The initial treatment consisted of endovascular stenting. Several months later, she presented with persistent inflammation of the aortic endoprosthesis. The prosthesis and inflammatory tissue were resected, and in situ reconstruction with autologous superficial femoral vein and omentoplasty was performed. Two years later, she remains well with no evidence for infection or bleeding. CONCLUSIONS Polymyalgia rheumatica might induce an AEF as in this patient no other provoking factors were retained. The different therapeutic options all have their advantages and disadvantages. In line with this case, we suggest an individualized approach for AEFs. In case of precarious hemodynamical state or life expectancy, endovascular treatment is indicated. Afterward, the possibility and/or necessity of open repair should be discussed. For stable patients with respectable life expectancy in situ repair with autologuous vein or rifampicin-soaked prosthesis (adjusted to comorbidities) might be most appropriate. Extra-anatomic reconstruction still remains a valuable alternative in older patients and in the presence of any other local factors hampering in situ reconstruction.
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Affiliation(s)
- Bram Keunen
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Sabrina Houthoofd
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Kim Daenens
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Jeroen Hendriks
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Inge Fourneau
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium.
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Kilic A, Arnaoutakis DJ, Reifsnyder T, Black JH, Abularrage CJ, Perler BA, Lum YW. Management of infected vascular grafts. Vasc Med 2015; 21:53-60. [PMID: 26584886 DOI: 10.1177/1358863x15612574] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Infections of vascular grafts are associated with significant mortality and morbidity risk and cost an estimated $640 million annually in the United States. Clinical presentation varies by time elapsed from implantation and by surgical site. A thorough history and physical examination in conjunction with a variety of imaging modalities is often essential to diagnosis. For infected aortic grafts, there are several options for treatment, including graft excision with extra-anatomic bypass, in situ reconstruction, or reconstruction with the neo-aortoiliac system. The management of infected endovascular aortic grafts is similar. For infected peripheral bypasses, graft preservation techniques can be utilized, but in cases where it is not possible, graft removal and revascularization through uninfected tissue planes is necessary. Infected dialysis access can be surgically treated by complete or subtotal graft excision. Diagnosis, general management, and surgical approaches to infected vascular grafts are discussed in this review.
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Affiliation(s)
- Arman Kilic
- Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | | | | | - James H Black
- Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | | | - Bruce A Perler
- Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Ying Wei Lum
- Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
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Akhtar M, Meecham L, Birkett R, Pherwani ADP, Fairhead JF. Conservative Treatment of an Infected Aortic Graft with Antibiotic Irrigation. Int J Angiol 2015; 25:e118-e120. [PMID: 28031673 DOI: 10.1055/s-0035-1548738] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Conservative management of an aortic graft infection is defined as "the nonresectional treatment of an aortic graft that has an established infection." Incidence of aortic graft infections is 0.5 to 5% and the estimated mortality rate from aortic graft infections ranges from 8 to 27%. We present the case of a 73-year-old male patient with an infected abdominal aortic graft following an emergency ruptured abdominal aortic aneurysm repair. Postemergency repair, he developed ischemic colitis with sigmoid colon perforation leading to fecal peritonitis and secondary sepsis. He developed a large infective collection within the aortic sac growing vancomycin-resistant enterococcus sensitive to linezolid. A percutaneous drain was placed in the aortic sac and this was irrigated with linezolid for a total of 28 days. The patient clinically improved. Overall, 7 months later, follow-up scan shows complete resolution of infection and the patient remains clinically stable. Conventional treatment of aortic graft infections involves an extra-anatomical bypass. Percutaneous drainage and antibiotic use may be used as bridging therapy for surgery or as definitive therapy when surgical treatment is impractical. Most aortic graft infections grow gram-positive cocci, the organisms form a biofilm which is protected from the external environment. Percutaneous drainage and antibiotic irrigation could possibly penetrate the biofilm and eradicate infection. Morris et al conducted a study on 10 patients having irrigation therapy and systemic antibiotic treatment and found a 1-year survival rate of 80%. In conclusion, conservative aortic graft treatment may be an effective alternative where surgical intervention is not suitable.
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Affiliation(s)
- M Akhtar
- Department of Vascular Surgery, Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom
| | - L Meecham
- Department of Vascular Surgery, Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom
| | - R Birkett
- Department of Vascular Surgery, Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom
| | - A D P Pherwani
- Department of Vascular Surgery, Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom
| | - J F Fairhead
- Department of Vascular Surgery, Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom
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Abstract
Treatment of severe aortoiliac disease has dramatically evolved from a dependence on open aortobifemoral grafting to hybrid and endovascular only approaches. Open surgery has been the gold standard treatment of severe aortoiliac disease with excellent patency rates, but with increased length of stay and major complications. In contrast, endovascular interventions can successfully treat almost any lesion with decreased risk, compared to open surgery. Although primary patency rates remain inferior, secondary endovascular interventions are often minor procedures resulting in comparable long-term outcomes. The risks of renal insufficiency, embolization and access complications are not insignificant; however, most can be prevented or managed without significant clinical consequence. Endovascular therapies should be considered a first-line treatment option for all patients with aortoiliac disease, especially those with high-risk cardiovascular comorbidities.
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Affiliation(s)
- Daniel G Clair
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
- Department of Vascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jocelyn M Beach
- Department of Vascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
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Erb S, Sidler JA, Elzi L, Gurke L, Battegay M, Widmer AF, Weisser M. Surgical and antimicrobial treatment of prosthetic vascular graft infections at different surgical sites: a retrospective study of treatment outcomes. PLoS One 2014; 9:e112947. [PMID: 25393400 PMCID: PMC4231097 DOI: 10.1371/journal.pone.0112947] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Accepted: 10/17/2014] [Indexed: 11/24/2022] Open
Abstract
Objective Little is known about optimal management of prosthetic vascular graft infections, which are a rare but serious complication associated with graft implants. The goal of this study was to compare and characterize these infections with respect to the location of the graft and to identify factors associated with outcome. Methods This was a retrospective study over more than a decade at a tertiary care university hospital that has an established multidisciplinary approach to treating graft infections. Cases of possible prosthetic vascular graft infection were identified from the hospital's infectious diseases database and evaluated against strict diagnostic criteria. Patients were divided into groups according to the locations of their grafts: thoracic-aortic, abdominal-aortic, or peripheral-arterial. Statistical analyses included evaluation of patient and infection characteristics, time to treatment failure, and factors associated specifically with cure rates in aortic graft infections. The primary endpoint was cure at one year after diagnosis of the infection. Results Characterization of graft infections according to the graft location did show that these infections differ in terms of their characteristics and that the prognosis for treatment seems to be influenced by the location of the infection. Cure rate and all-cause mortality at one year were 87.5% and 12.5% in 24 patients with thoracic-aortic graft infections, 37.0% and 55.6% in 27 patients with abdominal-aortic graft infections, and 70.0% and 30.0% in 10 patients with peripheral-arterial graft infections. In uni- and multivariate analysis, the type of surgical intervention used in managing infections (graft retention versus graft replacement) did not affect primary outcome, whereas a rifampicin-based antimicrobial regimen was associated with a higher cure rate. Conclusions We recommend that future prospective studies differentiate prosthetic vascular graft infections according to the location of the grafts and that rifampicin-based antimicrobial regimens be evaluated in clinical trials involving vascular graft infections caused by staphylococci.
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Affiliation(s)
- Stefan Erb
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, Basel, Switzerland
| | - Jan A. Sidler
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, Basel, Switzerland
| | - Luigia Elzi
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, Basel, Switzerland
| | - Lorenz Gurke
- Department of Vascular Surgery, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, Basel, Switzerland
| | - Manuel Battegay
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, Basel, Switzerland
| | - Andreas F. Widmer
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, Basel, Switzerland
| | - Maja Weisser
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, Basel, Switzerland
- * E-mail:
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Budtz-Lilly J, Eldrup N, Vammen S, Laustsen J. Femoral vein repair of arterial infections: technical tips to reduce procedure time. Vasc Endovascular Surg 2014; 48:367-71. [PMID: 24923287 DOI: 10.1177/1538574414539050] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Success with the neoaortoiliac system (NAIS) bypass has previously been reported. Drawbacks to this procedure include prolonged operative times and significant morbidity. The aim of this study was to evaluate whether a 2-team approach in addition to a consistent anastomosis technique reduces the operative time of the NAIS procedure. METHODS A single-center retrospective review was performed for operations using femoral vein in arterial reconstruction from 2003 to 2012. RESULTS A total of 40 patients, 25 men and 15 women, were included for analysis. Median operative time for all operations was 300 minutes (interquartile range). Thirty-day mortality was 7.5% (n = 3). Assisted primary patency at 1 year was 100%. CONCLUSION A 2-surgical team approach can reduce the operative time by up to 50%. This improves the attractiveness of this procedure, particularly when recalling that the treatment is definitive by virtue of its eradication of the source of infection.
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Affiliation(s)
- Jacob Budtz-Lilly
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Nikolaj Eldrup
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Sten Vammen
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Jesper Laustsen
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
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22
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Yamanaka K, Omura A, Nomura Y, Miyahara S, Shirasaka T, Sakamoto T, Inoue T, Matsumori M, Minami H, Okada K, Okita Y. Surgical strategy for aorta-related infection†. Eur J Cardiothorac Surg 2014; 46:974-80; discussion 980. [DOI: 10.1093/ejcts/ezu119] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Mussa FF, Hedayati N, Zhou W, El-Sayed HF, Kougias P, Darouiche RO, Lin PH. Prevention and treatment of aortic graft infection. Expert Rev Anti Infect Ther 2014; 5:305-15. [PMID: 17402845 DOI: 10.1586/14787210.5.2.305] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Prosthetic vascular graft infection remains one of the most challenging surgical problems for vascular surgeons. This condition is classically associated with high morbidity and mortality rates. Accurate diagnosis of a vascular graft infection can typically be made based on a thorough history and physical examination; although, infrequently, an extensive radiological evaluation is necessary to establish the clinical finding. Complete graft excision and extra-anatomic bypass grafting remains a commonly accepted surgical treatment strategy. Recent clinical data have supported other treatment modalities, including the use of in situ antibiotic-impregnated graft replacement, in situ allograft replacement and in situ autologous graft replacement. This article will review the pathobiology of aortic graft infection, as well as methods to prevent a prosthetic graft infection. Furthermore, various surgical treatment modalities of aortic graft infection will be discussed.
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Affiliation(s)
- Firas F Mussa
- The Michael E DeBakey VA Medical Center, Division of Vascular Surgery & Endovascular Therapy, Michael E DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
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24
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Treatment strategies and outcomes in patients with infected aortic endografts. J Vasc Surg 2013; 58:371-9. [DOI: 10.1016/j.jvs.2013.01.047] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Revised: 01/23/2013] [Accepted: 01/24/2013] [Indexed: 02/02/2023]
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25
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Maze M, Laws P, Buckenham T, Pithie A, Gallagher K, Metcalf S, Roake J, Chambers S. Outcomes of Infected Abdominal Aortic Grafts Managed with Antimicrobial Therapy and Graft Retention in an Unselected Cohort. Eur J Vasc Endovasc Surg 2013; 45:373-80. [DOI: 10.1016/j.ejvs.2013.01.019] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Accepted: 01/10/2013] [Indexed: 11/29/2022]
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Delva J, Déglise S, Bérard X, Dubuisson V, Delva F, Stecken L, Ducasse E, Midy D. In-Situ Revascularisation for Secondary Aorto-enteric Fistulae: The Success of Silver-coated Dacron is Closely Linked to a Suitable Bowel Repair. Eur J Vasc Endovasc Surg 2012; 44:417-24. [DOI: 10.1016/j.ejvs.2012.04.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2011] [Accepted: 04/05/2012] [Indexed: 10/27/2022]
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Batt M, Jean-Baptiste E, O'Connor S, Feugier P, Haulon S. Contemporary management of infrarenal aortic graft infection: early and late results in 82 patients. Vascular 2012; 20:129-37. [PMID: 22661612 DOI: 10.1258/vasc.2011.oa0315] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Management of aortic graft infection (AGI) remains contentious. The purpose of this study was to evaluate factors of clinical significance which influence the outcome of different treatment modalities for AGI. From 2000 to 2008, 82 consecutive patients were treated for AGI. In situ reconstruction (ISR) was performed in 63 patients with various conduits, extra-anatomic reconstruction (EAR) in 11, conservative treatment in five and resection without reconstruction in three. The perioperative mortality rate for the series (33%) was similar for EAR and ISR and was higher in patients with secondary aortoenteric fistula ( P < 0.001) in those undergoing emergency aortic reconstruction ( P < 0.001) and in AGI caused by virulent organisms ( P < 0.05). Fifteen (27%) of the surviving patients developed a recurrence of infection (RI). EAR patients were more exposed to RI ( P < 0.04). In conclusion, ISR may be more appropriate for AGI, but this study cannot draw a conclusion relating to the optimal conduit for ISR.
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Affiliation(s)
- Michel Batt
- Department of Vascular Surgery, University of Nice Sopha-Antipolis, Nice Cedex, 06006, France
| | - Elixène Jean-Baptiste
- Department of Vascular Surgery, University of Nice Sopha-Antipolis, Nice Cedex, 06006, France
| | | | - Patrick Feugier
- Department of Vascular Surgery, University of Lyon, Lyon Cedex 07, 69437
| | - Stéphan Haulon
- Department of Vascular Surgery, University of Lille, Lille Cedex, 59037, France
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Okamoto H, Tamenishi A, Matsumura Y, Niimi T. Composite Vein Graft Reconstruction for Infected Descending Aortic Prosthesis. Ann Thorac Surg 2012; 93:2061-3. [DOI: 10.1016/j.athoracsur.2011.08.056] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Revised: 08/08/2011] [Accepted: 08/24/2011] [Indexed: 11/16/2022]
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Berger P, Moll FL. Aortic Graft Infections: Is There Still a Role for Axillobifemoral Reconstruction? Semin Vasc Surg 2011; 24:205-10. [DOI: 10.1053/j.semvascsurg.2011.10.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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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]
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Lee CH, Hsieh HC, Ko PJ, Li HJ, Kao TC, Yu SY. In situ versus extra-anatomic reconstruction for primary infected infrarenal abdominal aortic aneurysms. J Vasc Surg 2011; 54:64-70. [DOI: 10.1016/j.jvs.2010.12.032] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2010] [Revised: 11/30/2010] [Accepted: 12/02/2010] [Indexed: 01/16/2023]
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Metzger PB, Barbato HA, Angelieri FMR, Almeida BLD, Filho FADCL, Jordão EDS, Kambara AM, Rossi FH, Izukawa NM. Enxerto aorto bi-ilíaco com veia femoral superficial: uma opção nas infecções de próteses e endopróteses aórticas - relato de caso. J Vasc Bras 2011. [DOI: 10.1590/s1677-54492011000200011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Uma das complicações mais temidas na cirurgia vascular é a infecção do enxerto sintético. Afeta 2% dos procedimentos cirúrgicos convencionais e 0,3 a 6% dos procedimentos endovasculares. Relatamos o caso de paciente tratada de aneurisma de aorta abdominal por ambos os métodos e que, após seis anos, foi submetida a retirada das próteses devido à infecção. A veia femoral superficial bilateral foi usada como substituto, com sucesso.
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Batt M, Jean-Baptiste E, O’Connor S, Saint-Lebes B, Feugier P, Patra P, Midy D, Haulon S. Early and Late Results of Contemporary Management of 37 Secondary Aortoenteric Fistulae. Eur J Vasc Endovasc Surg 2011; 41:748-57. [DOI: 10.1016/j.ejvs.2011.02.020] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Accepted: 02/16/2011] [Indexed: 11/29/2022]
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Kanka KC, Pak JJ, Hadley D, Alexander JQ. Hybrid aortoiliac revascularization to avoid nonautogenous groin reconstruction in an intravenous drug abuser. Ann Vasc Surg 2011; 25:387.e11-4. [PMID: 21269800 DOI: 10.1016/j.avsg.2010.09.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2010] [Revised: 08/02/2010] [Accepted: 09/26/2010] [Indexed: 11/16/2022]
Abstract
Traditional methods for revascularization of an occluded aortoiliac system have necessitated either in-line aortic reconstruction through an aortobifemoral bypass or extra-anatomic bypass. However, both these approaches require artificial material to be placed in the groin. The consequence of groin infection can be devastating leading to high rates of both limb loss and mortality. One of the most feared patient populations presenting with groin complications is that of the intravenous drug abuser. We present the case of a patient with a long history of intravenous drug abuse with severe aortoiliac disease. Instead of resorting to a more traditional open surgical approach necessitating artificial reconstruction in the groin, we chose to proceed with a hybrid open and endovascular procedure through a direct open surgical access to the aortic bifurcation. This allowed for revascularization without the placement of artificial material in the groin.
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Affiliation(s)
- Kristin C Kanka
- Surgery Department, University of California, San Francisco-East Bay, 1411 East 31st Street, Oakland, CA 94602, USA.
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Liedenbaum MH, Verdam FJ, Spelt D, de Groot HGW, van der Waal J, van der Laan L. The outcome of the axillofemoral bypass: a retrospective analysis of 45 patients. World J Surg 2010; 33:2490-6. [PMID: 19697078 PMCID: PMC2759976 DOI: 10.1007/s00268-009-0189-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Purpose This study was designed to retrospectively analyze outcomes of axillofemoral bypass (AxFB) operations performed in patients with severe comorbidities. Methods All patients (n = 45) who received an AxFB between 1990 and 2005 for aortoiliac occlusive disease (AIOD, n = 35) or infectious aortic disease (IAD, n = 10) were included. Information on patency of the bypass and mortality was retrieved from patient records. A Kaplan–Meier survival analysis was performed to illustrate survival rates, limb salvage, and primary and secondary patency. Results Included patients had several comorbidities and a high operative risk. In this group, a 30-day mortality rate of 20% was found: 17% for the AIOD group, and 30% for the IAD group. During 5-year follow-up 20 patients died, of which 15 during the first year after operation. Survival rates were at 64 and 41% at 1 and 5 years and limb salvage rates were 84% for both these years. Primary patency rates at 1 and 5 years were 72 and 58%, respectively, and secondary patency rates were 86% at both time points. Conclusions High mortality rates were found in AIOD or IAD patients who received an AxFB. However, for high-risk patients with an already reduced life expectancy, the AxFB remains an alternative with acceptable patency rates.
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Djoric P, Davidovic L, Stojakov D, Pejkic S, Tomic A, Bozic V. Challenging Treatment of Two Secondary Aortoenteric Fistulas in the Same Patient. Am Surg 2010. [DOI: 10.1177/000313481007601203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- P. Djoric
- Vascular Surgery Clinic Clinical Center of Serbia Belgrade, Serbia and School of Medicine University of Belgrade Belgrade, Serbia
| | - L. Davidovic
- Vascular Surgery Clinic Clinical Center of Serbia Belgrade, Serbia and School of Medicine University of Belgrade Belgrade, Serbia
| | - D. Stojakov
- School of Medicine University of Belgrade Belgrade, Serbia and Digestive System Diseases Institute Clinical Center of Serbia Belgrade, Serbia
| | - S. Pejkic
- Vascular Surgery Clinic Clinical Center of Serbia Belgrade, Serbia
| | - A. Tomic
- Clinic for Vascular Surgery Military Medical Academy Belgrade, Serbia
| | - V. Bozic
- Pathology Institute Medical Faculty in Belgrade Belgrade, Serbia
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Use of textile dyeing technology to create an infection-resistant functionalized polyester biomaterial. J Biomed Mater Res B Appl Biomater 2010; 95:118-25. [DOI: 10.1002/jbm.b.31690] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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38
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Kim YW. Infected aneurysm: current management. Ann Vasc Dis 2010; 3:7-15. [PMID: 23555382 DOI: 10.3400/avd.avdctiia09003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2010] [Indexed: 01/16/2023] Open
Affiliation(s)
- Young-Wook Kim
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Saleem BR, Meerwaldt R, Tielliu IF, Verhoeven EL, van den Dungen JJ, Zeebregts CJ. Conservative treatment of vascular prosthetic graft infection is associated with high mortality. Am J Surg 2010; 200:47-52. [DOI: 10.1016/j.amjsurg.2009.05.018] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2009] [Revised: 05/13/2009] [Accepted: 05/13/2009] [Indexed: 11/15/2022]
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Affiliation(s)
- Young-wook Kim
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Poirier M, Rosset E, Cuvelier BA, Favre JP, Ribal JP, Barral X. Infrarenal iterative aortic surgery: early and late morbi-mortality observed in 61 patients. Ann Vasc Surg 2009; 23:729-37. [PMID: 19875007 DOI: 10.1016/j.avsg.2009.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2008] [Revised: 01/11/2009] [Accepted: 03/26/2009] [Indexed: 10/20/2022]
Abstract
The aim of this study was to analyze the early and late results of iterative aortic surgery after bypass of infrarenal aorta. Results from Clermont-Ferrand and Saint-Etienne hospitals have been collected. Between January 1993 and December 2001, 61 patients (59 men and two women, mean age 65 years) underwent a partial or complete second aortic reconstruction through a direct approach. Three different indications that required redo surgery were detected. Twenty-three patients presented with an infection (37%), 17 with an occlusive pathology (28%), and 21 with an aneurysm (34%). Medical or endoluminal treatment could no longer be considered. Mean period of time for redo surgery was 101 months (range 1-294). Eighteen of the procedures were emergency surgeries. A polyester prosthesis was used in 45 cases, an arterial allograft in 15 cases, and autogenous venous material in one case. In 22 cases (36%) a visceral, renal, or infracrural revascularization was associated. Four patients died (6.5%): three with an infection and one with an occlusive pathology. Global morbidity rate was 64%. Twelve vascular surgical complications (19%) required redo surgery: seven limb ischemia, three hemorrhage, and two colic ischemia. The preoperative factors generating severe complications were a septic context, renal insufficiency, and American Society of Anesthesiologists grade 3 or 4. Follow-up concerned the 57 surviving patients with a 43-month mean period of time (range 4-105). Actuarial survival rate was 80.7% at 3 years and could be compared to that observed after infrarenal aortic first surgery. Primary and secondary global patency rates were, respectively, 66.4 +/- 6.7% and 94.6 +/- 3% at 3 years with no major amputation. In our series including 37% of septic patients and nearly 30% of patients operated on in emergency, aortic iterative surgery led to mortality and morbidity rates twice and four times as important as those resulting from infrarenal aortic initial surgery, respectively. In the long term, patient survival and limb salvage rates were quite similar to those obtained with de novo surgery.
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Affiliation(s)
- Mathieu Poirier
- Service de chirurgie vasculaire, CHU de Clermont-Ferrand, Hôpital Gabriel Montpied, Clermont-Ferrand, France
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Ehsan O, Gibbons C. A 10-year Experience of Using Femoro-popliteal Vein for Re-vascularisation in Graft and Arterial Infections. Eur J Vasc Endovasc Surg 2009; 38:172-9. [DOI: 10.1016/j.ejvs.2009.03.009] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2009] [Accepted: 03/16/2009] [Indexed: 11/25/2022]
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Ali AT, Modrall JG, Hocking J, Valentine RJ, Spencer H, Eidt JF, Clagett GP. Long-term results of the treatment of aortic graft infection by in situ replacement with femoral popliteal vein grafts. J Vasc Surg 2009; 50:30-9. [DOI: 10.1016/j.jvs.2009.01.008] [Citation(s) in RCA: 127] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2008] [Revised: 12/22/2008] [Accepted: 01/03/2009] [Indexed: 11/29/2022]
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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]
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Secondary Infections of Thoracic and Abdominal Aortic Endografts. J Vasc Interv Radiol 2009; 20:173-9. [DOI: 10.1016/j.jvir.2008.10.032] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2008] [Revised: 10/23/2008] [Accepted: 10/28/2008] [Indexed: 11/20/2022] Open
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Efficacy of collagen silver-coated polyester and rifampin-soaked vascular grafts to resist infection from MRSA and Escherichia coli in a dog model. Ann Vasc Surg 2008; 22:815-21. [PMID: 18835516 DOI: 10.1016/j.avsg.2008.06.011] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2007] [Revised: 04/20/2008] [Accepted: 06/26/2008] [Indexed: 11/23/2022]
Abstract
The primary objective of this study was to compare the efficacy of a collagen silver-coated polyester graft, InterGard, with a gelatin-sealed graft, Gelsoft, both soaked in rifampin, for resistance to direct bacterial contamination in an animal model. The second objective was to confirm the lack of inflammation from silver acetate. Vascular grafts, 6 mm in diameter, were implanted in the infrarenal aorta of 28 dogs. Intravenous cefamandole (20 mg/kg) was injected intraoperatively in all dogs. The dogs were divided into three groups. Group I included 12 dogs. Six dogs received silver grafts and six dogs received gelatin-sealed grafts, all soaked with rifampin. Grafts implanted in group I were directly infected with methicillin-resistant Staphylococcus aureus (MRSA). Group II included also six silver grafts and six gelatin-sealed grafts, all soaked with rifampin. Dogs of group II were directly infected with Escherichia coli. Group III comprised four dogs, which received gelatin unsealed grafts, directly infected with MRSA, the control group. All dogs were followed by regular clinical examination, including blood cultures. Grafts in groups I and III and in group II were harvested at 30 days and 10 days, respectively. Bacterial analyses were performed on the explanted grafts. Histology was performed on both the tissue samples and the anastomotic sites of the harvested grafts. In group I, no grafts were infected with MRSA, irrespective of graft type. In group II, no silver grafts were infected with E. coli, whereas one (16.6%) of six gelatin-sealed grafts was infected (p = 0.317). In group III, three (75%) of the four grafts were infected with MRSA. The infection rate in the silver grafts and the gelatin-sealed grafts soaked in rifampin in group I compared with the unsealed gelatin grafts in group III was statistically significantly different (p < 0.05). There was no statistically significant difference in the inflammation score, obtained by histological analysis, between rifampin-soaked silver and Gelsoft grafts in either group I or group II. There were signs of necrosis at the anastomoses in three (25%) gelsoft grafts of 12 in groups I and II. There were no clinical or biological signs of inflammation from use of silver-coated grafts. These results indicate that collagen silver-coated grafts and gelatin-sealed grafts, both soaked in rifampin, provide resistance against MRSA and E. coli. There was a trend toward better resistance but without statistical significance against E. coli from the rifampin silver graft compared with the rifampin-soaked Gelsoft graft, without signs of inflammation from InterGard silver grafts.
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Aortoiliac aneurysms infected by Campylobacter fetus. J Vasc Surg 2008; 48:815-20. [DOI: 10.1016/j.jvs.2008.05.076] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2008] [Revised: 05/28/2008] [Accepted: 05/28/2008] [Indexed: 11/21/2022]
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49
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Primary aortoenteric fistula. Am J Surg 2008; 195:506-7. [DOI: 10.1016/j.amjsurg.2007.03.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2007] [Revised: 03/27/2007] [Accepted: 03/27/2007] [Indexed: 11/24/2022]
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50
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Javerliat I, Goëau-Brissonnière O, Sivadon-Tardy V, Coggia M, Gaillard JL. Prevention of Staphylococcus aureus graft infection by a new gelatin-sealed vascular graft prebonded with antibiotics. J Vasc Surg 2007; 46:1026-31. [PMID: 17905555 DOI: 10.1016/j.jvs.2007.06.023] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2007] [Accepted: 06/03/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the efficacy of a new gelatin-sealed graft prebonded with two antibiotics in resisting infection with Staphylococcus aureus (S aureus) A980142 after direct bacterial application in a dog model. METHODS Twelve 6.0-mm polyester grafts were implanted in dogs end-to-end into the infrarenal aorta. The dogs were divided into two groups. A test group (n = 6) received experimental antibiotic-bonded gelatin-sealed knitted polyester grafts, loaded with two antibiotics, rifampin and tobramycin. A control group (n = 6) received commercial gelatin-sealed knitted polyester grafts. At the end of graft implantation, 50 mul of a 1.8 x 10(4) CFU/mL S aureus solution were instilled directly over the graft. One week after implantation, grafts were harvested with sterile technique. Quantitative cultures were obtained from all the harvested grafts. The results were expressed as colony-forming units per cm(2) of surface of the graft. Bacteriological study was also performed on various tissue samples. The chi(2) test was used to compare the culture proven infection of control and antibiotics-bonded grafts. RESULTS Mean inoculum size was similar in the two groups of dogs. Five of the six control grafts grew S aureus A980142 at the time of graft removal, whereas none of the six antibiotic-bonded gelatin-sealed grafts were infected (P = .0192). None of the organ samples were infected in the group implanted with antibiotic-bonded grafts, whereas 15/34 samples grew S. aureus in the control group. CONCLUSION These results indicate that this gelatin sealed graft prebonded with two antibiotics resists infection caused by S aureus graft contamination in a dog model.
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Affiliation(s)
- Isabelle Javerliat
- Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique-Hôpitaux de Paris, Boulogne-Billancourt, France
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