1
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Pennetta FF, De Santis F, Millarelli M, Diotallevi N, Chiappa R. Modified upside-down technique with Gore tapered iliac limbs for isolated iliac artery aneurysms. Vascular 2024:17085381241242859. [PMID: 38527213 DOI: 10.1177/17085381241242859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
PURPOSE To describe the off-label use of tapered iliac limbs for the treatment of isolated iliac aneurysms with proximal landing zone significantly larger than distal landing zone. TECHNIQUE Inversion of a Gore Excluder tapered leg (W. L. Gore & Associates Inc, Flagstaff, Arizona) with a modified upside-down technique is described. The endoprosthesis, with the olive at the tip of the releasing system previously cut, is inserted in a tip-to-tip fashion into a 15 Fr introducer sheath. The graft is released inside the introducer. An 18 Fr introducer sheath is advanced up to the proximal sealing zone. Following the removal of the 18 Fr dilator, the 15 Fr introducer with the pre-released graft is inserted co-axially into the 18 Fr introducer. A pre-cut 15 Fr dilator is brought up to the endograft and used as a pusher. A pull-back maneuver of the co-axial system, countertractioning with the dilator maintained in position, allows the delivery of the endograft. CONCLUSION This technique might offer a feasible option in case of endovascular exclusion of isolated iliac artery aneurysms with significant landing zone diameter mismatch. Extracorporeal inversion is time-saving and could be safer in terms of graft damage and infection.
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Affiliation(s)
| | - Francesco De Santis
- Vascular and Endovascular Surgery Unit, Sandro Pertini Hospital, Rome, Italy
| | | | - Nicolò Diotallevi
- Vascular and Endovascular Surgery Unit, Sandro Pertini Hospital, Rome, Italy
| | - Roberto Chiappa
- Vascular and Endovascular Surgery Unit, Sandro Pertini Hospital, Rome, Italy
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2
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Correia RM, Nakano LCU, Vasconcelos V, Flumignan RLG. Prevention of infection in peripheral arterial reconstruction of the lower limb. Hippokratia 2022. [DOI: 10.1002/14651858.cd015022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Rebeca M Correia
- Department of Surgery, Division of Vascular and Endovascular Surgery; Universidade Federal de São Paulo; São Paulo Brazil
| | - Luis CU Nakano
- Department of Surgery, Division of Vascular and Endovascular Surgery; Universidade Federal de São Paulo; São Paulo Brazil
- Cochrane Brazil; Universidade Federal de São Paulo; São Paulo Brazil
| | - Vladimir Vasconcelos
- Department of Surgery, Division of Vascular and Endovascular Surgery; Universidade Federal de São Paulo; São Paulo Brazil
- Cochrane Brazil; Universidade Federal de São Paulo; São Paulo Brazil
| | - Ronald LG Flumignan
- Department of Surgery, Division of Vascular and Endovascular Surgery; Universidade Federal de São Paulo; São Paulo Brazil
- Cochrane Brazil; Universidade Federal de São Paulo; São Paulo Brazil
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3
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PET imaging in cardiovascular infections. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00140-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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4
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Dorpmans D, Peeters K, Mufty H, Debaveye Y, Van Wijngaerden E, Fourneau I. Vascular Graft Infections With Candida: A Factor for Increased Mortality in in-situ Reconstructions. Ann Vasc Surg 2021; 82:206-211. [PMID: 34902469 DOI: 10.1016/j.avsg.2021.11.004] [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: 07/12/2021] [Revised: 11/03/2021] [Accepted: 11/06/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The empiric antibiotic regimen started after deep cultures and explantation of the graft mostly do not cover antifungals. We retrospectively studied the outcome of candida compared to non-candida VGI and assessed whether these results could justify the addition of antifungals to the empiric antibiotics in the early postoperative period. METHODS All patients treated for infected aorto(ilio)femoral graft with excision and reconstruction at the vascular department of University Hospitals Leuven between January 2010 and 2017 (n = 56) were studied retrospectively. Patients were allocated to the candida group (n = 10) or non-candida group (n = 46) according to the presence of Candida in deep culture isolates. RESULTS All-cause mortality was significantly higher in the candida group compared to the non-candida group. All-cause 30-day mortality was 40% and 13% for both groups respectively (P = 0.066). At 5 years this was 90% and 46% respectively (P = 0.014). In the candida group 6 patients (60%) had to be revised in the operating room due to bleeding, compared to 5 patients (11%) in the non-candida group (P = 0.002). Two patients (20%) and 5 patients (11%) had to be readmitted to the ICU, respectively. CONCLUSION Survival of candida related VGI is significantly worse, especially in the first 5 postoperative months. This could justify the addition of an antifungal to the early empiric postoperative antibiotic cocktail, especially in patients with an aorto-enteric fistula. A cost-benefit analysis could be useful to evaluate the yield.
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Affiliation(s)
- Dries Dorpmans
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Karen Peeters
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Hozan Mufty
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Yves Debaveye
- Department of Intensive Care Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Eric Van Wijngaerden
- Department of General Internal Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Inge Fourneau
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium..
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Dmitriev OV, Ital'iantsev AI, Chernovalov DA, Kozin II, Griaznova DA, Vachev AN. [Prosthetic repair of the aorta with a cadaveric homograft for infection of bifurcated synthetic vascular prosthesis]. ANGIOLOGII︠A︡ I SOSUDISTAI︠A︡ KHIRURGII︠A︡ = ANGIOLOGY AND VASCULAR SURGERY 2021; 27:132-139. [PMID: 34528597 DOI: 10.33529/angio2021315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Infection of arterial vascular grafts is a rare but utterly severe complication in vascular surgery. Therapeutic policy in patients with graft infection has not been standardized, to be determined individually. One of the variants of surgical treatment is considered to be repeat aortic repair using a cadaveric graft. Presented in the article is a clinical case report concerning a 60-year-old male patient previously subjected to aortofemoral bifurcation bypass grafting with stage IV ischaemia of lower limbs according to the Pokrovsky-Fontaine classification. In the early postoperative period the events of critical ischaemia were not arrested. Due to the presence of a block of the femoropopliteal segment, as the second stage 3 days after the primary operation, the patient underwent autovenous femoropopliteal bypass grafting with a reversed autovein above the knee-joint fissure. The clinical course of critical ischaemia of the limb was relieved. During subsequent 8 months of follow up his state remained stable. Eight months after the primary operation he developed purulent discharge from the postoperative scar on the left femur. In the setting of the Purulent Surgery Department, the patient was emergently subjected to opening and drainage of the abscess of the postoperative scar. On the bottom of the wound there was a freely lying branch of a synthetic vascular prosthesis. Computed tomography revealed infection of the entire synthetic prosthesis and aneurysms of distal anastomoses. Given extremely high risk for the development of arrosive haemorrhage, a decision was made on operative treatment - repeat prosthetic repair of the abdominal aorta with a cadaveric allograft. At the Vascular Department of the Clinic of Faculty Surgery, laparotomy was performed, with removal of the infected graft, followed by debridement of the retroperitoneal space and repeat aortofemoral bifurcation prosthetic repair of the abdominal aorta with a cadaveric allograft. The wound healed with first intention. There was no evidence of infectious process relapse. The patient was discharged on postoperative day 15 in a satisfactory condition. The duration of follow up amounted to 6 months. The control examination showed that the pain-free walking distance was 500 m. Doppler ultrasonography demonstrated that the graft was functioning, with no signs of either anastomotic aneurysms or suppuration of the retroperitoneal space.
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Affiliation(s)
- O V Dmitriev
- Department of Faculty Surgery, Samara State Medical University, Samara, Russia; Department of Vascular Surgery #1, Clinic of the Samara State Medical University, Samara, Russia
| | - A Iu Ital'iantsev
- Department of Vascular Surgery #1, Clinic of the Samara State Medical University, Samara, Russia
| | - D A Chernovalov
- Department of Vascular Surgery #1, Clinic of the Samara State Medical University, Samara, Russia
| | - I I Kozin
- Department of Vascular Surgery #1, Clinic of the Samara State Medical University, Samara, Russia
| | - D A Griaznova
- Department of Vascular Surgery #1, Clinic of the Samara State Medical University, Samara, Russia
| | - A N Vachev
- Department of Faculty Surgery, Samara State Medical University, Samara, Russia
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6
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Gouveia E Melo R, Martins B, Pedro DM, Santos CM, Duarte A, Fernandes E Fernandes R, Garrido P, Mendes Pedro L. Microbial evolution of vascular graft infections in a tertiary hospital based on positive graft cultures. J Vasc Surg 2020; 74:276-284.e4. [PMID: 33348004 DOI: 10.1016/j.jvs.2020.12.071] [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] [Received: 07/30/2020] [Accepted: 12/09/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Vascular graft infections are a serious complication in vascular surgery. Correct antibiotic therapy targeted to the most likely infecting species is essential to treat these patients, although the bacterial epidemiology and pathogenesis are still not completely understood. We analyzed the behavior of vascular graft infections and the microbiologic patterns of resistance. METHODS A 10-year (2008-2018), single-center, retrospective cohort study was performed of all patients admitted with vascular graft infection identified by positive direct graft cultures. An extensive microbiologic study was performed to analyze the bacterial strains, antibiotic resistance and sensitivity, and prevalence stratified by the year. RESULTS A total of 72 vascular graft infections with positive graft cultures occurring in 65 patients were found. Their mean age was 67 ± 9.6 years, and 85% were men. Infection-related mortality was 11%. Of the 65 patients, 14 had undergone aortobifemoral bypass, 13 axillofemoral bypass, 5 femorofemoral bypass, 27 femoropopliteal bypass, and 4 femoral endarterectomy with synthetic patch angioplasty. The median interval from the index procedure to infection was longer for intracavitary than for extracavitary grafts (P = .011). Of the 72 infections, 48 were monomicrobial and 24 were polymicrobial. Gram-negative bacteria were predominantly identified in intracavitary graft infections (54%). In contrast, gram-positive bacteria were most frequent in the extracavitary graft group (58%). Multidrug-resistant bacterial species occurred more frequently in early graft infections (P = .002). Throughout the study duration, an overall decrease in gram-positive infections and an increase in gram-negative infections was observed, especially in extensively drug-resistant strains. A similar progression was found in all nosocomial infections. CONCLUSIONS The present study has shown that vascular graft infection microbiology changed in accordance with graft location and interval to infection from revascularization surgery and had also evolved over the study period with patterns similar to those for all nosocomial infections. This highlights the importance of studying the specific microbiology of each healthcare center and its relationship to vascular graft infections to achieve the best treatment possible.
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Affiliation(s)
- Ryan Gouveia E Melo
- Faculty of Medicine, University of Lisbon, Hospital Santa Maria (Centro Hospitalar Universitário Lisboa Norte), Lisbon, Portugal; Division of Vascular Surgery, Heart and Vessels Department, Hospital Santa Maria (Centro Hospitalar Universitário Lisboa Norte), Lisbon, Portugal; Lisbon Academic Medical Centre, Lisbon, Portugal.
| | - Beatriz Martins
- Faculty of Medicine, University of Lisbon, Hospital Santa Maria (Centro Hospitalar Universitário Lisboa Norte), Lisbon, Portugal
| | - Diogo Mendes Pedro
- Faculty of Medicine, University of Lisbon, Hospital Santa Maria (Centro Hospitalar Universitário Lisboa Norte), Lisbon, Portugal; Lisbon Academic Medical Centre, Lisbon, Portugal; Infectious Disease Department, Hospital Santa Maria (Centro Hospitalar Universitário Lisboa Norte), Lisbon, Portugal
| | - Carla Mimoso Santos
- Faculty of Medicine, University of Lisbon, Hospital Santa Maria (Centro Hospitalar Universitário Lisboa Norte), Lisbon, Portugal; Lisbon Academic Medical Centre, Lisbon, Portugal; Grupo de Coordenação Local do Programa de Prevenção e Controlo de Infeção e Resistência aos Antimicrobianos do Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal; Infectious Disease Department, Hospital Santa Maria (Centro Hospitalar Universitário Lisboa Norte), Lisbon, Portugal
| | - António Duarte
- Division of Vascular Surgery, Heart and Vessels Department, Hospital Santa Maria (Centro Hospitalar Universitário Lisboa Norte), Lisbon, Portugal; Lisbon Academic Medical Centre, Lisbon, Portugal
| | - Ruy Fernandes E Fernandes
- Faculty of Medicine, University of Lisbon, Hospital Santa Maria (Centro Hospitalar Universitário Lisboa Norte), Lisbon, Portugal; Division of Vascular Surgery, Heart and Vessels Department, Hospital Santa Maria (Centro Hospitalar Universitário Lisboa Norte), Lisbon, Portugal; Lisbon Academic Medical Centre, Lisbon, Portugal
| | - Pedro Garrido
- Division of Vascular Surgery, Heart and Vessels Department, Hospital Santa Maria (Centro Hospitalar Universitário Lisboa Norte), Lisbon, Portugal; Lisbon Academic Medical Centre, Lisbon, Portugal
| | - Luís Mendes Pedro
- Faculty of Medicine, University of Lisbon, Hospital Santa Maria (Centro Hospitalar Universitário Lisboa Norte), Lisbon, Portugal; Division of Vascular Surgery, Heart and Vessels Department, Hospital Santa Maria (Centro Hospitalar Universitário Lisboa Norte), Lisbon, Portugal; Lisbon Academic Medical Centre, Lisbon, Portugal
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7
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Salmoukas C, Ruemke S, Rubalskii E, Burgwitz K, Haverich A, Kuehn C. Vascular Graft Pre-Treatment with Daptomycin Prior to Implantation Prevents Graft Infection with Staphylococcus aureus in an In Vivo Model. Surg Infect (Larchmt) 2020; 21:161-168. [DOI: 10.1089/sur.2019.124] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Christina Salmoukas
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
- NIFE - Lower Saxony Centre for Biomedical Engineering, Implant Research and Development, Hannover, Germany
| | - Stefan Ruemke
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
- NIFE - Lower Saxony Centre for Biomedical Engineering, Implant Research and Development, Hannover, Germany
| | - Evgenii Rubalskii
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
- NIFE - Lower Saxony Centre for Biomedical Engineering, Implant Research and Development, Hannover, Germany
| | - Karin Burgwitz
- NIFE - Lower Saxony Centre for Biomedical Engineering, Implant Research and Development, Hannover, Germany
| | - Axel Haverich
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
- NIFE - Lower Saxony Centre for Biomedical Engineering, Implant Research and Development, Hannover, Germany
| | - Christian Kuehn
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
- NIFE - Lower Saxony Centre for Biomedical Engineering, Implant Research and Development, Hannover, Germany
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8
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Lejay A, Diener H, Chakfe N. How to Best Manage an Aortic Graft Infection is a Never-Ending Story. Eur J Vasc Endovasc Surg 2019; 58:282. [PMID: 31178358 DOI: 10.1016/j.ejvs.2019.03.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 03/27/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Anne Lejay
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, France.
| | - Holger Diener
- Department of Vascular Medicine, University Heart Center, Hamburg, Germany
| | - Nabil Chakfe
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, France
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9
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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.
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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.
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10
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Sollini M, Berchiolli R, Delgado Bolton RC, Rossi A, Kirienko M, Boni R, Lazzeri E, Slart R, Erba PA. The "3M" Approach to Cardiovascular Infections: Multimodality, Multitracers, and Multidisciplinary. Semin Nucl Med 2018; 48:199-224. [PMID: 29626939 DOI: 10.1053/j.semnuclmed.2017.12.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Cardiovascular infections are associated with high morbidity and mortality. Early diagnosis is crucial for adequate patient management, as early treatment improves the prognosis. The diagnosis cannot be made on the basis of a single symptom, sign, or diagnostic test. Rather, the diagnosis requires a multidisciplinary discussion in addition to the integration of clinical signs, microbiology data, and imaging data. The application of multimodality imaging, including molecular imaging techniques, has improved the sensitivity to detect infections involving heart valves and vessels and implanted cardiovascular devices while also allowing for early detection of septic emboli and metastatic infections before these become clinically apparent. In this review, we describe data supporting the use of a Multimodality, Multitracer, and Multidisciplinary approach (the 3M approach) to cardiovascular infections. In particular, the role of white blood cell SPECT/CT and [18F]FDG PET/CT in most prevalent and clinically relevant cardiovascular infections will be discussed. In addition, the needs of advanced hybrid equipment, dedicated imaging acquisition protocols, specific expertise for image reading, and interpretation in this field are discussed, emphasizing the need for a specific reference framework within a Cardiovascular Multidisciplinary Team Approach to select the best test or combination of tests for each specific clinical situation.
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Affiliation(s)
- Martina Sollini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (Milan), Italy
| | - Raffaella Berchiolli
- Vascular Surgery Unit Department of Translational Research and Advanced Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Roberto C Delgado Bolton
- Department of Diagnostic Imaging and Nuclear Medicine, University Hospital San Pedro and Centre for Biomedical Research of La Rioja (CIBIR), Logronño, La Rioja, Spain
| | - Alexia Rossi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (Milan), Italy
| | - Margarita Kirienko
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (Milan), Italy
| | - Roberto Boni
- Nuclear Medicine Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Elena Lazzeri
- Regional Center of Nuclear Medicine, Department of Translational Research and Advanced Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Riemer Slart
- University Medical Center Groningen, Medical Imaging Center, University of Groningen, Groningen, The Netherlands; Faculty of Science and Technology, Biomedical Photonic Imaging, University of Twente, Enschede, The Netherlands
| | - Paola Anna Erba
- Regional Center of Nuclear Medicine, Department of Translational Research and Advanced Technologies in Medicine, University of Pisa, Pisa, Italy; University Medical Center Groningen, Medical Imaging Center, University of Groningen, Groningen, The Netherlands.
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11
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The Marriage of Sartorius and Tensor Fasciae Latae in Treating Vascular Prosthetic Graft Infections. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2017; 5:e1274. [PMID: 28507848 PMCID: PMC5426867 DOI: 10.1097/gox.0000000000001274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 02/01/2017] [Indexed: 12/19/2022]
Abstract
Background: Vascular prosthetic graft infection in the groin is associated with high morbidity and mortality. This article presents a case series on the use of 2 flaps in the treatment of this condition. Methods: Five patients, mean age 65 years (range, 49–74 years), with significant comorbidity were treated for an exposed and infected vascular prosthetic graft in the groin with a combination of sartorius muscle (SM) flap and tensor fascia lata (TFL) myocutaneous flap after debridement and start of microbiologic culture–guided antibiotic treatment. The SM flap was used to cover the exposed graft. To obtain stable wound coverage, the SM and remaining groin defect were closed with a pedicle TFL flap. Results: All flaps survived, with only 1 TFL flap suffering a small tip necrosis. All patients obtained stable wound coverage. Donor-site morbidity was minimal. During the follow-up, mean 46 months (range, 15–79 months), 1 patient had a recurrence after 15 months due to a kink in the elongated prosthetic graft that protruded through the skin alongside the SM and TFL flaps. Conclusions: The combination of SM and TFL flaps could be a new treatment option for patients who have an exposed and infected vascular prosthetic graft in the groin. This flap combination could also be used as a prophylactic procedure for those patients with a high risk to develop such a serious complication.
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12
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Fernández Martín-Forero P, Baquero Yebra Y, Arribas Díaz A, González García A, Aparicio Martínez C. Complicaciones debidas al manejo conservador de la infección de injerto fémoro-femoral con exposición del mismo. A propósito de un caso. ANGIOLOGIA 2017. [DOI: 10.1016/j.angio.2015.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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13
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Greaves NS, Katsogridakis E, Faris B, Murray D. Prophylactic antibiotics for percutaneous endovascular procedures. Eur J Clin Microbiol Infect Dis 2016; 36:597-601. [DOI: 10.1007/s10096-016-2848-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 11/15/2016] [Indexed: 10/20/2022]
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14
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Lichtenfels E, D'Azevedo PA, Frankini AD, Erling Jr. N, Aerts NR. Morbidity and mortality associated with arterial surgery site infections by resistant microorganisms. J Vasc Bras 2014. [DOI: 10.1590/jvb.2014.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background:Surgical site infection is a severe complication of peripheral vascular surgery with high morbidity and mortality rates.Objective:To evaluate the morbidity and mortality of infections of peripheral artery surgery sites caused by resistant microorganisms.Methods:This was a prospective study of a cohort of patients who underwent peripheral artery revascularization procedures and developed surgical site infections between March 2007 and March 2011.Results:Mean age was 63.7 years; males accounted for 64.3% of all cases. The overall prevalence of bacterial resistance to antimicrobials was 65.7%. The most common microorganism identified was Staphylococcus aureus (30%). Comparison of the demographic and surgical characteristics of both subsets (resistant versus non-resistant) detected a significant difference in length of preoperative hospital stay (9.3 days vs. 3.7 days). The subset of patients with infections by resistant microorganisms had higher rates of reoperation, lower numbers of limb amputations and lower mortality, but the differences compared to the subset without resistant infections were not significant. Long-term survival was similar.Conclusions:This study detected no statistically significant differences in morbidity or mortality between subsets with surgical wound infections caused by resistant and not-resistant microorganisms.
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Affiliation(s)
- Eduardo Lichtenfels
- Universidade Federal de Ciências da Saúde de Porto Alegre – UFCSPA, Brazil; Hospital Santa Casa, Brazil
| | | | - Airton Delduque Frankini
- Universidade Federal de Ciências da Saúde de Porto Alegre – UFCSPA, Brazil; Hospital Santa Casa, Brazil
| | - Nilon Erling Jr.
- Universidade Federal de Ciências da Saúde de Porto Alegre – UFCSPA, Brazil; Hospital Santa Casa, Brazil
| | - Newton Roesch Aerts
- Universidade Federal de Ciências da Saúde de Porto Alegre – UFCSPA, Brazil; Hospital Santa Casa, Brazil
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15
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Erba PA, Leo G, Sollini M, Tascini C, Boni R, Berchiolli RN, Menichetti F, Ferrari M, Lazzeri E, Mariani G. Radiolabelled leucocyte scintigraphy versus conventional radiological imaging for the management of late, low-grade vascular prosthesis infections. Eur J Nucl Med Mol Imaging 2013; 41:357-68. [DOI: 10.1007/s00259-013-2582-9] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2013] [Accepted: 09/12/2013] [Indexed: 11/28/2022]
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16
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Kim JT, Yoon YH, Baek WK, Kim KH, Heo YS. Conservative Treatment of a Thoracic Aortic Graft Infection Using an Omental Flap without Graft Removal. Vasc Specialist Int 2012. [DOI: 10.5758/kjves.2012.28.2.79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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17
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Diagnosis and management of prosthetic vascular graft infections. Med Mal Infect 2012; 42:102-9. [DOI: 10.1016/j.medmal.2012.01.003] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Accepted: 01/03/2012] [Indexed: 01/15/2023]
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18
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Abstract
Infections in vascular surgery are usually of multifactorial nature resulting from a complex interplay of patient, surgical and environmental factors. Preventative measures initiated from the stage of pre-operative screening, maintenance of patient homeostasis and the use of organism-directed antibiotics can contribute to reduce infection rates. Graft preservation techniques are becoming increasingly popular as a method to treat established graft infections. In this article we report on the current trends and techniques on the management of infections in vascular surgery. Ongoing studies are required to continue to accumulate data on the effectiveness of these techniques.
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Affiliation(s)
- M R Tatterton
- Leeds Vascular Institute, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, UK.
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19
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Correa M, Restrepo R, Arboleda C, Mosquera J, García Martínez G. Factores de riesgo para el desarrollo de infección de injerto protésico infrainguinal en un Servicio de Cirugía Vascular en Medellín (Colombia). ANGIOLOGIA 2011. [DOI: 10.1016/j.angio.2011.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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20
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Lichtenfels E, Frankini AD, Paludo J, d'Azevedo PA. Prevalência de resistência bacteriana nas infecções de ferida operatória em cirurgia arterial periférica. J Vasc Bras 2008. [DOI: 10.1590/s1677-54492008000300009] [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
CONTEXTO: A infecção de sítio cirúrgico é uma complicação grave da cirurgia vascular periférica. O recente aparecimento de microorganismos resistentes e agressivos gera uma nova preocupação com relação ao manejo dessas infecções. OBJETIVO: Verificar a prevalência de resistência bacteriana, a epidemiologia, os possíveis fatores associados e o padrão de resistência nas infecções de ferida operatória das cirurgias arteriais periféricas. MÉTODOS: Estudo de prevalência, envolvendo 40 pacientes portadores de infecção da ferida operatória e submetidos à cirurgia de revascularização arterial periférica no período de janeiro de 2007 a maio de 2008. RESULTADOS: Participaram do estudo pacientes com média de idade de 64,2 anos, predominantemente do sexo masculino (70%). A prevalência geral de resistência bacteriana foi 72,5%, e de multirresistência, 60%. O microorganismo mais freqüentemente isolado foi o Staphylococcus aureus (40%), sendo 11 das 16 culturas (68,7%) resistentes à oxacilina. As taxas de resistência aos principais antimicrobianos testados foram: ampicilina, 85,7%; cefalosporina, 76,9%; oxacilina, 65%; e ciprofloxacina, 62,5%. Não foi identificada resistência à vancomicina e ao imipenem. CONCLUSÕES: Os achados deste estudo sugerem que a resistência bacteriana é um problema atual e muito prevalente nas cirurgias arteriais periféricas. O Staphylococcus aureus segue sendo o principal patógeno envolvido, demonstrando altas taxas de resistência. A vancomicina e o imipenem seguem sendo as principais opções terapêuticas para esse tipo de infecção.
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Affiliation(s)
- Eduardo Lichtenfels
- Universidade Federal de Ciências da Saúde de Porto Alegre; Complexo Hospitalar Santa Casa de Porto Alegre
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Gao H, Lund L, Prag J, Sandermann J, Lindholt JS. Laparoscopic Diagnosis and Treatment of Aortic Vascular Prosthetic Graft Infections in a Porcine Model. Eur J Vasc Endovasc Surg 2008; 35:41-5. [PMID: 17719807 DOI: 10.1016/j.ejvs.2007.07.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2007] [Accepted: 07/07/2007] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To study the feasibility and efficacy of experimental laparoscopy in the diagnosis of aortic graft infection in pigs. MATERIAL AND METHODS Eight pigs had an aortic tube graft implanted and inoculated with either 5 x 10(4) or 10(6) CFU of Staphylococcus aureus ATCC 29213. Laparoscopy was performed after a median of 20 days with debridement and sampling for bacterial culture. Thereafter, the grafts were locally soaked in rifampicin and postoperatively, the pigs received rifampicin and ciprofloxacin orally for two weeks and were then sacrificed. RESULTS All pigs developed graft infection. One pig died from severe clostridial septicaemia before laparoscopy could be performed. The remaining pigs had all samples for bacterial culture taken by laparoscopy from the inflamed tissue. The temperature dropped significantly after laparoscopy, and no macroscopic signs of infection presented at autopsy. However, only culture from one pig was without S. aureus at autopsy. CONCLUSIONS Laparoscopy is a potential diagnostic tool for aortic graft infection and also affords the opportunity to carry out bacteriological sampling and local antibiotic treatment. The efficacy of laparoscopic treatment needs further evaluation.
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Affiliation(s)
- H Gao
- Vascular Research Unit, Department of Vascular Surgery, Viborg Hospital, 8800 Viborg, Denmark
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Martínez-Vázquez C, Sopeña B, Oliveira I, Bouzas R, Encisa J, Ocampo A, Gallego C, Bordón J. Infección asociada a prótesis vascular: manejo exitoso sin retirada de prótesis. Rev Clin Esp 2007; 207:317-21. [PMID: 17662195 DOI: 10.1157/13107942] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Removal of graft with intravenous antibiotics is traditionally considered the most effective treatment of vascular graft-associated infections. However, an increasing number of reports suggests that this complication can be effectively treated without graft removal. METHODS A prospective study to evaluate the outcome of conservative management of vascular graft-associated infection seen in our center was performed. The diagnosis of graft-associated infection was based on microbiological tests, and imaging studies. In our study, patients were hemodynamically stable with functioning vascular graft as per clinical and imaging evaluations. Conservative management included antibiotic treatment and local debridement without removal of vascular graft. RESULTS Fourteen patients with vascular graft-associated infection were enrolled in our study. Eleven out of 14 patients (78.6%) responded successfully to conservative management. Treatment failure was reported in 3 patients, 2 of whom required graft removal. After a two-year follow-up, these 14 patients were clinically stable without recurrence of infection. CONCLUSIONS Our study has revealed that conservative management of vascular graft-associated infection seems to be effective and should be considered in hemodynamically stable patients with functioning vascular graft.
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Affiliation(s)
- C Martínez-Vázquez
- Unidad de Enfermedades Infecciosas, Hospital Xeral-Cíes, Vigo, Pontevedra, Spain.
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Muralidhar B, Anwar SM, Handa AI, Peto TEA, Bowler ICJW. Prevalence of MRSA in Emergency and Elective Patients Admitted to a Vascular Surgical Unit: Implications for Antibiotic Prophylaxis. Eur J Vasc Endovasc Surg 2006; 32:402-7. [PMID: 16716610 DOI: 10.1016/j.ejvs.2006.03.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2005] [Accepted: 03/26/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVES MATERIALS AND METHODS 200 consecutive emergency/transfer and 150 consecutive elective patients admitted between April 2004 and January 2005, were studied. Data was obtained from departmental Morbidity and Mortality records and the computerised laboratory medicine information system. RESULTS 261 (75%) of the 350 patients were screened for MRSA on admission (target 100%). The proportions of emergency/transfer and elective patients screened were similar (78% and 72% respectively). The prevalence of MRSA carriage detected by admission screening in emergency/transfer patients 30/153 (20%), was significantly higher (p<0.0001) than in elective patients 2/108 (2%). A simple decision analysis model suggests that gentamicin should be used when the prevalence of MRSA reaches 10% and vancomycin when the prevalence reaches 50%. CONCLUSIONS The high prevalence of MRSA colonisation in emergency/transfer patients has important implications for pre-operative antibiotic prophylaxis.
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Affiliation(s)
- B Muralidhar
- Nuffield Department of Surgery, John Radcliffe Hospital, Oxford, OX3 9DU, UK.
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Martínez Chamorro E, Revilla Ostoloza Y. [Fever of unknown origin in 71 year old male in hemodialysis, operated on for aneurysm of the abdominal aorta]. Rev Clin Esp 2005; 205:509-10. [PMID: 16238964 DOI: 10.1157/13079768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Malaki M, Perkins JM, Mortensen NJ, Hands LJ. Graft-enteric Erosion: an Unusual Colonoscopic Diagnosis. Eur J Vasc Endovasc Surg 2001; 21:283-4. [PMID: 11352691 DOI: 10.1053/ejvs.2001.1250] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- M Malaki
- Nuffield Department of Surgery, The John Radcliffe, Oxford, U.K
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