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Lovelock T, Thoo C. Primary lower-limb arterial stent infection managed with resection and In situ bovine pericardial revascularization. INDIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2022. [DOI: 10.4103/ijves.ijves_102_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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2
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Alataby HA, Muzangwa LG, Atere MK, Bibawy J, Diaz KT, Nfonoyim JM. A rare case of an infected aortoiliac graft complicated with Eggerthella lenta bacteremia and septic shock. J Community Hosp Intern Med Perspect 2020; 10:452-455. [PMID: 33235681 PMCID: PMC7671738 DOI: 10.1080/20009666.2020.1809260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
We describe the successful medical management of an infected aorto-bi-Iliac endograft. In this case report, we provide an example of a patient with an infected aorto-bi-iliac endograft and how appropriate medical management may result in a positive outcome. We report a case of a 67-year-old man with several medical comorbidities who developed aorto-bi-iliac endograft infection one year after graft placement. The patient presented to our E.R. with fever, lethargy, tachycardia, tachypnea, and hypotension. The diagnosis of an infected endograft was established after excluding any other possible source of infection plus the strong radiological evidence by computed tomographic scan and WBCs labeled Indium-111 tropolone scan. Blood cultures revealed the development of Eggerthella lenta, Escherichia coli Extended-spectrum beta-lactamase (ESBL), and Enterococcus Faecalis. To our knowledge, this is a rare case of an infected endograft and bacteremia due to Eggerthella lenta. After the administration of vancomycin and Meropenem, no improvements were noted to the patient’s clinical condition. However, upon the administration of Tigecycline, the patient’s clinical condition improved. Two days later, repeat blood cultures were negative. After completion of the course of antibiotics and stabilization of other comorbidities, the patient was discharged home with long term antibiotic therapy under close control of inflammation markers.
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Affiliation(s)
- Harith A Alataby
- Department of Medicine, Richmond University Medical Center, Staten Island, NY, USA
| | - Lloyd G Muzangwa
- Department of Medicine, Richmond University Medical Center, Staten Island, NY, USA
| | - Muhamed K Atere
- Department of Medicine, Richmond University Medical Center, Staten Island, NY, USA
| | - Joseph Bibawy
- Department of Radiology, Richmond University Medical Center, Staten Island, NY, USA
| | - Keith T Diaz
- Department of Medicine, Richmond University Medical Center, Staten Island, NY, USA.,Department of Radiology, Richmond University Medical Center, Staten Island, NY, USA.,Department of Critical Care, Richmond University Medical Center, Staten Island, NY, USA
| | - Jay M Nfonoyim
- Department of Medicine, Richmond University Medical Center, Staten Island, NY, USA.,Department of Radiology, Richmond University Medical Center, Staten Island, NY, USA.,Department of Critical Care, Richmond University Medical Center, Staten Island, NY, USA
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3
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Xu L, Lin S, Yang Y. Perigraft abscess after DeBakey type-1 aortic dissection: a case report. J Cardiothorac Surg 2020; 15:94. [PMID: 32404182 PMCID: PMC7222299 DOI: 10.1186/s13019-020-01128-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 04/28/2020] [Indexed: 11/30/2022] Open
Abstract
Background Perigraft abscess is a rare condition which constitutes a small proportion of aortic graft infection (AGI). Early diagnosis is very important for timely intervention and improving the survival rate of patients because of its significant morbidity and mortality. Case presentation A 24-year-old young male patient with a history of complicated total arch replacement using elephant trunk technique for acute DeBakey type-1 aortic dissection 6 months before visited our hospital with the chief complaint of persistent fever. Antibiotic treatment in local hospital was ineffective. Echocardiography showed liquid dark area around the aortic graft, and a computerized tomography angiography (CTA) was done for further evaluation of periaortic fluid collection which showed findings to suggest perigraft abscess. The patient underwent surgical debridement of the abscess and was found to have an abscess around the aortic graft which was drained followed by antibiotic treatment. The patient was discharged to his local hospital and recovered well at 2 month follow-up appointment. Conclusion This is a very rare case of aortic abscess around the graft that could successfully be managed by graft-conserving surgery, and it emphasizes the significance of early diagnosis of perigraft abscess in patients with aortic dissection surgery.
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Affiliation(s)
- Lingling Xu
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, 1277 Jiefang Ave, Wuhan, 430022, China
| | - Shan Lin
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, 1277 Jiefang Ave, Wuhan, 430022, China
| | - Yali Yang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China. .,Hubei Province Key Laboratory of Molecular Imaging, 1277 Jiefang Ave, Wuhan, 430022, China.
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4
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Biocompatible Polymer Materials with Antimicrobial Properties for Preparation of Stents. NANOMATERIALS 2019; 9:nano9111548. [PMID: 31683612 PMCID: PMC6915381 DOI: 10.3390/nano9111548] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 10/15/2019] [Accepted: 10/29/2019] [Indexed: 12/17/2022]
Abstract
Biodegradable polymers are promising materials for use in medical applications such as stents. Their properties are comparable to commercially available resistant metal and polymeric stents, which have several major problems, such as stent migration and stent clogging due to microbial biofilm. Consequently, conventional stents have to be removed operatively from the patient's body, which presents a number of complications and can also endanger the patient's life. Biodegradable stents disintegrate into basic substances that decompose in the human body, and no surgery is required. This review focuses on the specific use of stents in the human body, the problems of microbial biofilm, and possibilities of preventing microbial growth by modifying polymers with antimicrobial agents.
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5
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Nomura Y, Nagao K, Hasegawa S, Kawashima M, Tsujimoto T, Izumi S, Matsumori M, Tanaka H, Murakami H, Honda T, Kawasaki R, Mukohara N. Outcomes of Late Open Conversion after Endovascular Abdominal Aneurysm Repair. Ann Vasc Dis 2019; 12:340-346. [PMID: 31636744 PMCID: PMC6766758 DOI: 10.3400/avd.oa.19-00009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective: To review our experience with a late open conversion as a final option for an endograft infection and aneurysm expansion after endovascular aneurysm repair (EVAR), especially in endoleaks for which radiological intervention is impossible. Materials and Methods: In this retrospective study, 13 late open conversions out of 513 consecutive patients treated by EVAR were analyzed. Indications for an open conversion were aneurysm enlargement, including all endoleaks, endograft migration, and endograft infection. The patients' data on demographics, operative details, and outcomes were reviewed. Results: Indications for a late open conversion included endoleaks, infection, and migration in 61.5%, 30.8%, and 7.7% of patients, respectively. The median interval from the initial EVAR was 32.4 months. Complete endograft explantation was performed in four patients with an endograft infection. In endoleak cases, the endograft was partially preserved and a neo-neck was used. Sacotomy and branch ligation were performed in one case. One major operative complication was an aortic injury during infrarenal aortic cross-clamping in an endograft migration case. There was no operative mortality. Conclusion: A late open conversion after EVAR is valuable as a final option. The aortic cross-clamp site, especially in endograft migration cases, should be carefully considered. To avoid aneurysm-related events, graft replacement is recommended, if possible.
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Affiliation(s)
- Yoshikatsu Nomura
- Department of Cardiovascular Surgery, Hyogo Brain and Heart Center at Himeji, Himeji, Hyogo, Japan
| | - Kanetsugu Nagao
- Department of Cardiovascular Surgery, Hyogo Brain and Heart Center at Himeji, Himeji, Hyogo, Japan
| | - Shota Hasegawa
- Department of Cardiovascular Surgery, Hyogo Brain and Heart Center at Himeji, Himeji, Hyogo, Japan
| | - Motoharu Kawashima
- Department of Cardiovascular Surgery, Hyogo Brain and Heart Center at Himeji, Himeji, Hyogo, Japan
| | - Takanori Tsujimoto
- Department of Cardiovascular Surgery, Hyogo Brain and Heart Center at Himeji, Himeji, Hyogo, Japan
| | - So Izumi
- Department of Cardiovascular Surgery, Hyogo Brain and Heart Center at Himeji, Himeji, Hyogo, Japan
| | - Masamichi Matsumori
- Department of Cardiovascular Surgery, Hyogo Brain and Heart Center at Himeji, Himeji, Hyogo, Japan
| | - Hiroshi Tanaka
- Department of Cardiovascular Surgery, Hyogo Brain and Heart Center at Himeji, Himeji, Hyogo, Japan
| | - Hirohisa Murakami
- Department of Cardiovascular Surgery, Hyogo Brain and Heart Center at Himeji, Himeji, Hyogo, Japan
| | - Tasuku Honda
- Department of Cardiovascular Surgery, Hyogo Brain and Heart Center at Himeji, Himeji, Hyogo, Japan
| | - Ryota Kawasaki
- Department of Radiology, Hyogo Brain and Heart Center at Himeji, Himeji, Hyogo, Japan
| | - Nobuhiko Mukohara
- Department of Cardiovascular Surgery, Hyogo Brain and Heart Center at Himeji, Himeji, Hyogo, Japan
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Periaortic Abscess following DeBakey Type-1 Aortic Dissection Repair with Dacron Graft-Early Diagnosis and Management. Case Rep Cardiol 2019; 2019:6915356. [PMID: 31205789 PMCID: PMC6530244 DOI: 10.1155/2019/6915356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 05/02/2019] [Indexed: 11/17/2022] Open
Abstract
A 71-year-old male with history of DeBakey type-1 aortic dissection and repair with dacron graft three months prior to presentation was brought to the emergency room with complaints of high-grade fevers, chills, and shortness of breath. Chest X-ray revealed right lower lobe infiltrates and widened superior mediastinum. A follow-up CT chest with contrast showed fluid collection around the aortic graft. He was started on intravenous broad-spectrum antibiotics, and a TEE was done for further evaluation of periaortic fluid collection which showed findings to suggest periaortic abscess. The patient underwent surgical drainage of the abscess and was found to have an abscess around the surgical aortic graft which was drained followed by two weeks of antibiotic treatment. The patient was discharged to a rehabilitation facility and remained asymptomatic at three-month follow-up appointment. Type-1 aortic dissection is a medical emergency requiring acute surgical intervention, and despite significant advancements in diagnosis and management, the immediate and long-term complications remain high leading to increased risk of mortality. Our patient developed spontaneous periaortic abscess three months postoperatively requiring intensive antibiotic therapy along with surgical drainage. Our case emphasizes the importance of early diagnosis and management of late complications of periaortic abscess in patients with aortic dissection repair.
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Yamamoto T, Oka K, Kanda K, Sakai O, Watanabe T, Yaku H. In Situ Graft Replacement for a Ruptured Abdominal Aortic Aneurysm Infected with Listeria monocytogenes after Endovascular Aneurysm Repair. Ann Vasc Dis 2018; 11:346-349. [PMID: 30402187 PMCID: PMC6200609 DOI: 10.3400/avd.cr.18-00040] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Listeria monocytogenes infection and rupture of the aneurysm sac, after endovascular aneurysm repair (EVAR), are both rare. We report the case of an 82-year-old man who presented with a ruptured aneurysm by infection with L. monocytogenes after EVAR. We successfully treated him by in situ reconstruction with a bifurcated expanded polytetrafluoroethylene (ePTFE) graft, with partial removal of the infected stent graft. At 30 months from the reoperation, the patient was in good health at home, with no symptoms of infection, and the gallium-67-citrate single-photon emission computed tomography/computed tomography (SPECT/CT) fusion images confirmed no fluid accumulation.
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Affiliation(s)
- Tsunehisa Yamamoto
- Department of Cardiovascular Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Katsuhiko Oka
- Department of Cardiovascular Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Keiichi Kanda
- Department of Cardiovascular Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Osamu Sakai
- Department of Cardiovascular Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Taiji Watanabe
- Department of Cardiovascular Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hitoshi Yaku
- Department of Cardiovascular Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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8
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Mandegaran R, Tang CSW, Pereira EAC, Zavareh A. Spondylodiscitis following endovascular abdominal aortic aneurysm repair: imaging perspectives from a single centre's experience. Skeletal Radiol 2018; 47:1357-1369. [PMID: 29656303 PMCID: PMC6105147 DOI: 10.1007/s00256-018-2939-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 03/19/2018] [Accepted: 03/22/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Very few reports have previously described spondylodiscitis as a potential complication of endovascular aortic aneurysm repair (EVAR). We present to our knowledge the first case series of spondylodiscitis following EVAR based on our institution's experience over an 11-year period. Particular attention is paid to the key imaging features and challenges encountered when performing spinal imaging in this complex patient group. MATERIALS AND METHODS Of 1,847 patients who underwent EVAR at our institution between January 2006 and January 2017, a total of 9 patients were identified with imaging features of spondylodiscitis (0.5%). All cross-sectional studies before and after EVAR were assessed by a Consultant Musculoskeletal Radiologist and a Musculoskeletal Radiology Fellow to evaluate for features of spondylodiscitis. RESULTS All 9 patients had single-level spondylodiscitis involving lumbosacral levels adjacent to the aortic/iliac stent graft. Eight out of nine patients had an extensive anterior paravertebral phlegmon/abscess that was contiguous with the infected stent graft and native aneurysm sac ± anterior vertebral body erosion. Epidural disease was present in only 3 out of 9 patients and was a minor feature. MRI was non-diagnostic in 3 out of 9 patients owing to susceptibility artefact. 18F-FDG PET/CT accurately depicted the spinal level involved and adjacent paravertebral disease in patients with non-diagnostic MRI and was adopted as the follow-up modality in 3 out of 5 surviving patients. CONCLUSION Spondylodiscitis is a rare complication post-EVAR. Imaging features of disproportionate anterior paravertebral disease and anterior vertebral body bony involvement suggest direct spread of infection posteriorly to the adjacent vertebral column. Use of MRI versus 18F-FDG PET/CT as the optimal imaging modality should be directed by the type of stent graft deployed.
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Affiliation(s)
- Ramin Mandegaran
- Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, 2nd Floor Tower Wing, Great Maze Pond, London, SE1 9RT, UK.
| | - Christopher S W Tang
- Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, 2nd Floor Tower Wing, Great Maze Pond, London, SE1 9RT, UK
| | - Erlick A C Pereira
- Academic Neurosurgery Unit St George's, University of London, London, SW17 0QT, UK
| | - Ali Zavareh
- Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, 2nd Floor Tower Wing, Great Maze Pond, London, SE1 9RT, UK
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9
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The Importance of Antibacterial Surfaces in Biomedical Applications. ADVANCES IN BIOMEMBRANES AND LIPID SELF-ASSEMBLY 2018. [DOI: 10.1016/bs.abl.2018.05.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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10
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Argyriou C, Georgiadis GS, Lazarides MK, Georgakarakos E, Antoniou GA. Endograft Infection After Endovascular Abdominal Aortic Aneurysm Repair: A Systematic Review and Meta-analysis. J Endovasc Ther 2017; 24:688-697. [DOI: 10.1177/1526602817722018] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Purpose: To report a meta-analysis of the published evidence on the outcomes of aortic endograft infection after endovascular aneurysm repair (EVAR). Methods: A search of electronic information sources (PubMed/MEDLINE, SCOPUS, CENTRAL) and bibliographic reference lists identified 12 studies reporting on 362 patients (mean age 72 years; 279 men). The methodological quality of the selected studies was assessed using the Newcastle-Ottawa scale. Endpoints were 30-day/in-hospital mortality and follow-up mortality. Pooled estimates are reported with the 95% confidence interval (CI). The review was registered at the International Prospective Register of Systematic Reviews in Health and Social Care (CRD42016034166). Results: The incidence of graft infection after EVAR was 0.6% (95% CI 0.4% to 0.8%). The time from implantation to diagnosis ranged from 1 to 128 months (mean 25). The majority of patients (293, 81%) underwent surgical treatment (95% CI 77% to 83%); 9 (2.5%) patients (95% CI 21% to 43%) received conservative treatment. Aortic replacement with a prosthetic graft was performed in 58% (95% CI 52% to 62%), whereas cryopreserved allografts and autologous grafts were used in 31% (95% CI 28% to 33%) and 11% (95% CI% 8 to 14%), respectively. Less than half of the patients (40%) had emergency surgery. The pooled estimate of 30-day/in-hospital mortality was 26.6% (95% CI 16.9% to 39.2%). The pooled 30-day/in-hospital mortality for 9 patients treated conservatively was 63.3% (95% CI 30.7% to 87.0%). The pooled overall follow-up mortality was 45.7% (95% CI 36.4% to 55.4%) vs 58.6% (95% CI 28.8% to 83.3%) for the 9 patients receiving conservative treatment. Conclusion: Aortic endograft infection is a rare complication after EVAR. Surgical treatment with complete explantation of the infected endograft seems to be the optimal management in selected patients. Supportive medical treatment without surgical intervention has a significant associated mortality.
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Affiliation(s)
- Christos Argyriou
- Department of Vascular and Endovascular Surgery, University General Hospital of Alexandroupolis, “Democritus” University of Thrace, Alexandroupolis, Greece
| | - George S. Georgiadis
- Department of Vascular and Endovascular Surgery, University General Hospital of Alexandroupolis, “Democritus” University of Thrace, Alexandroupolis, Greece
| | - Miltos K. Lazarides
- Department of Vascular and Endovascular Surgery, University General Hospital of Alexandroupolis, “Democritus” University of Thrace, Alexandroupolis, Greece
| | - Efstratios Georgakarakos
- Department of Vascular and Endovascular Surgery, University General Hospital of Alexandroupolis, “Democritus” University of Thrace, Alexandroupolis, Greece
| | - George A. Antoniou
- Department of Vascular and Endovascular Surgery, The Royal Oldham Hospital, Pennine Acute Hospitals NHS Trust, Manchester, UK
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11
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Kondo N, Tamura K, Sakaguchi T, Chikazawa G, Yoshitaka H. Replacement of the Thoracoabdominal Aorta after Endovascular Abdominal Aneurysm Repair for Ruptured Infected Aneurysm: A Case Report. Ann Vasc Dis 2017; 10:63-65. [PMID: 29034025 PMCID: PMC5579787 DOI: 10.3400/avd.cr.16-00062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 12/25/2016] [Indexed: 11/13/2022] Open
Abstract
A 73-year-old man underwent emergency endovascular abdominal aneurysm repair (EVAR) for a ruptured infected abdominal aortic aneurysm. Two years after EVAR, he was admitted with a spiking fever and left lower back pain. Computed tomography scan revealed not only recurrent graft infection with psoas abscess but also infection around the orifice of the superior mesenteric artery. Because conservative medical therapy with antibiotics could not control the infection, we performed complete removal of the infected stent graft, debridement of psoas abscess, and in situ replacement of the thoracoabdominal aorta using rifampicin-soaked prosthetic grafts, followed by the omental flap. He was discharged with no complications.
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Affiliation(s)
- Nobuo Kondo
- Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Okayama, Japan
| | - Kentaro Tamura
- Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Okayama, Japan
| | - Taichi Sakaguchi
- Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Okayama, Japan
| | - Genta Chikazawa
- Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Okayama, Japan
| | - Hidenori Yoshitaka
- Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Okayama, Japan
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12
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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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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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Montelione N, Menna D, Sirignano P, Capoccia L, Mansour W, Speziale F. Open Conversion after Aortic Endograft Infection Caused by Colistin-Resistant, Carbapenemase-Producing Klebsiella pneumoniae. Tex Heart Inst J 2016; 43:453-457. [PMID: 27777535 DOI: 10.14503/thij-15-5265] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
A 62-year-old man presented with fever, abdominal pain, and malaise 13 months after emergency endovascular aortic repair. Computed tomographic angiograms showed a periprosthetic fluid and gas collection, so infection was diagnosed. Open conversion was performed, involving endograft explantation and in situ aortic reconstruction. Cultures and the explanted prosthesis were positive for carbapenemase-producing Klebsiella pneumoniae, resistant to colistin. Because of the sparse data on endograft infections caused by this pathogen, we placed the patient on an empiric double-carbapenem regimen for 4 weeks. Symptomatic recovery occurred after 21 days. On the 30th day, we deployed a stent to treat a new pseudoaneurysm. Three years later, the patient had no signs of persistent or recurrent infection. We think that this is the first report of aortic endograft infection caused by colistin-resistant, carbapenemase-producing K. pneumoniae.
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15
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Jayakrishnan TT, Keyashian B, Amene J, Malinowski M. Aortic Endograft Infection by Pasteurella multocida: A Rare Case. Vasc Endovascular Surg 2016; 50:435-7. [PMID: 27581225 DOI: 10.1177/1538574416665987] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Infection of an aortic endograft is a rare complication following endovascular aneurysm repair. These patients have been treated with explantation of the graft to obtain source control followed by an extra-anatomic bypass to restore circulation. The present case study describes an interesting case of Pasteurella infection involving an aortic endograft managed nonoperatively by percutaneous drainage and graft preservation.
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Affiliation(s)
- Thejus T Jayakrishnan
- Division of Vascular Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Brian Keyashian
- Division of Vascular Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Juliet Amene
- Division of Vascular Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Michael Malinowski
- Division of Vascular Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
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Lahoz C, Gracia CE, García LR, Montoya SB, Hernando ÁB, Heredero ÁF, Tembra MS, Velasco MB, Guijarro C, Ruiz EB, Pintó X, de Ceniga MV, Moñux Ducajú G. [Not Available]. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ARTERIOSCLEROSIS 2016; 28 Suppl 1:1-49. [PMID: 27107212 DOI: 10.1016/s0214-9168(16)30026-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Carlos Lahoz
- Unidad de Lípidos y Riesgo Vascular, Servicio de Medicina Interna, Hospital Carlos III, Madrid, España.
| | - Carlos Esteban Gracia
- Servicio de Angiología y Cirugía Vascular, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España
| | | | - Sergi Bellmunt Montoya
- Servicio de Angiología y Cirugía Vascular, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - Ángel Brea Hernando
- Unidad de Lípidos, Servicio de Medicina Interna, Hospital San Pedro, Logroño, España
| | | | - Manuel Suárez Tembra
- Unidad de Lípidos y Riesgo Cardiovascular, Servicio de Medicina Interna, Hospital San Rafael, A Coruña, España
| | - Marta Botas Velasco
- Servicio de Angiología y Cirugía Vascular, Hospital de Cabueñes, Gijón, España
| | - Carlos Guijarro
- Consulta de Riesgo Vascular, Unidad de Medicina Interna, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | - Esther Bravo Ruiz
- Servicio de Angiología y Cirugía Vascular, Hospital Universitario de Basurto, Bilbao, España
| | - Xavier Pintó
- Unidad de Riesgo Vascular, Servicio de Medicina Interna, Hospital Universitario de Bellvitge, L' Hospitalet de Llobregat, Barcelona, España
| | - Melina Vega de Ceniga
- Servicio de Angiología y Cirugía Vascular, Hospital de Galdakao-Usansolo, Vizcaya, España
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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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Abstract
A 78-year-old male presented with early gastric cancer and a 5.5 cm-sized infrarenal abdominal aortic aneurysm, detected during regular screening. Endovascular aneurysm repair (EVAR) was performed first, followed by laparoscopic distal gastrectomy. After gastrectomy, the patient underwent computed tomography (CT) scan due to persistent fever, which showed increased perigraft fluid collection around the right iliac limb graft. Echocardiography also revealed mitral valve vegetation, consistent with infective endocarditis. Despite intensive antibiotic treatment, the patient had persistent fever and showed fluid extension to the psoas muscle on CT scan. On the 49th post operative day (POD) after EVAR, stent graft explantation and aortic reconstruction with the left superficial femoral vein was performed. Ligation of the right iliac artery for infection control and simultaneous femoro-femoral bypass was also performed. The patient was discharged on the 46th POD after graft removal without any events
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Affiliation(s)
- Hong Kyung Shin
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jae Young Park
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Taeseung Lee
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
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Jeng EI, Ortiz D, Khan A, Benedetti E, Borhani M, Oberholzer J. Inferior Vena Cava Stent-Graft Sepsis. Ann Vasc Surg 2015; 29:1451.e17-20. [PMID: 26122419 DOI: 10.1016/j.avsg.2015.04.067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 03/30/2015] [Accepted: 04/06/2015] [Indexed: 11/27/2022]
Abstract
We present the case of a patient with a complicated medical history, which included stent grafting as a life-saving measure for an iatrogenic inferior vena cava (IVC) injury. For persistent sepsis secondary to stent-graft infection, the patient underwent extraction of 2 IVC stent grafts, primary repair of a duodenal-caval fistula, and repair of the IVC with an allograft vein patch. Discussion of this case sought to shed light on the intricacies involved in medical decision making in an era of advanced medical technology.
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Affiliation(s)
- Eric I Jeng
- Department of Surgery, University of Illinois at Chicago, Chicago, IL.
| | - Damaris Ortiz
- Department of Surgery, University of Illinois at Chicago, Chicago, IL
| | - Arshad Khan
- Department of Surgery, University of Illinois at Chicago, Chicago, IL
| | - Enrico Benedetti
- Department of Surgery, University of Illinois at Chicago, Chicago, IL
| | - Martin Borhani
- Department of Surgery, University of Illinois at Chicago, Chicago, IL
| | - Jose Oberholzer
- Department of Surgery, University of Illinois at Chicago, Chicago, IL
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21
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Juntermanns B, Bernheim J, Cyrek A, Burzec W, Reinhardt R, Kühl H, Paul A, Hoffmann JN. Successful Management of an Infected Aortic Stent Graft in a Liver Transplanted Patient. Ann Vasc Surg 2015; 29:1449.e1-4. [PMID: 26117206 DOI: 10.1016/j.avsg.2015.03.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Revised: 03/15/2015] [Accepted: 03/17/2015] [Indexed: 11/20/2022]
Abstract
We report on a 57-year-old female liver transplanted patient who underwent endovascular aneurysm repair because of an infrarenal abdominal aortic aneurysm. Two months later, she developed an infection, and positron emission tomography computed tomography detected a paraprosthetic abscess. Explantation of the endoprosthesis and aortic reconstruction with a Y-shaped silver graft was made. The patient was discharged on the 12th postoperative day and shows up regularly in our outpatients department in a good clinical condition. After meticulous research of the current literature, this is the first published case of the successful management of an infected endovascular aortic stent in a liver transplanted patient.
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Affiliation(s)
- Benjamin Juntermanns
- Division of Vascular Surgery, Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany
| | - Johannes Bernheim
- Division of Vascular Surgery, Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany
| | - Anna Cyrek
- Division of Vascular Surgery, Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany
| | - Wieslaw Burzec
- Division of Vascular Surgery, Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany
| | - Renate Reinhardt
- Division of Vascular Surgery, Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany
| | - Hilmar Kühl
- Department of Diagnostic and Interventional Radiology, University Hospital Essen, Essen, Germany
| | - Andreas Paul
- Division of Vascular Surgery, Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany
| | - Johannes N Hoffmann
- Division of Vascular Surgery, Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany.
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Maeda K, Kanaoka Y, Ohki T, Sumi M, Toya N, Fujita T. Better Clinical Practice Could Overcome Patient-Related Risk Factors of Vascular Surgical Site Infections. J Endovasc Ther 2015; 22:640-6. [DOI: 10.1177/1526602815591553] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Purpose: To clarify the current status of surgical site infection (SSI) during endovascular aortic repair and to define risk factors for SSI among the patients who underwent thoracic or abdominal stent-graft repair through a groin incision. Methods: Between 2006 and 2013, data were collected from 1604 patients (mean age 75.2±9.5 years; 1282 men) with 2799 groin incisions for transfemoral access during aortic stent-graft procedures. SSIs were classified as superficial or deep (both occurring within 30 days) or organ/space infections (occurring within 1 year after surgery) according to the Centers for Disease Control and Prevention guidelines. Strategies in place for minimizing SSIs were (1) employing oblique groin incisions, (2) covering the incision with saline-soaked gauze, (3) irrigating the incision thoroughly with saline per layer, and (4) using absorbable sutures. Results: Overall incidence of SSI was 0.4% (6 patients). The majority of SSIs were late-onset prosthetic graft infections (5, 0.3%). Five of the 6 were successfully treated with conservative therapy; one patient died of sepsis. Univariate analysis showed additional therapy (eg, coil embolization) with a stent-graft procedure was a risk factor for SSI. Conclusion: Appropriate antibiotic administration, oblique groin incision, meticulous operative technique, protection against airborne infection during the operation, and closed dressings may avert vascular wound SSIs.
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Affiliation(s)
- Koji Maeda
- Division of Vascular Surgery, Department of Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Yuji Kanaoka
- Division of Vascular Surgery, Department of Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Takao Ohki
- Division of Vascular Surgery, Department of Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Makoto Sumi
- Division of Vascular Surgery, Department of Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Naoki Toya
- Division of Vascular Surgery, Department of Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Tetsuji Fujita
- Division of Vascular Surgery, Department of Surgery, Jikei University School of Medicine, Tokyo, Japan
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Menna D, Capoccia L, Sirignano P, Esposito A, Rossi M, Speziale F. Infective Etiology Affects Outcomes of Late Open Conversion After Failed Endovascular Aneurysm Repair. J Endovasc Ther 2015; 22:110-5. [DOI: 10.1177/1526602814562777] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To retrospectively review all patients undergoing late open conversion (LOC) after endovascular aneurysm repair (EVAR) in order to identify any clinical or technical predictors of poor outcome. Methods: Twenty-six consecutive patients (24 men; mean age 74.7±8.3 years) underwent LOC between June 2006 and April 2013 at our institution. The mean interval from index EVAR to LOC was 40.4±29.2 months (range 5–93 months). The indication for LOC was endoleak in 14 (54%) patients and infection in 12 (46%): 2 (8%) patients with endoleak had a ruptured aneurysm and 6 (23%) patients with infection had a recurrent secondary aortoesophageal fistula (sAEF). Results: In all 12 cases of infection and in 12 of 14 endoleaks, the entire endograft was explanted. A rifampin-soaked Dacron silver graft was implanted in all patients with infection. Patients with any infection and with recurrent AEF required more blood units than patients with endoleak (6.40 vs. 1.86, p=0.045; 6.76 vs. 1.86, p=0.0036, respectively). Compared with endoleak, the duration of conversions in the setting of infection (274 vs. 316 minutes, p=0.42) and recurrent sAEF (274 vs. 396 minutes, p=0.021) was longer. All patients with recurrent sAEF died at a mean 3.0±2.5 days after LOC from proximal anastomosis disruption and hemorrhagic shock (n=2), myocardial infarction (n=2), acute stroke (n=1), or persistent sepsis (n=1). Perioperative mortality was significantly higher in patients with endograft infection (6/12, p=0.002) and in cases of supraceliac cross-clamping (4/6, p=0.003). The association of infection with supraceliac cross-clamping was a strong predictor for perioperative mortality (p<0.001). Conclusion: In our experience, endograft infection led to greater perioperative mortality after LOC. Recurrent aortoenteric fistula in association with supraceliac cross-clamping is a strong predictor of poor outcome. Patients surviving the perioperative period may have good chances of long-term survival.
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Setacci C, Chisci E, Setacci F, Ercolini L, de Donato G, Troisi N, Galzerano G, Michelagnoli S. How To Diagnose and Manage Infected Endografts after Endovascular Aneurysm Repair. AORTA : OFFICIAL JOURNAL OF THE AORTIC INSTITUTE AT YALE-NEW HAVEN HOSPITAL 2014; 2:255-64. [PMID: 26798744 DOI: 10.12945/j.aorta.2014.14-036] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 10/03/2014] [Indexed: 12/14/2022]
Abstract
The prevalence of endograft infections (EI) after endovascular abdominal aortic aneurysm repair is below 1%. With the growing number of patients with aortic endografts and the aging population, the number of patients with EI might also increase. The diagnosis is based on an association of clinical symptoms, imaging, and microbial cultures. Angio-computed tomography is currently the gold-standard technique for diagnosis. Low-grade infection sometimes requires nuclear medicine imaging to make a correct diagnosis. There is no good evidence to guide management so far. In the case of active gastrointestinal bleeding, pseudoaneurysm, or extensive perigraft purulence involving adjacent organs, an invasive treatment should always be attempted. In the other cases (the majority), when there is not an immediate danger to the patient's life, a conservative management is started with a proper antimicrobial therapy. Any infectious cavity can be percutaneously drained. Management depends on the patient's condition and a tailored approach should always be offered. In the case of a patient who is young, has a good life expectancy, or in whom there is absence of significant comorbidities, a surgical attempt can be proposed. Surgical techniques favor, in terms of mortality, patency, and reinfection rate, the in situ reconstruction. Choice of technique relies on the center and the operator's experience. Long-term antibiotic therapy is always required in all cases, with close monitoring of the C-reactive protein.
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Affiliation(s)
- Carlo Setacci
- Vascular and Endovascular Surgery Unit, University of Siena, Siena, Italy
| | - Emiliano Chisci
- Department of Surgery, Vascular and Endovascular Surgery Unit, "San Giovanni di Dio" Hospital, Florence, Italy; and
| | - Francesco Setacci
- P. Valdoni Department of Surgery, La Sapienza University, Rome, Italy
| | - Leonardo Ercolini
- Department of Surgery, Vascular and Endovascular Surgery Unit, "San Giovanni di Dio" Hospital, Florence, Italy; and
| | | | - Nicola Troisi
- Department of Surgery, Vascular and Endovascular Surgery Unit, "San Giovanni di Dio" Hospital, Florence, Italy; and
| | - Giuseppe Galzerano
- Vascular and Endovascular Surgery Unit, University of Siena, Siena, Italy
| | - Stefano Michelagnoli
- Department of Surgery, Vascular and Endovascular Surgery Unit, "San Giovanni di Dio" Hospital, Florence, Italy; and
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25
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Moulakakis KG, Sfyroeras GS, Kakisis JD, Papapetrou A, Antonopoulos CN, Mantas G, Brountzos EN, Liapis CD. Endograft Infection and Treatment with Preservation of the Endograft: Early Results in 3 Cases. Ann Vasc Surg 2014; 28:1789.e1-7. [DOI: 10.1016/j.avsg.2014.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2013] [Revised: 01/29/2014] [Accepted: 02/03/2014] [Indexed: 10/25/2022]
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Ferrero E, Ferri M, Viazzo A, Trevisan A, Psacharopulo D, Ripepi M, Gibello L, Nessi F. Fungal infection of aortic Endograft because of Aspergillus fumigatus. Ann Vasc Surg 2014; 28:1795.e11-4. [PMID: 24858585 DOI: 10.1016/j.avsg.2014.04.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Revised: 04/01/2014] [Accepted: 04/01/2014] [Indexed: 10/25/2022]
Abstract
A 59-year-old male, referred to our center with a ruptured aortic aneurysm, underwent urgent endovascular repair and femoro-femoral crossover bypass. An endograft infection because of Aspergillus fumigatus occurred about 20 days after surgery. We removed the endograft and femoral prosthesis and we then performed an aorto-bi-iliac bypass with autogenous reversed superficial femoral veins. Five days after surgery, the patient died. Microbiological examination and postmortem examination showed the presence of A. fumigatus in femoral prosthesis, aortic wall, and periaortic exudate.
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Affiliation(s)
- Emanuele Ferrero
- Vascular and Endovascular Surgery Unit, Mauriziano Umberto I Hospital, Turin, Italy.
| | - Michelangelo Ferri
- Vascular and Endovascular Surgery Unit, Mauriziano Umberto I Hospital, Turin, Italy
| | - Andrea Viazzo
- Vascular and Endovascular Surgery Unit, Mauriziano Umberto I Hospital, Turin, Italy
| | - Alessandra Trevisan
- Vascular and Endovascular Surgery Unit, Mauriziano Umberto I Hospital, Turin, Italy
| | - Daniele Psacharopulo
- Vascular and Endovascular Surgery Unit, Mauriziano Umberto I Hospital, Turin, Italy
| | - Matteo Ripepi
- Vascular and Endovascular Surgery Unit, Mauriziano Umberto I Hospital, Turin, Italy
| | - Lorenzo Gibello
- Vascular and Endovascular Surgery Unit, Mauriziano Umberto I Hospital, Turin, Italy
| | - Franco Nessi
- Vascular and Endovascular Surgery Unit, Mauriziano Umberto I Hospital, Turin, Italy
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Purulent cutaneous fistula: as the first symptom of the late aortic stent-graft infection-a case report and review of the literature. Case Rep Surg 2013; 2013:421780. [PMID: 23984163 PMCID: PMC3745921 DOI: 10.1155/2013/421780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Accepted: 06/30/2013] [Indexed: 11/18/2022] Open
Abstract
Purpose. Aortic stent-graft infection with fistula formation is a rare complication with high mortality rate when treated surgically by stent-graft removal. We report a case of a patient with aortic stent-graft infection, prosthetic-duodenal, and prosthetic-cutaneous fistulas operated without the removal of an infected prosthesis and ineffectively tailored antibiotic therapy. Case Report. A 66-year-old patient with high cardiovascular risk and endovascular stent-graft implantation developed a symptomatic infection of the aortic stent graft 42 months after procedure. It was manifested by iliolumbar muscle abscess and two fistulas: prosthetic cutaneous and prosthetic duodenal. The prosthetic-duodenal fistula was excised and separated from the prosthesis. The perforation within the duodenum was closed in layers. Iliolumbar abscess was removed and drainage was effected .The stent graft was left. The patient received tailored antibiotic therapy. He was readmitted to hospital after 4 weeks with symptoms of infection and leakage of pus discharge in the lumbar area. Despite the antibiotic therapy, the total parenteral nutrition of the patient's clinical status and malnutrition deteriorated and he died of cardiac arrest. Conclusion. The presented case confirms that leaving off of the infected stent graft in the patient with severe comorbidity and treated with a tailored antibiotic therapy may not be effective.
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28
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de Campos FPF, Silva ES, Luccia ND, Ribeiro VH, Martines BMR, Martines JADS. Late infra-renal aortic graft infection: a fearsome complication. AUTOPSY AND CASE REPORTS 2013; 3:45-51. [PMID: 31528597 PMCID: PMC6671876 DOI: 10.4322/acr.2013.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 03/05/2013] [Indexed: 11/23/2022] Open
Abstract
Since the 1950s, aortic graft infections (AGIs) constitute one of the most feared complications after reconstructive vascular surgery. This complication is not frequent, ranging from 1% to 2% in the recently reported series; however, the high rate of death and morbidity after therapeutic attempts justifies its dreadful fame. The majority of cases occur during the first month after surgery. Staphylococcus aureus is the cause of 70% of the early infection cases. Late infections, on the other hand, are even rarer, showing a strong relationship with low virulence microorganisms, where Staphylococcus epidermidis is the main cause. Gram-negative bacteria are also observed in late infections, mainly when an aortic or graft enteric fistula is present. Treatment modalities are plenty, but still debatable. The authors report a case of a woman who was operated on 6 years ago for a reconstructive aortic aneurysm with the implantation of an infrarenal Dacron graft in the aorto bifemoral position. She looked for medical assistance with a 2-month history of weight loss, abdominal/back pain, and fever. Her clinical status rapidly deteriorated. A computed tomography of the abdomen disclosed the diagnosis of an AGI. The patient was promptly treated with antibiotics. Surgery was undertaken to explant the infected graft and another graft was placed into the axillobifemoral position. Culture from the infections site was negative. After surgery the patient quickly developed refractory septic shock and died immediately post-operatively.
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Affiliation(s)
| | - Erasmo Simão Silva
- Department of Vascular Surgery - Hospital das Clínicas - Faculdade de Medicina - Universidade de São Paulo, São Paulo/SP - Brazil
| | - Nelson De Luccia
- Department of Vascular Surgery - Hospital das Clínicas - Faculdade de Medicina - Universidade de São Paulo, São Paulo/SP - Brazil
| | - Vivian Helena Ribeiro
- Department of Vascular Surgery - Hospital das Clínicas - Faculdade de Medicina - Universidade de São Paulo, São Paulo/SP - Brazil
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29
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Sedivy P, Spacek M, El Samman K, Belohlavek O, Mach T, Jindrak V, Rohn V, Stadler P. Endovascular Treatment of Infected Aortic Aneurysms. Eur J Vasc Endovasc Surg 2012; 44:385-94. [DOI: 10.1016/j.ejvs.2012.07.011] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Accepted: 07/02/2012] [Indexed: 10/28/2022]
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30
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Moon E, Tam MDBS, Kikano RN, Karuppasamy K. Prophylactic antibiotic guidelines in modern interventional radiology practice. Semin Intervent Radiol 2012; 27:327-37. [PMID: 22550374 DOI: 10.1055/s-0030-1267853] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Modern interventional radiology practice is continuously evolving. Developments include increases in the number of central venous catheter placements and tumor treatments (uterine fibroid therapy, radio- and chemoembolization of liver tumor, percutaneous radiofrequency and cryoablation), and new procedures such as abdominal aortic aneurysm stent-graft repair, vertebroplasty, kyphoplasty, and varicose vein therapies. There have also been recent advancements in standard biliary and urinary drainage procedures, percutaneous gastrointestinal feeding tube placement, and transjugular intrahepatic portosystemic shunts. Prophylactic antibiotics have become the standard of care in many departments, with little clinical data to support its wide acceptance. The rise in antibiotic-resistant strains of organisms in all hospitals worldwide have forced every department to question the use of prophylactic antibiotics. The authors review the evidence behind use of prophylactic antibiotics in standard interventional radiology procedures, as well as in newer procedures that have only recently been incorporated into interventional radiology practice.
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Affiliation(s)
- Eunice Moon
- Department of Vascular and Interventional Radiology, Cleveland Clinic Foundation, Cleveland, Ohio
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31
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Valente T, Rossi G, Lassandro F, Rea G, Marino M, Dialetto G, Muto R, Scaglione M. Unusual complications of endovascular repair of the thoracic aorta: MDCT findings. Radiol Med 2012; 117:831-54. [PMID: 22228128 DOI: 10.1007/s11547-011-0771-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Accepted: 06/20/2011] [Indexed: 11/26/2022]
Abstract
With the development of minimally invasive surgical techniques, endovascular stent-graft placement has become an accepted and widely used alternative to the traditional surgical repair of aortic disease and is gaining acceptance as the treatment of choice. Many studies show that endovascular stent-graft therapy is safe and effective, although complications related to this treatment are also recognised. Although the incidence of major complication is low, neurological sequelae remain the major concern of endovascular repair. With growing experience, however, the spectrum of mid- and long-term complications has broadened to include potentially disastrous events, other than paraplegia or stroke, that require diligent surveillance. Three-dimensional data sets acquired quickly by multidetector computed tomography (MDCT) allow multiplanar reformations and 3D viewing, as well as quantitative assessment of vessel lumens, walls and surroundings. Although a large portion of radiologists will not be involved in the actual endograft deployment, many will be involved in the interpretation of postprocedural surveillance studies. Accordingly, the goal of this report is to summarise our experience with the presentation, diagnostic approach, management and outcomes of these unusual, but potentially catastrophic, postendovascular aortic repair complications to highlight their significance and increase familiarity with them among the imaging community. Increasing awareness of these complications may facilitate rapid diagnosis and/or triage and treatment.
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Affiliation(s)
- T Valente
- Dipartimento di Diagnostica per Immagini, Servizio di Radiologia, A.O.R.N. Monaldi, 80131, Napoli, Italy
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32
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Lee JH, Jeon YS, Cho SG, Choi SK, Shin WY, Kim JY, Hong KC. Adjunctive Procedure as Treatment of Type I Endoleak after EVAR. Vasc Specialist Int 2011. [DOI: 10.5758/kjves.2011.27.4.184] [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
Affiliation(s)
- Joo Hyung Lee
- Department of Surgery, Inha University College of Medicine, Incheon, Korea
| | - Yong Sun Jeon
- Department of Radiology, Inha University College of Medicine, Incheon, Korea
| | - Soon Gu Cho
- Department of Radiology, Inha University College of Medicine, Incheon, Korea
| | - Sun Keun Choi
- Department of Surgery, Inha University College of Medicine, Incheon, Korea
| | - Woo Young Shin
- Department of Surgery, Inha University College of Medicine, Incheon, Korea
| | - Jang Yong Kim
- Department of Surgery, Inha University College of Medicine, Incheon, Korea
| | - Kee Chun Hong
- Department of Surgery, Inha University College of Medicine, Incheon, Korea
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Parmar J, Winterbottom A, Cooke F, Lever AML, Gaunt M. Endovascular aortic stent graft infection with Streptococcus equi: the first documented case. Vascular 2011; 21:14-6. [PMID: 21803839 DOI: 10.1258/vasc.2010.cr0258] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Streptococcus equi is a common equine infectious disease, but transmission to man is rare and confined to those who commonly come into close contact with horses. Similarly, prosthetic stent graft infection is a rare complication of endovascular aortic aneurysm repair. We describe the first reported case of aortic stent graft with S. equi occurring in a professional racehorse trainer. Clinical presentation, investigations, imaging and management of this case are described. In conclusion, clinicians should consider infection with rare organisms in patients with prosthetic implants who regularly come into contact with horses and other ruminants.
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Affiliation(s)
- Jitesh Parmar
- Cambridge Vascular Unit, Addenbrooke's Hospital, Cambridge, UK.
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34
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West CA, Karam J, Poopat C, Shepard AD, Nypaver TJ, Weaver M. Late endovascular aneurysm repair infection presenting with juxatrenal aortic rupture treated with in situ aortic replacement. J Vasc Surg 2011; 54:1157-60. [PMID: 21723686 DOI: 10.1016/j.jvs.2011.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Revised: 03/31/2011] [Accepted: 04/01/2011] [Indexed: 10/18/2022]
Abstract
Infection of an endovascular abdominal aneurysm repair (EVAR) is rare but has become more prevalent with the standardization of EVAR for treating infrarenal abdominal aortic aneurysms. The understanding of this complex aortic condition has improved but still remains to evolve. We present a patient with an EVAR infection manifesting with juxtarenal aortic rupture as a result of a urinary tract infection. This report describes an unusual presentation of an EVAR infection treated with in situ aortic reconstruction and provides >1 year of follow-up.
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Affiliation(s)
- Charles A West
- Department of Surgery, Division of Vascular Surgery, The Edith and Benson Ford Cardiovascular Institute, Henry Ford Hospital, Detroit, Mich., USA.
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35
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Laser A, Baker N, Rectenwald J, Eliason JL, Criado-Pallares E, Upchurch GR. Graft infection after endovascular abdominal aortic aneurysm repair. J Vasc Surg 2011; 54:58-63. [DOI: 10.1016/j.jvs.2010.11.111] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Revised: 11/17/2010] [Accepted: 11/18/2010] [Indexed: 11/25/2022]
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Park EJ, Kim HT, Cho WH, Kim YH. Type I Endoleak Five Year after Endovascular Repair of Abdominal Aortic Aneurysm. Vasc Specialist Int 2011. [DOI: 10.5758/kjves.2011.27.2.76] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Ei Jun Park
- Department of Surgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Hyoung Tae Kim
- Department of Surgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Won Hyun Cho
- Department of Surgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Young Hwan Kim
- Department of Radiology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
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37
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Abstract
A infecção envolvendo endopróteses é uma complicação pouco frequente, associada a elevadas taxas de mortalidade. A apresentação clínica é geralmente tardia, podendo variar de sintomas inespecíficos até complicações graves como pseudoaneurisma e fístula aortoentérica. O diagnóstico envolve alto índice de suspeição e investigação com exames de imagem e laboratoriais. O tratamento segue os preceitos da infecção de prótese em cirurgia convencional, indicando-se, para a maioria dos pacientes, a excisão cirúrgica acompanhada da revascularização in situ ou extra-anatômica. O tratamento conservador fica reservado para casos selecionados.
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38
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Moll FL, Powell JT, Fraedrich G, Verzini F, Haulon S, Waltham M, van Herwaarden JA, Holt PJE, van Keulen JW, Rantner B, Schlösser FJV, Setacci F, Ricco JB. Management of abdominal aortic aneurysms clinical practice guidelines of the European society for vascular surgery. Eur J Vasc Endovasc Surg 2011; 41 Suppl 1:S1-S58. [PMID: 21215940 DOI: 10.1016/j.ejvs.2010.09.011] [Citation(s) in RCA: 996] [Impact Index Per Article: 76.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2010] [Accepted: 09/12/2010] [Indexed: 12/11/2022]
Affiliation(s)
- F L Moll
- Department of Vascular Surgery, University Medical Center Utrecht, The Netherlands.
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39
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Walker TG, Kalva SP, Yeddula K, Wicky S, Kundu S, Drescher P, d'Othee BJ, Rose SC, Cardella JF. Clinical Practice Guidelines for Endovascular Abdominal Aortic Aneurysm Repair: Written by the Standards of Practice Committee for the Society of Interventional Radiology and Endorsed by the Cardiovascular and Interventional Radiological Society of Europe and the Canadian Interventional Radiology Association. J Vasc Interv Radiol 2010; 21:1632-55. [DOI: 10.1016/j.jvir.2010.07.008] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Revised: 05/24/2010] [Accepted: 07/11/2010] [Indexed: 12/17/2022] Open
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40
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Pryluck DS, Kovacs S, Maldonado TS, Jacobowitz GR, Adelman MA, Charles HC, Clark TWI. Percutaneous Drainage of Aortic Aneurysm Sac Abscesses Following Endovascular Aneurysm Repair. Vasc Endovascular Surg 2010; 44:701-7. [DOI: 10.1177/1538574410376451] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: To report preliminary experiences with the treatment of aortic aneurysm sac abscesses following prior endovascular aortic aneurysm repair (EVAR) using computerized tomography (CT)-guided percutaneous drainage. Case Reports: Three patients aged 73 to 78 years with aortic aneurysm sac infections following prior EVAR, 2 of which were associated with aortoduodenal fistula, underwent CT-guided percutaneous drainage and catheter placement. One patient had complete resolution of the aortic aneurysm sac abscess following percutaneous drainage; 1 patient was stabilized to eventual extraanatomic bypass, graft explantation, and fistula repair; and 1 patient was temporized to debridement and fistula repair with endograft preservation. Conclusion: CT-guided percutaneous drainage may be a helpful therapy in selected patients for the treatment of aortic aneurysm sac infections following EVAR.
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Affiliation(s)
- D. S. Pryluck
- Division of Vascular and Interventional Radiology, Department of Radiology, New York University School of Medicine, NYU Langone Medical Center, NY, USA
| | - S. Kovacs
- Division of Vascular and Interventional Radiology, Department of Radiology, New York University School of Medicine, NYU Langone Medical Center, NY, USA
| | - T. S. Maldonado
- Division of Vascular Surgery, Department of Surgery, New York University School of Medicine, NYU Langone Medical Center, NY, USA
| | - G. R. Jacobowitz
- Division of Vascular Surgery, Department of Surgery, New York University School of Medicine, NYU Langone Medical Center, NY, USA
| | - M. A. Adelman
- Division of Vascular Surgery, Department of Surgery, New York University School of Medicine, NYU Langone Medical Center, NY, USA
| | - H. C. Charles
- Division of Vascular and Interventional Radiology, Department of Radiology, New York University School of Medicine, NYU Langone Medical Center, NY, USA
| | - T. W. I. Clark
- Division of Vascular and Interventional Radiology, Department of Radiology, New York University School of Medicine, NYU Langone Medical Center, NY, USA,
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41
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Karmy-Jones R, Teso D, Jackson N, Ferigno L, Bloch R. Endovascular approach to acute aortic trauma. World J Radiol 2009; 1:50-62. [PMID: 21160721 PMCID: PMC2998886 DOI: 10.4329/wjr.v1.i1.50] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2009] [Revised: 12/18/2009] [Accepted: 12/21/2009] [Indexed: 02/06/2023] Open
Abstract
Traumatic thoracic aortic injury remains a major cause of death following motor vehicle accidents. Endovascular approaches have begun to supersede open repair, offering the hope of reduced morbidity and mortality. The available endovascular technology is associated with specific anatomic considerations and complications. This paper will review the current status of endovascular management of traumatic thoracic aortic injuries.
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42
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Polymicrobial Abdominal Aortic Endograft Infection Secondary to Aorto-Enteric Para-Prosthetic Erosion. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2009. [DOI: 10.1097/ipc.0b013e3181a74cfc] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Sikkink C, Reijnen M, Zeebregts C. The Creation of the Optimal Dedicated Endovascular Suite. Eur J Vasc Endovasc Surg 2008; 35:198-204. [DOI: 10.1016/j.ejvs.2007.08.009] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2007] [Accepted: 08/08/2007] [Indexed: 01/04/2023]
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44
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Park KH, Jung SI, Jang MO, Chang NK, Kim JK. Investigation of Prophylactic Antibiotic Usage for Interventional Radiology in Korea. Infect Chemother 2008. [DOI: 10.3947/ic.2008.40.5.266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Kyung-Hwa Park
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Sook-In Jung
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Mi Ok Jang
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Nam-Kyu Chang
- Department of Diagnostic Radiology, Chonnam National University Medical School, Gwangju, Korea
| | - Jae Kyu Kim
- Department of Diagnostic Radiology, Chonnam National University Medical School, Gwangju, Korea
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45
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46
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Silberfein EJ, Lin PH, Bush RL, Zhou W, Lumsden AB. Aortic endograft infection due to Pasteurella multocida following a rabbit bite. J Vasc Surg 2007; 43:393-5. [PMID: 16476621 DOI: 10.1016/j.jvs.2005.10.067] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2005] [Accepted: 10/14/2005] [Indexed: 01/11/2023]
Abstract
Abdominal aortic endograft infection is a serious complication after an endovascular abdominal aortic aneurysm repair. Pasteurella multocida, a gram-negative bacterium, is a commonly found organism in the mouth flora of many house pets. We report a case of an aortic endograft infection caused by P multocida after a rabbit bite. Successful treatment was performed by extra-anatomic revascularization followed by endograft removal.
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Affiliation(s)
- Eric J Silberfein
- Division of Vascular Surgery & Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas 77030, USA
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47
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Hulin SJ, Morris GE. Aortic Endograft Infection: Open Surgical Management with Endograft Preservation. Eur J Vasc Endovasc Surg 2007; 34:191-3. [PMID: 17478113 DOI: 10.1016/j.ejvs.2007.03.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2006] [Accepted: 03/03/2007] [Indexed: 11/16/2022]
Abstract
INTRODUCTION We report successful management of aortic endograft infection without graft explantation or extra-anatomic bypass. REPORT A 66 year-old male who had undergone endovascular repair of an aortic aneurysm presented with abdominal pain and raised inflammatory markers following embolisation of a type-2 'endoleak'. CT scanning revealed a left psoas fluid collection. Endograft infection was diagnosed. Following failure of CT-guided drainage and conservative management, surgical drainage with irrigation drain placement was undertaken with preservation of the endograft. There was no evidence of recurrent infection after follow-up at 30 months. DISCUSSION Aortic endograft infection may be managed without endograft removal and extra-anatomic bypass.
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Affiliation(s)
- S J Hulin
- Department of Vascular Surgery, Southampton General Hospital, Southampton, Hants, UK.
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48
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Parkinson TJ, Rosales C, Wyatt MG. Peripheral Seeding of Mycotic Aneurysms from an Infected Aortic Stent Graft. Eur J Vasc Endovasc Surg 2007; 33:684-6. [PMID: 17293129 DOI: 10.1016/j.ejvs.2006.12.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2006] [Accepted: 12/13/2006] [Indexed: 11/30/2022]
Abstract
Aortic stent graft infection is rare and there are no reported cases of seeded peripheral mycotic aneurysms complicating this condition. We describe the case of a 54 year old man who developed a late stent graft infection at three years, resulting in the peripheral seeding of three mycotic aneurysms with two incidents of rupture. He was successfully treated with extra-anatomic bypass of the aorta and both surgical and endovascular repair of his peripherally seeded mycotic aneurysms.
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MESH Headings
- Aneurysm, Infected/etiology
- Aneurysm, Infected/microbiology
- Aneurysm, Infected/therapy
- Aneurysm, Ruptured/etiology
- Aneurysm, Ruptured/microbiology
- Aneurysm, Ruptured/therapy
- Anti-Infective Agents/therapeutic use
- Aortic Aneurysm, Abdominal/diagnostic imaging
- Aortic Aneurysm, Abdominal/surgery
- Blood Vessel Prosthesis Implantation/adverse effects
- Blood Vessel Prosthesis Implantation/instrumentation
- Enterococcus faecalis/isolation & purification
- Follow-Up Studies
- Gram-Positive Bacterial Infections/etiology
- Gram-Positive Bacterial Infections/microbiology
- Gram-Positive Bacterial Infections/therapy
- Humans
- Male
- Middle Aged
- Prosthesis-Related Infections/etiology
- Prosthesis-Related Infections/microbiology
- Prosthesis-Related Infections/therapy
- Radiography
- Reoperation
- Rupture, Spontaneous
- Stents/adverse effects
- Stents/microbiology
- Tibial Arteries
- Time Factors
- Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic use
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Affiliation(s)
- T J Parkinson
- Northern Vascular Centre, Freeman Hospital, Newcastle upon Tyne, UK
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49
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Whitehead EJ, Thompson JF, Lewis DR. Contamination and decontamination of Doppler probes. Ann R Coll Surg Engl 2007; 88:479-81. [PMID: 17002855 PMCID: PMC1964674 DOI: 10.1308/003588406x114866] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Nosocomial infection occurs in 2-9% of patients undergoing vascular surgery and can lead to death, amputation or require complex revision surgery. Neck ties, pagers, stethoscopes and Doppler probes have been shown to carry pathogens. We measured bacterial colonisation of Doppler probes on a vascular unit and audited the effect of staff education at reducing this contamination. MATERIALS AND METHODS Bacteriological culture swabs were taken from hand-held Doppler probes on the vascular surgical ward and clinic. There was no protocol for cleaning the Doppler probes, so manufacturers were contacted for their recommendations. The results of cultures were presented to nursing and medical staff, who were then asked to clean the probes with alcohol wipes after each use. After an interval of 1 week, bacteriological cultures from the same Doppler probes was repeated. RESULTS Fifty bacteriological cultures were performed from 10 Doppler probes over a 4-week period. Thirteen (26%) cultures were positive for diphtheroids, coliforms, coagulase-negative staphylococci and skin flora. After staff education, 42 further swabs were taken from the same probes; two positive cultures were obtained with scanty growth of skin flora (chi2 P < 0.05). CONCLUSIONS Staff education and simple cleaning significantly reduces the contamination of hand-held Doppler probes and may help prevent nosocomial infection.
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Affiliation(s)
- Emma J Whitehead
- Department of Surgery, Royal Devon and Exeter Hospital, Exeter, UK.
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50
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Auftreten und Virulenzfaktoren bakterieller Erreger bei Gefäßinfektionen. GEFÄSSCHIRURGIE 2006. [DOI: 10.1007/s00772-006-0492-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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