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Perini P, Gargiulo M, Silingardi R, Bonardelli S, Bellosta R, Piffaretti G, Michelagnoli S, Ferrari M, Turicchia GU, Freyrie A, Fornasari A, Mariani E, Faggioli G, Spath P, Migliari M, Gennai S, Paro B, Baggi P, Attisani L, Pegorer M, Franchin M, Mauri F, Chisci E, Troisi N, Paciaroni E, Fanelli M. Twenty-Five Year Multicentre Experience of Explantation of Infected Abdominal Aortic Endografts. Angiology 2023:33197231206430. [PMID: 37820380 DOI: 10.1177/00033197231206430] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
We report a multicenter experience of open conversions (OC) for aortic endograft infections (AEI). We retrospectively analyzed all patients who underwent OC for AEI after endovascular aneurysm repair (EVAR), from 1997 to 2021 in 12 Italian centers. The endpoints were as follows: mortality (30-days, in-hospital), major postoperative complications. Follow-up data included: survival, aortic-related complications, infection persistence or reoccurrence. Fifty-eight patients (mean age: 73.8 ± 6.6 years) were included. Median time from EVAR to OC was 14 months (interquartile range 7-45). Thirty-five patients (60.3%) were symptomatic at presentation. Aortic reconstruction was anatomic in 32 patients (55.2%), extra-anatomic in 26 (44.8%). Thirty-day mortality was 31% (18/58). Six additional patients died after 30 days during the same hospitalization (in-hospital mortality: 41.4%). Most common post-operative complications included respiratory failure (38.6%) and renal insufficiency (35.1%). During 28.1 ± 4 months follow-up, 4 aneurysm-related deaths were recorded. Infection re-occurred in 29.4% of the patients. Estimated survival was 50% at 1 year, and 30% at 5 years, and was significantly lower for patients who underwent extra-anatomic reconstructions (37 vs 61% at 1 year, 16 vs 45% at 5 years; log-rank P = .021). OC for AEI is associated with high early mortality. The poor mid-term survival is influenced by aortic complications and infection re-occurrence.
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Affiliation(s)
- Paolo Perini
- Vascular Surgery, Department of Medicine and Surgery, University of Parma, Parma, Italy
- Vascular Surgery, Cardio-Thoracic and Vascular Department, University Hospital of Parma, Parma, Italy
| | - Mauro Gargiulo
- Vascular Surgery, Department of Experimental, Diagnostic and Speciality Medicine, University of Bologna, Bologna, Italy
| | - Roberto Silingardi
- Vascular Surgery, Department of Biomedical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Stefano Bonardelli
- Vascular Surgery, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Raffaello Bellosta
- Vascular Surgery, Department of Surgery, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Gabriele Piffaretti
- Vascular Surgery, Department of Medicine and Surgery, School of Medicine, University of Insubria, Varese, Italy
| | - Stefano Michelagnoli
- Vascular and Endovascular Surgery, Department of Surgery, USL Toscana Centro, "San Giovanni di Dio" Hospital, Florence, Italy
| | - Mauro Ferrari
- Vascular Surgery, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | | | - Antonio Freyrie
- Vascular Surgery, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Anna Fornasari
- Vascular Surgery, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Erica Mariani
- Vascular Surgery, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - GianLuca Faggioli
- Vascular Surgery, Department of Experimental, Diagnostic and Speciality Medicine, University of Bologna, Bologna, Italy
| | - Paolo Spath
- Vascular Surgery, Department of Experimental, Diagnostic and Speciality Medicine, University of Bologna, Bologna, Italy
| | - Mattia Migliari
- Vascular Surgery, Department of Biomedical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Stefano Gennai
- Vascular Surgery, Department of Biomedical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Barbara Paro
- Vascular Surgery, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Paolo Baggi
- Vascular Surgery, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Luca Attisani
- Vascular Surgery, Department of Surgery, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Matteo Pegorer
- Vascular Surgery, Department of Surgery, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Marco Franchin
- Vascular Surgery, Department of Medicine and Surgery, School of Medicine, University of Insubria, Varese, Italy
| | - Francesca Mauri
- Vascular Surgery, Department of Medicine and Surgery, School of Medicine, University of Insubria, Varese, Italy
| | - Emiliano Chisci
- Vascular and Endovascular Surgery, Department of Surgery, USL Toscana Centro, "San Giovanni di Dio" Hospital, Florence, Italy
| | - Nicola Troisi
- Vascular Surgery, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Elisa Paciaroni
- Department of Vascular Surgery, Cesena Hospital, AUSL Romagna, Forlì-Cesena, Italy
| | - Mara Fanelli
- Department of Vascular Surgery, Cesena Hospital, AUSL Romagna, Forlì-Cesena, Italy
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Kobayashi K, Uchida T, Kuroda Y, Yamashita A, Ohba E, Ochiai T, Sadahiro M. Aortobifemoral Bypass Grafting with Reversed L-Shaped Technique for Endograft Infection. Ann Thorac Cardiovasc Surg 2020; 26:369-372. [PMID: 32741883 PMCID: PMC7801177 DOI: 10.5761/atcs.nm.20-00099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Endograft infection after abdominal endovascular aortic repair is a rare but catastrophic complication associated with high perioperative mortality and postoperative recurrent infection. The optimal surgical treatment is still controversial, particularly regarding in situ or extra-anatomical revascularization. Herein, we describe a successful surgically treated case of a patient with an endograft infection complicated with abscess formation in the retroperitoneal space around the right common iliac artery. We performed an aortobifemoral bypass grafting using the reversed L-shaped technique by rerouting the right leg of the new prosthesis to avoid the infected area. The patient is doing well 1 year after surgery without recurrent infection. This technique was considered to be advantageous because revascularization could be performed remotely from the infected area.
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Affiliation(s)
- Kimihiro Kobayashi
- Second Department of Surgery, Faculty of Medicine, Yamagata University, Yamagata, Yamagata, Japan
| | - Tetsuro Uchida
- Second Department of Surgery, Faculty of Medicine, Yamagata University, Yamagata, Yamagata, Japan
| | - Yoshinori Kuroda
- Second Department of Surgery, Faculty of Medicine, Yamagata University, Yamagata, Yamagata, Japan
| | - Atushi Yamashita
- Second Department of Surgery, Faculty of Medicine, Yamagata University, Yamagata, Yamagata, Japan
| | - Eiichi Ohba
- Second Department of Surgery, Faculty of Medicine, Yamagata University, Yamagata, Yamagata, Japan
| | - Tomonori Ochiai
- Second Department of Surgery, Faculty of Medicine, Yamagata University, Yamagata, Yamagata, Japan
| | - Mitsuaki Sadahiro
- Second Department of Surgery, Faculty of Medicine, Yamagata University, Yamagata, Yamagata, Japan
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Ma JW, Hu SY, Lin TC, Tsai CA. Psoas abscess associated with aortic endograft infection caused by bacteremia of Listeria monocytogenes: A case report and literature review (CARE Complaint). Medicine (Baltimore) 2019; 98:e17885. [PMID: 31702663 PMCID: PMC6855657 DOI: 10.1097/md.0000000000017885] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
RATIONALE Endograft infection following endovascular stent for aortic aneurysm is rare (0.6%-3%), but it results in high mortality rate of 25% to 88%. PATIENT CONCERNS A 66-year-old hypertensive man underwent an endovascular stent graft for abdominal aortic aneurysm 18 months ago. Recurrent episodes of fever, chills, and abdominal fullness occurred 6 months ago before this admission. Laboratory data showed 20 mg/dL of C-reactive protein and abdominal computed tomography (CT) revealed an aortic endoleak at an urban hospital, so 4-day course of intravenous (IV) amoxicillin/clavulanic acid was given and he was discharged after fever subsided. He was admitted to our hospital due to fever, chills, and watery diarrhea for 1 day. Abdominal CT showed left psoas abscess associated with endograft infection. Blood culture grew Listeria monocytogenes. DIAGNOSIS Left psoas abscess associated with endograft infection caused by bacteremia of Listeria monocytogenes. INTERVENTIONS IV ampicillin with 8 days of synergistic gentamicin was prescribed and it created satisfactory response. Ampicillin was continued for 30 days and then shifted to IV co-trimoxazole for 12 days. OUTCOMES He remained asymptomatic with a decline of CRP to 0.36 mg/dL and ESR to 39 mm/h. He was discharged on the 44th hospital day. Orally SMX/TMP was prescribed for 13.5 months. LESSONS Only few cases of aortic endograft infection caused by Listeria monocytogenes had been reported. In selected cases, particularly with smoldering presentations and high operative risk, endograft retention with a prolonged antimicrobial therapy seem plausible as an initial therapeutic option, complemented with percutaneous drainage or surgical debridement if necessary.
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Affiliation(s)
- Jen-Wen Ma
- Department of Emergency Medicine, Taichung Veterans General Hospital
- School of Medicine
| | - Sung-Yuan Hu
- Department of Emergency Medicine, Taichung Veterans General Hospital
- School of Medicine
- Institute of Medicine, Chung Shan Medical University
- Department of Nursing, College of Health, National Taichung University of Science and Technology
- Department of Nursing, Central Taiwan University of Science and Technology, Taichung
- Department of Nursing, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli County
| | - Tzu-Chieh Lin
- Department of Emergency Medicine, Taichung Veterans General Hospital
- School of Medicine
- College of Public Health, China Medical University
| | - Che-An Tsai
- Department of Internal Medicine, Division of Infectious Disease, Taichung Veterans General Hospital, Taichung, Taiwan
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Pleger SP, Nink N, Böning A, Koshty A. Ascendobifemoral Bypass for the Treatment of a Thoracic Endograft Infection. Thorac Cardiovasc Surg Rep 2017; 6:e32-e34. [PMID: 29026687 PMCID: PMC5633407 DOI: 10.1055/s-0037-1607272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 09/05/2017] [Indexed: 11/24/2022] Open
Abstract
Background
Endograft infections (EIs) are rare complications after endovascular procedures in the thoracic and abdominal aortas. The challenging treatment encloses antibiotic and surgical therapies.
Case Description
A 74-year-old male patient developed an EI after an endovascular procedure (thoracic endovascular aortic repair [TEVAR]). Despite a long-term oral antibiotic therapy, the clinical symptoms showed no falling trend. Because of the expanded infection from above the celiac trunk up to the aortic arch, we decided to remove the infected endograft and to implant an extra-anatomic ascendobifemoral bypass.
Conclusion
The implantation of an ascendobifemoral bypass was a successful treatment option for EIs after TEVAR.
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Affiliation(s)
- Sebastian Paul Pleger
- Department of Vascular and Endovascular Surgery, Jung-Stilling Hospital, Siegen, Germany
| | - Nadine Nink
- Department of Vascular and Endovascular Surgery, Jung-Stilling Hospital, Siegen, Germany
| | - Andreas Böning
- Department of Adult and Pediatric Cardiovascular Surgery and Vascular Surgery, University Hospital of Giessen, Justus Liebig University, Giessen, Germany
| | - Ahmed Koshty
- Department of Vascular and Endovascular Surgery, Jung-Stilling Hospital, Siegen, Germany
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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