Management of an Aortic Graft Infection after Endovascular Aneurysm Repair (original) (raw)
Related papers
2020
Vascular graft infection is considered as one of the most serious complications after vascular graft surgery, with a poor prognosis. The main treatment of vascular graft infection is the removal of the infected vascular graft. Extra-anatomical bypass is often required for revascularization. Yet, removal of the stent graft may be difficult in poor-risk patients who have undergone endovascular aneurysm repair (EVAR). In this case, we observed an abscess in the aortic aneurysm surrounding the stent graft following EVAR and treated the stent-graft infection conservatively.
Management of Infected Grafts and Aneurysms of the Aorta
Annals of Vascular Surgery, 2005
Seventeen patients treated for infected grafts (11/17) or aneurysms (6/17) of the aorta between 1998 and 2003 were reviewed to evaluate our experience with aortic infection. The causative organisms were identified in 12 patients (71%), with 5 (29%) having methicillin-resistant Staphylococcus aureus. A periaortic abscess occurred in eight patients, and all of them were associated with infected grafts. Surgical treatment included cryopreserved allograft replacement in eight patients, prosthetic graft replacement in four patients, and drainage with or without omental wrapping in five patients. One patient was still hospitalized at the end of the study period. Five patients with infected grafts died after the operation during the initial hospitalization. No early mortality occurred in the aneurysm group. The early mortality rate was 31% for all patients, 50% for the graft group, and 63% for patients with a periaortie abscess. Another patient with an infected aneurysm died of arrhythmia after discharge from the initial hospitalization, Ten patients are still alive without evidence of reinfection. The early mortality rate for patients with infected aortic grafts is higher than that for those with infected aneurysms, especially when a periaortic abscess accompanies them. However, the late outcome is favorable, with no reinfection or late treatment-related deaths.
Graft infection after endovascular abdominal aortic aneurysm repair
Journal of Vascular Surgery, 2011
Introduction: Although the natural history and management of infected open abdominal aortic aneurysm (AAA) repair is well described, only sporadic case reports have described the fate of patients with infected endografts placed in the abdominal aorta. The present study describes a tertiary referral center's experience with infected endovascular aneurysm repairs (EVARs). Methods: The medical records of 1302 open and endovascular aortic procedures were queried from January 2000 to January 2010. The cases were reviewed for prior aortic procedures, prosthetic implants, and etiology of current open procedure. Demographics, operative details, and perioperative courses were documented. Results: Nine patients (1 woman) with a mean age of 71 years had an EVAR that later required an open procedure for explantation and surgical revision for suspected infection. All grafts were explanted through a midline transperitoneal approach, with a mean time to explant of 33 months. The explanted endografts included 4 Zenith (Cook, Bloomington, Ind), 2 Ancure (Endovascular Technologies, Menlo Park, Calif), 2 Excluders (Gore, Flagstaff, Ariz), and 1 AneuRx (Medtronic, Minneapolis, Minn). Eight of the nine original EVARs were performed at other hospitals; 1 patient had EVAR and open explant at the University of Michigan. All patients had preoperative computed tomography scans, except one who was transferred in extremis with a gastrointestinal hemorrhage. Three patients also had a tagged leukocyte scan, and two had magnetic resonance imaging to further reinforce the suspicion of infection before explantation and bypass planning. Rifampin-soaked Hemashield (Boston Scientific) in situ grafts were used in four patients, with extra-anatomic (axillary-bifemoral) bypass used in the other five. The in situ group had no positive preoperative or postoperative cultures, with the exception of the unstable patient who died the day of surgery. For the other five patients, positive tissue cultures were found for Bacteroides, Escherichia coli, coagulase-negative Staphylococcus, Streptococcus, and Candida. Three patients were found to have aortic-enteric fistula, two of whom died before discharge from the hospital. The remaining seven survived to discharge. Average length of stay was 22 days, with a median follow-up of 11 months. Conclusion: This series of infected EVARs is the largest group of infected AAA endografts reported to date. Because EVAR of AAAs is presently the most common method of repair, development of endograft infection, while rare, can be managed with acceptable mortality rates. Patients presenting with aortic-enteric fistula after EVAR appear to have a more virulent course.
Journal of Surgical Case Reports, 2014
We present a case of a 73-year-old gentleman with an aortic endograft infection post endovascular abdominal aneurysm repair (EVAR), from whence erosion has come in from an acutely inflamed appendix. To our best understanding, there is no similar case published in the literature. Intra-operatively, there was obvious inflammation and oedema over the retroperitoneal tissue, with frank pus and thrombotic material projecting from the aorta. The tip of an obviously inflamed appendix had stuck to and eroded through the aortic sac, seeding the infection. The endograft was explanted and the aneurysm sac oversewn. Lower limb circulation was preserved with a right axillo-femoral Dacron bypass graft. This case highlights a rare complication following EVAR, and for one to consider unusual sources of graft infection.
2016
Even though aggressive surgical management is recommended for most cases of aortic endoprosthesis infection, because of the high surgical risk presented, conservative treatment should also be considered in selected cases. We present here a clinical case of a 84-year-old patient, presenting with low back pain, fever and weight loss for two months. He had undergone an endovascular infra renal aortic aneurysm repair three years ago. A computed tomography scans demonstrated bubbles inside the sac and a perianeurysmatic collection. A puncture of this collection was undertaken and the diagnosis of aortic endograft infection, caused by Propionibacterium sp, was made. The patient was successfully managed conservatively with parenteral followed by long-term oral antibiotic therapy.
EJVES Extra, 2005
Endograft infection is a rare event, with few reports in the literature. This report describes delayed infection of an aortic endoprosthesis that eventually resulted in abdominal aortic aneurysm (AAA) rupture. The procedure was performed in an angiographic suite. In the postoperative period the patient developed a central venous line infection. This appears to be the first recognized and reported case in which the infected aortic neck completely dilated due to the radial force of the stent graft.
Surgical management of infected abdominal aortic grafts: Review of a 25-year experience
Journal of Vascular Surgery, 1986
Eighty-four patients with infected abdominal aortic grafts managed from 1961 through February 1985 were reviewed. Thirty-three patients had associated aortoenteric fistula formation. Twenty-eight infections (33%) and 13 aortoenteric fistulas (39%) originated at The Cleveland Clinic, yielding an incidence of aortic graft infection a,f 0.77% (28 of 3652 grafts) and aortoenteric fistula formation of 0.36% (13 of 3652: grafts) at this center. Staphylococcus organisms alone or in combination with other organisms were isolated from 34% of the series. Management consisted of graft removal and extra-anatomic bypass in 54 patients (64%), graft removal alone in 14 (17%) patients, partial graft removal and extra-anatomic bypass in seven (8%) patients, and miscellaneous operations in nine (11%) patients. Twenty-three patients (27%) required major amputations, nine of which were bilateral. Life-table analysis yielded 30-day and l-year survival rates of 72% and 42%, respectively. Thirty-day survival of the aortoenteric fist&a subset (49%) was less than that (86%) of the nonaortoenteric fistula subset (p = 0.003). One-year survival of patients treated since 1980 (54%) was superior to that of patients treated before 1980 (31%, p = 0.035). No difference in operative or l-year survival was demonstrated between the group treated with extra-anatomic bypass and subsequent graft removal and another in which both procedures were performed simuhane:ously, although the staged group experienced substantially fewer (p = 0.04) amputations (7%) than the combined group (41%). (J VASC SURG 1986; 3:725-31.) Since the initial experience with abdominal aortic reconstruction more than 30 years ago, many advances have been made in the management of patients who require this procedure. Despite dramatic improvements in antibiotic prophylaxis, synthetic graft materials, and surgical treatment, infection in an abdominal aortic prosthesis remains one of the most serious complications in vascular surgery. Formnately, its incidence is low, approximating 2% in most reported series.'-4 Although it is a rare event, aortic graft infection still is associated with mortality rates ranging from 25% to 75% and with morbidity in the form of amputation in approximately 30% of patients in whom it does occur.'-' Because of the low incidence of graft sepsis in general, most published series of patients have been small and many include patients with infected arterial prostheses that do not involve the aorta. Consequently, it has been difficult to draw statistically valid From the Department of Vascular Surgery, The Cleveland Clinic Foundation.
Treatment of Aortic Graft Infection in the Endovascular Era
Current Infectious Disease Reports, 2017
Purpose of Review This review provides an overview of the current literature surrounding the medical and surgical treatment of aortic graft infection with particular focus on the role of endovascular aortic grafts in the changing demographics and management of these infections. Recent Findings Definitive therapy for aortic graft infection continues to include parenteral antibiotics and surgical explantation and revascularization procedures, which are historically vast operations and sources of significant operative stress. Surgical management has evolved to include more options for infection resistant in situ conduits, attempts at partial explantations, and use of endovascular therapy to temporize the urgent sequelae of these infections, such as aortoenteric fistula. Summary Aortic graft infection continues to be a significant and morbid complication of graft placement even with the advent of endovascular therapy, and its treatment will only increase in difficulty as a more frail population has gained access to complex aortic repair. In the future, more flexible revascularization and partial explantation options are keys, along with long-term suppressive antibiotics where appropriate.
A complicated course for an infected endovascular stent graft
Journal of Vascular Surgery Cases and Innovative Techniques, 2020
The management of an infected endovascular aortic stent graft can be complex and morbid. Therefore, caution should be exercised before an endovascular approach is considered in patients presenting with a saccular aneurysm who are younger than 65 years and without risk factors for this may indicate a mycotic aneurysm. An open approach with consideration of aneurysm excision should be entertained to prevent an endovascular implantation in the setting of an infected aorta. We report a case of endovascular aortic stent graft infection that led to complex surgical management and prolonged postoperative care.
Juxtarenal Modular Aortic Stent Graft Infection Caused by Staphylococcus aureus
Case Reports in Vascular Medicine, 2016
Introduction. We are presenting a case report of an infected modular abdominal stent graft.Case Presentation. A 67-year-old male patient three years after Cook’s modular abdominal aortic aneurysm (AAA) graft implantation for juxtarenal AAA with an implantation of a stent extension into the right common iliac artery for type Ib endoleak. The patient was admitted into our center in severe condition with suspected retroperitoneal bleeding. Computed tomography angiography (CTAG) confirmed retroperitoneal bleeding in the right common iliac artery. An urgent surgical revision was indicated; destructed arterial wall around the stent extension in the right common iliac artery was discovered. Due to the severe state of health of the patient, a resection of the infected stent and affected arterial wall was performed, followed by an iliac-femoral crossover bypass. The patient was transported to the intensive care unit with hepatic and renal failure, with maximal catecholamine support. Combined...