Aortic sepsis: Is there a role for in situ graft reconstruction?

Robinson, Jovien; Johansen, Kaj

doi:10.1016/0741-5214(91)90353-v

Cited by 100 publications

(29 citation statements)

References 20 publications

(2 reference statements)

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“…6 Wide resection of the infected tissue followed by extra-anatomic bypass grafting has been proposed by some authors for infected abdominal aortic aneurysms. 7 However, according to a previous report 6 from our hospital in situ reconstruction was acceptable after aggressive debridement for a SAP infected by Salmonella. Moreover, in situ reconstruction with postoperative antibiotic therapy yielded a good outcome in the management of an abdominal aortic aneurysm infected by Campylobacter fetus, which is one of the known human pathogenic Campylobacter spp.…”

Section: Discussionmentioning

confidence: 75%

Abdominal septic aortic pseudoaneurysm caused by Campylobacter jejuni infection: Report of a case

Roan

Luo

2009

Surg Today

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Campylobacter jejuni infection is one of the most common bacterial causes of acute gastroenteritis worldwide. An extraintestinal manifestation is rare and, to our knowledge, an aortic aneurysm has until now never been documented. We report a case of a 72-year-old patient with a septic aortic pseudoaneurysm caused by C. jejuni infection. Computed tomography and magnetic resonance imaging showed a pseudoaneurysm in the abdominal aorta. The preoperative blood culture indicated a Gram-negative bacillus, which was identified 7 days later as C. jejuni. An aneurysmectomy, extensive debridement, and an in situ graft wrapped with the omentum were done, and the patient was given a 6-week course of antibiotics. Despite readmissions for abdominal infection and Salmonella bacteremia, a graft infection did not develop. In the 3 years since the procedure the patient has shown no signs of a relapse.

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Section: Discussionmentioning

confidence: 75%

Abdominal septic aortic pseudoaneurysm caused by Campylobacter jejuni infection: Report of a case

Roan

Luo

2009

Surg Today

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“…The simplest approach to reconstruction is in situ graft replacement, which is far from being generally accepted for the management of graft infection, but can avoid the potential risk of an aortic stump blowout. The results of a total excision of the infected graft and in situ reconstruction with prosthetic grafts in the previous reports 3,5,[7][8][9][10]14,[27][28][29][30][31][32] are as follows: perioperative mortality, 0%-100%; major amputation, 0%-11%; new graft infection, 0%-100%; new graft failure, 0%-14% (Table 3A). This technique may carry an increased risk of a newly implanted graft infection; therefore, it is only indicated for properly selected patients with minimal or localized contamination, or with graft infection caused by low virulence bacteria, such as Staphylococcus epidermidis.…”

Section: Discussionmentioning

confidence: 99%

Treatment for Aortic Graft Infection

et al. 2001

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Nine patients with an aortic graft infection presented after undergoing aortic grafting. Seven of 9 patients underwent an initial aortic reconstruction in our hospital. The incidence of aortic graft infection was 1.5% (7/456). There were 6 cases of paraprosthetic infection and 3 cases of aortointestinal fistulas. The treatments consisted of a complete graft excision and an axillofemoral bypass in 6 patients, a complete graft excision alone, a partial graft excision and a femorofemoral bypass, and the preservation of the graft with omental wrapping and irrigation in 1 each. Broad-spectrum antibiotics were intravenously administered to all patients and were then replaced by selective antibiotics for the responsible organisms. All surviving patients received antibiotics orally for 3-6 months. The early postoperative mortality rate was 11.1%. Aortoduodenal fistula occurred in 1 patient with graft excision alone. Graft thrombosis occurred in 2 patients with an axillofemoral bypass. No late graft infection or stump blowout occurred in any patient. We believe that a complete excision of the infected graft as well as the maintenance of distal tissue perfusion is necessary. However, based on the condition of the patient, the appearance of the operating field, and the difficulty of a repeat operation, we would like to stress the importance of selecting the best and safest treatment plan for each case.

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“…Moreover, the principle of in situ repair even before control of infection is well established. [8][9][10] The pseudoaneurysm in our patient developed in the midportion of the ascending aorta and the aortic wall was not infected macroscopically at the time of repair. Therefore, patch angioplasty using Dacron material seemed reasonable, after which we expected that the preserved anterior wall of the aorta would grow and subsequent surgical intervention would not be required.…”

Section: Discussionmentioning

confidence: 99%