Bridge Use of Endovascular Repair and Delayed Open Operation for Infected Aneurysm of Aortic Arch

Tamura, Kentaro; Yoshitaka, Hidenori; Totsugawa, Toshinori; Tsushima, Yoshimasa; Chikazawa, Genta; Ohno, Tsukasa; Sakaguchi, Taichi

doi:10.1016/j.athoracsur.2013.01.095

Cited by 11 publications

(7 citation statements)

References 8 publications

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“…For high-risk patients, we propose the temporary use of TEVAR, 5 with or without the irrigation of the infected aneurysmal sac, before open surgery, thus stabilizing the infection and allowing for a safer open reconstruction. In the case of patient 2, we administered daily irrigation with gentian violet solution through a drainage tube to help sterilize the infected bed.…”

Section: Discussionmentioning

confidence: 99%

Minimally invasive triple valve surgery through a right minithoracotomy

Lio

Murzi

Solinas

et al. 2014

The Journal of Thoracic and Cardiovascular Surgery

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Section: Discussionmentioning

confidence: 99%

Minimally invasive triple valve surgery through a right minithoracotomy

Lio

Murzi

Solinas

et al. 2014

The Journal of Thoracic and Cardiovascular Surgery

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“…On the other hand, because endovascular therapy has become more widely used, the employment of SGs for treatment of MAs has been described in many reports (1-7,9,13). The Japanese guidelines for diagnosis and treatment of aortic MAs classify SG therapy as class III, and some authors have stated that EVAR should be a ''bridge'' treatment to delay open repair (9,(20)(21)(22). In other studies, EVAR was combined with abscess drainage (1,23).…”

Section: Discussionmentioning

confidence: 99%

Surgical Treatment for Primary Mycotic Aneurysms Using Endovascular Therapy, Focusing on Patient Selection: Single-Center Experience

Furui

Sakaguchi

Yoshida

et al. 2021

Surgical Infections

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Background: Mycotic aneurysms (MAs) are relatively rare but life-threatening. Some recent reports have described the use of endovascular therapy for their treatment; however, this still is a controversial treatment, and a definite target population has not been determined. Methods: We performed surgery on 34 patients with MAs from March 2005 to March 2019. Twenty patients who underwent open surgery (OS) first comprised the OS group, and 14 patients who underwent endovascular therapy first comprised the stent-graft (SG) group. We analyzed between-group differences, long-term outcomes, and risk factors for death retrospectively. Patients in the OS group had a higher initial white blood cell count than those in the SG group (p = 0.047). The SG group had more patients with a low albumin concentration (£2.0 mg/dL) than did the OS group (p = 0.026). Results: There were no significant differences in the operative mortality rates between the groups (p = 0.773). Additional procedures were required more often in the SG than the OS group (p = 0.0013). The overall survival rate as estimated by the Kaplan-Meier method was 88% at 1 month, 67% at 1 year, 57% at 3 years, and 45% at 10 years. In the univariable analysis, chronic obstructive pulmonary disease (COPD) was a risk factor for death (p = 0.003). Conclusions: Endovascular therapy for MAs produced reasonable outcomes when patient selection was based on the activity level, nutritional condition, and degree of inflammation. Endovascular therapy may become an option for patients with a low albumin concentration or COPD despite the fact that additional procedures may be needed.

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“…Hence, it is imperative to develop multiple therapeutic strategies in order to achieve the best possible clinical outcome. Endo is of great value in treating anatomical challenging lesion like thoracic aorta 11,32 and may serve the role as a bridge 33 to "more definite repair" for the fragile patients with rupture aneurysm or unstable vital signs once the infection has resolved substantially and the patient has stabilized beyond the acute presentation. Recently, we have applied a novel method of "stage" repair for high-risk patients (Supplemental Figure 3).…”

Section: Discussionmentioning

confidence: 99%

Infection-relapse and a potentially surgical stratification model for the treatment of mycotic aortic aneurysms: A propensity-matched pilot study

Liu

et al. 2019

Vascular

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Objective This study evaluates the overall survival and the infection-relapse after endovascular repair (Endo) vs. open surgery (Open) for mycotic aortic aneurysms and the potential influence of perioperative severity of infection to the decision-making on the long-term survival. Design A multicenter, retrospective analysis of 5247 consecutive aortic aneurysm repair performed from January 2003 to December 2017 at five tertiary medical centers was conducted. Among the study population, 257 patients with mycotic aortic aneurysms s were identified. Methods: Finally, 73 patients were enrolled in the cohort after exclusion and a 1:1 propensity-matched analysis. The study cohort drawn from matched data included 37 patients in the Endo group and 36 patients in the Open group. The primary endpoint was overall survival. Secondary endpoints included infection-relapse during the follow-up. Univariate and multivariate Cox regression analyses were used to assess predictors for late mortality. Results The mean follow-up time for the entire cohort was 41 months (range, 1 to 135 months). Among propensity-matched patients, there was no significant difference in baseline characteristics. There was no difference in overall survival ( P = 0.083) between the groups at five years, but Open group was associated with a lower infection-relapse incidence during the follow-up ( P = 0.011). Subgroup analysis revealed a better survival rate for Open in patients with severe infection ( P = 0.003) or small periaortic abscess ( P = 0.049). Conclusion There were no significant differences between Endo and Open in overall survival. However, Open was a more definite option with less infection-relapse and had potential advantages for patients with severe infection or with a small periaortic abscess.

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Bridge Use of Endovascular Repair and Delayed Open Operation for Infected Aneurysm of Aortic Arch

Cited by 11 publications

References 8 publications

Minimally invasive triple valve surgery through a right minithoracotomy

Minimally invasive triple valve surgery through a right minithoracotomy

Surgical Treatment for Primary Mycotic Aneurysms Using Endovascular Therapy, Focusing on Patient Selection: Single-Center Experience

Infection-relapse and a potentially surgical stratification model for the treatment of mycotic aortic aneurysms: A propensity-matched pilot study

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