Conservative Management First Strategy in Aortic Vascular Graft and Endograft Infections

Ljungquist, Oskar; Haidl, Sven; Dias, Nuno; Sonesson, Björn; Sörelius, Karl; Trägårdh, Elin; Ahl, Jonas

doi:10.1016/j.ejvs.2023.03.003

Cited by 14 publications

(11 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The overall mortality after the two-year mean follow-up was found to be 43% ( Figure 3 A, Table 4 ). Regarding the good short- and midterm survival rates of over 90% at six months published lately for both aortic and thoracic VGEIs, surgical graft removal must eventually be considered as “added mortality/morbidity” in this vulnerable cohort [ 12 , 13 ]. Here, the complexity of repair and additional operative procedures had no influence on the in-hospital mortality ( Figure 4 , Supplementary Table S5 ).…”

Section: Discussionmentioning

confidence: 99%

“…Here, upon graft removal, early and late mortality have been summarized to vary between 4.3–48% and 9–85%, respectively [ 3 , 11 ]. Conservative treatment with or without eventual drainage, irrigation and lifelong anti-infectives is palliative and only scarcely reported [ 12 ]. If no bleeding or fistulas occurred, singular cases were shown to have good life expectancy [ 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Aortic Vascular Graft and Endograft Infection–Patient Outcome Cannot Be Determined Based on Pre-Operative Characteristics

Puttini,

Kapalla,

Braune

et al. 2024

JCM

View full text Add to dashboard Cite

Vascular graft/endograft infection (VGEI) is a serious complication after aortic surgery. This study investigates VGEI and patient characteristics, PET/CT quantification before surgical or conservative management of VGEI and post-intervention outcomes in order to identify patients who might benefit from such a procedure. PET standard uptake values (SUV) were quantitatively assessed and compared to a non-VGEI cohort. The primary endpoints were in-hospital mortality and aortic reintervention-free survival at six months. Ninety-three patients (75% male, 65 ± 10 years, 82% operated) were included. The initial operation was mainly for aneurysm (67.7%: 31% EVAR, 12% TEVAR, 57% open aortic repair). Thirty-two patients presented with fistulae. PET SUVTLR (target-to-liver ratio) showed 94% sensitivity and 89% specificity. Replacement included silver-coated Dacron (21.3%), pericardium (61.3%) and femoral vein (17.3%), yet the material did not influence the overall survival (p = 0.745). In-hospital mortality did not differ between operative and conservative treatment (19.7% vs. 17.6%, p = 0.84). At six months, 50% of the operated cohort survived without aortic reintervention. Short- and midterm morbidity and mortality remained high after aortic graft removal. Neither preoperative characteristics nor the material used for reconstruction influenced the overall survival, and, with limitations, both the in-hospital and midterm survival were similar between the surgically and conservatively managed patients.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Aortic Vascular Graft and Endograft Infection–Patient Outcome Cannot Be Determined Based on Pre-Operative Characteristics

Puttini,

Kapalla,

Braune

et al. 2024

JCM

View full text Add to dashboard Cite

show abstract

“…Percutaneous drainage can reduce the local bacterial burden and provide microbiological specimens for antimicrobial sensitivity testing. The percutaneous catheter can be connected to a closed drainage bag, and repeated irrigation can be performed using an A retrospective, observational, single-center cohort study from Sweden reported the results of conservative management of aortic graft (n=8) and endograft (n=42) infections [53]. The study included patients without an aortic fistula.…”

Section: ) Conservative Treatmentmentioning

confidence: 99%

Aortic Endograft Infection: Diagnosis and Management

Kim

2023

Vasc Specialist Int

View full text Add to dashboard Cite

Aortic endograft infection (AEI) is a rare but life-threatening complication of endovascular aneurysm repair (EVAR). The clinical features of AEI range from generalized weakness and mild fever to fatal aortic rupture or sepsis. The diagnosis of AEI usually depends on clinical manifestations, laboratory tests, and imaging studies. Management of Aortic Graft Infection Collaboration (MAGIC) criteria are often used to diagnose AEI. Surgical removal of the infected endograft, restoration of aortic blood flow, and antimicrobial therapy are the main components of AEI treatment. After removing an infected endograft, in situ aortic reconstruction is often performed instead of an extra-anatomic bypass. Various biological and prosthetic aortic grafts have been used in aortic reconstruction to avoid reinfection, rupture, or occlusion. Each type of graft has its own merits and disadvantages. In patients with an unacceptably high surgical risk and no evidence of an aortic fistula, conservative treatment can be an alternative. Treatment results are determined by bacterial virulence, patient status, including the presence of an aortic fistula, and hospital factors. Considering the severity of this condition, the best strategy is prevention. When encountering a patient with AEI, current practice emphasizes a multidisciplinary team approach to achieve an optimal outcome.

show abstract

“…1 Thus, long-term antibiotic treatment together with the best supportive care measures avoiding invasive graft removal is being discussed more frequently. 2 Often, such high-risk patients present as emergencies with bleeding complications at risk of death. In these cases, a standard polyester stent graft can be implanted as a bridging procedure.…”

Section: Introductionmentioning

confidence: 99%

Physician-made pericardium stent graft as a potential endovascular alternative for infectious aortic disease – an ex-vivo proof-of-concept study

Reutersberg,

Meuli,

Zimmermann

et al. 2024

Science Progress

View full text Add to dashboard Cite

Purpose. The treatment of infectious aortic disease is still challenging with open surgical debridement and reconstruction using biological, preferably autologous material, being the treatment of choice. However, these procedures are associated with high morbidity and mortality. Endovascular therapy is often considered a bridging method only, since the biologically inactive fabric of the covered stent grafts usually cannot be treated sufficiently with anti-infective agents in the event of a (obligate) consecutive secondary graft infection. This study aims to prove the feasibility of a physician-made pericardium stent graft ex-vivo. Technique. A state-of-the-art TEVAR was modified by separating the fabric from the z-stents and suturing a hand-sewn bovine pericardium tube to the bare metal. Feasibility of preparation, re-sheathing, and delivery is demonstrated in an ex-vivo model. Conclusion. This first xenogeneic stent graft could be manufactured and deployed successfully. In the future this may provide a bridging alternative for high-risk patients with infected native aortic aneurysm or aortic fistulas, eventually followed by surgical or thoracoscopic/laparoscopic debridement. Further studies on simulators or animal models are needed to test the technique and investigate its long-term durability. Additionally, this study prompts reflection on whether materials currently used should be further developed to prevent graft infections.

show abstract

Conservative Management First Strategy in Aortic Vascular Graft and Endograft Infections

Cited by 14 publications

References 31 publications

Aortic Vascular Graft and Endograft Infection–Patient Outcome Cannot Be Determined Based on Pre-Operative Characteristics

Aortic Vascular Graft and Endograft Infection–Patient Outcome Cannot Be Determined Based on Pre-Operative Characteristics

Aortic Endograft Infection: Diagnosis and Management

Physician-made pericardium stent graft as a potential endovascular alternative for infectious aortic disease – an ex-vivo proof-of-concept study

Contact Info

Product

Resources

About