Conservative treatment of major aortic graft infection

Quick, Clive R.G.; Vassallo, Diana; Jf, Colin; Heddle, R. M.

doi:10.1016/s0950-821x(05)80040-4

Cited by 26 publications

(12 citation statements)

References 11 publications

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“…Since the 1980s, improvements in perioperative care and surgical technique have improved limb salvage and early mortality from 50% to less than 15%. 1,2 Although small series report on nonsurgical management, 3,4 larger series show poor long-term results. 5,6 Debridement of dead tissue, repair of graft-enteric erosions, and systemic antibiotics with or without graft excision are the mainstays of treatment.…”

mentioning

confidence: 99%

Reinfection after resection and revascularization of infected infrarenal abdominal aortic grafts

Charlton-Ouw

Sandhu²,

Huang

et al. 2014

Journal of Vascular Surgery

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mentioning

confidence: 99%

Reinfection after resection and revascularization of infected infrarenal abdominal aortic grafts

Charlton-Ouw

Sandhu²,

Huang

et al. 2014

Journal of Vascular Surgery

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“…The results of conservative treatment in the previous reports are as follows: perioperative mortality, 0%-25%; need for surgical intervention, 0%-50%; complete cure, 25%-100% 32,50,54 (Table 5). Perhaps all of the reported cases might be appropriate candidates for a trial of conservative nonresectional management of aortic graft infection.…”

Section: Discussionmentioning

confidence: 97%

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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“…The 'gold standard' treatment has been radical removal of the infected graft with extra-anatomic bypass to the lower limbs4,*". Recently, there have been reports of less extensive surgery12, 13,22 or irrigation regimens with claims of good OUtCOmel~, 16,[23][24][25][26] . The numbers treated by these latter techniques are small and long-term follow-up is not always available.…”

Section: Major Outcomementioning

confidence: 99%

“…The numbers treated by these latter techniques are small and long-term follow-up is not always available. Irrigation techniques are suggested for those patients who are at 'high risk' or 'not suitable' f o r radical surgery15, 16,23,24 . Undoubtedly local surgery is occasionally successful but, as has been shown in previous studies, recurrent graft infection is to be expected in 22-100 per cent of cases, depending of the technique used4,*'.…”

Section: Major Outcomementioning

confidence: 99%

Aortic prosthetic infection: 50 Patients treated by radical or local surgery

Hannon

Wolfe

Mansfield

1996

Journal of British Surgery

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Fifty patients with aortic prosthetic infection were managed in a period of 10 years from 1983 to 1993. Twenty-five patients had recurrent sepsis after local surgery (group 1) and 22 of these eventually required radical surgery. Twenty-five patients had radical graft excision as the first procedure (group 2). Group 1 contained an excess of patients with local groin symptoms (11 in group 1 versus five in group 2, P = 0.03) and in this group fewer radiological techniques were used to document the extent of graft infection. The perioperative mortality rate was similar in both groups (seven in group 1 versus five in group 2). The number of amputations was also similar (five in group 1 versus four in group 2). The triad of occlusive disease, aortobifemoral bypass and groin symptoms was associated with eight of nine amputations. While the authors would consider using local techniques if the anastomosis was intact, the graft remained patent and infection appeared to be confined to the groin, this combination is uncommon and radical graft excision remains the preferred treatment.

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Conservative treatment of major aortic graft infection

Cited by 26 publications

References 11 publications

Reinfection after resection and revascularization of infected infrarenal abdominal aortic grafts

Reinfection after resection and revascularization of infected infrarenal abdominal aortic grafts

Treatment for Aortic Graft Infection

Aortic prosthetic infection: 50 Patients treated by radical or local surgery

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