Endovascular therapy for infected aortic aneurysms

Kritpracha, Boonprasit; Premprabha, Dhanakom; Sungsiri, Jitpreedee; Tantarattanapong, Wittawat; Rookkapan, Sorracha; Juntarapatin, Pong

doi:10.1016/j.jvs.2011.03.301

Cited by 76 publications

(81 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In these patients, Vallejo and others reported that a combination (hybrid) of in situ reconstruction and EVT might be necessary. 190,228,[241][242][243][244][245][246][247][248] Subsequent explantation of EVT devices is especially challenging in patients with hybrid procedures and might not be technically feasible. Vallejo and colleagues 190 recommended EVT or hybrid procedures only in selected patients and concluded that open in situ repair remains the surgical management of choice.…”

Section: Clinical Statements and Guidelinesmentioning

confidence: 99%

Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: A Scientific Statement From the American Heart Association

Wilson¹,

Bower²,

Creager³

et al. 2016

Circulation

373

307

View full text Add to dashboard Cite

The use of synthetic material for reconstructive vascular surgery was first reported during the early 1950s. Infection involving vascular graft prostheses is an infrequent but devastating complication of reconstructive vascular graft surgery and is associated with a high morbidity and, in some situations, mortality. Improvements in surgical techniques and graft design, including the use of native venous or arterial tissue, have reduced the frequency of infection and severity of complications from vascular graft infection (VGI). However, these advances have also led to more frequent vascular graft procedures occurring in a patient population with multiple underlying comorbidities that would have previously disqualified them as candidates for vascular reconstructive surgery. Underlying comorbidities, such as diabetes mellitus or immune compromise, increase the risk of infection and serious infection-related complications. The major complications of VGI include sepsis, amputation, disruption of infected anastomotic suture line with rupture or pseudoaneurysm formation, embolization of infected thrombi, reinfection of reconstructed vascular grafts, enteric fistulae to the small or large bowel, bacteremic spread of infection to other sites, and death. VGIs can be categorized broadly into those that occur in an extracavitary location, primarily in the groin or lower extremities, or in an intracavitary location, primarily within the abdomen or less commonly within the thorax. frequencyThe frequency of VGI depends on the anatomic location of the graft. The infection rate is 1.5% to 2% for most extracavitary grafts and as high as 6% with vascular grafts in the groin. [1][2][3][4][5][6][7][8][9] For intracavitary grafts, the infection rate is ≈1% to 5%. 1-6 Graft infection is most common after emergency procedures and after reoperation. [1][2][3][4]10 Aortic graft erosion or fistulous communication into the duodenum or other areas of the bowel reportedly occurs in 1% to 2% of patients after aortic reconstruction. 11,12 MicrobiologyThe microbiological cause of VGI has evolved over the years. 1 In early published studies, Staphylococcus aureus was the predominant microorganism recovered. 1,13 Improvements in surgical technique, administration of prophylactic antistaphylococcal antimicrobial therapy, and other factors have resulted in a changing microbiological epidemiology. Vascular graft surgery performed on patients with multiple underlying comorbidities and the increased frequency of emergency procedures have contributed to the changing spectrum of infection. Other factors such as changes in hospital flora, surgery in patients with complicated vascular anatomy, and multiple revisions of previous vascular surgery have resulted in a more diverse microbio- clInIcal stateMents anD GuIDelInes logical spectrum of infection, which includes multidrugresistant strains, polymicrobial infection, and Candida species. Gram-positive cocci accounts for at least two thirds of VGIs. 1,13 Infections caused by coagulase-negative staphylococ...

show abstract

Section: Clinical Statements and Guidelinesmentioning

confidence: 99%

Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: A Scientific Statement From the American Heart Association

Wilson¹,

Bower²,

Creager³

et al. 2016

Circulation

373

307

View full text Add to dashboard Cite

show abstract

“…An endoluminal approach may also be used in cases without clinical evidence of HIV activity and in high surgical risk patients, and that was our choice in Case 1. In similar cases, broad spectrum antibiotics should be used, although treatment duration has not been defined and may last months, years, or the rest of the patient's life 10,7,11 .…”

Section: Discussionmentioning

confidence: 99%

Pseudoaneurismas em associacao com infeccao pelo virus da imunodeficiencia humana: relato de dois casos

et al. 2013

View full text Add to dashboard Cite

The authors describe the cases of two patients with pseudoaneurysms, discuss the difficulty in establishing diagnosis and treatment due to human immunodeficiency virus infection, and demonstrate the similarity with atherosclerotic saccular aneurysm of the abdominal aorta.Keywords: HIV; pseudoaneurysm; saccular aneurysm. ResumoOs autores descrevem os casos de dois pacientes que apresentaram pseudoaneurismas e ressaltam a dificuldade diagnóstica e terapêutica por apresentar associação com a infecção pelo vírus da imunodeficiência humana, e também demonstram a semelhança com aneurisma sacular aterosclerótico da aorta abdominal.Palavras-chave: HIV; pseudoaneurisma; aneurisma sacular. As the patient was obese, had previous abdominal surgery and her anatomy was favorable, the plan was to use an endovascular approach to place an aortic endoprosthesis for aneurysm repair.Right femoral dissection and left femoral puncture were used to place a 25 mm × 16 mm × 100 mm Powerlink R endoprosthesis (Endologix, Irvine, CA) using a 9F introducer sheath, and the aneurysm was immediately repaired. Post-operative progression was good, and the patient was discharged on the second day after operation. Ten days after the operation, she presented with left lower back pain, diarrheic stools, vomiting and paresthesia of left lower extremity. Physical examination detected femoral and distal pulses and no sign of hyperemia in the surgical wound; laboratory tests were normal. Two days after hospitalization, her general state deteriorated and she had abdominal and lower extremity pain. Physical examination found that the lower extremities were cold, and no pulses should be detected. Ultrasound scanning confirmed the clinical hypothesis of endoprosthesis occlusion. She underwent an urgent surgery for an axillobifemoral bypass and placement of an 8-mm Dacron prosthesis, and revascularization of the lower extremities was successful. After operation in the ICU, she was administered broad spectrum antibiotics (vancomycin 1 g, 12h/12h and meropenem 1 g, 8h/8h), but had refractory septic shock and died. Case 2A previously healthy 47-year-old male smoking patient was transferred from another hospital ward with a history of daily low fever for 20 days. Nine

show abstract

“…Furthermore, for infected aneurysms affecting the thoracic aorta and aortic arch, the surgical procedure typically employs extracorporeal circulation, cardiopulmonary bypass, and even a period of deep hypothermic circulatory arrest (DHCA), further increasing the operative risks. The feasibility of endovascular aortic repair (EVAR) for infected aortic aneurysms has been investigated in numerous studies, which in turn provided encouraging short-term results [18,42,[70][71][72][73][74]. However, the long-term survival and late-onset complications, especially recurrent or persistent infections, are of greater concerns [74].…”

Section: Managementmentioning

confidence: 99%

“…Several studies continuously demonstrated that EVAR is a possible alternative procedure for infected aortic aneurysm patients with high surgical risks, with an early mortality rate less than 20%, which is comparable to that of traditional open repair. A poorer outcome was still evident in patients with aneurysm-related fistulation complication [71,72,[124][125][126][127]. Persistent infection greatly contributed to both early and late mortalities; thus, adjunctive procedures to eliminate contamination and prolonged antibiotic therapy duration after EVAR were usually advocated in the literatures [18,72,74] (see more details in Sections 7.4 and 7.5).…”

Section: Endovascular Techniquementioning

confidence: 99%

“…In 2011, Kritpracha and colleagues published their institutional experience of endovascular therapy for infected aortic aneurysms and showed an impressive mid-term outcome for those without an aortic fistulation [72]. They routinely prescribed lifelong antibiotics to the patients, and no adjunctive procedure was conducted.…”

Section: Adjunctive Procedures After the Initial Evarmentioning

confidence: 99%

See 1 more Smart Citation

Infected Aortic Aneurysms

Lin¹,

Kan²

2017

Aortic Aneurysm

View full text Add to dashboard Cite

Infected aortic aneurysms are surgical urgencies, requiring prompt management to avoid the development of catastrophic complications. Although traditional open surgery composed of radical debridement and aortic reconstruction remains the gold-standard, many favorable results of the endovascular repair strategy have been reported. In this chapter, the etiology, bacteriology, clinical manifestation, and diagnostic criteria of infected aortic aneurysms will be discussed in detail at first, followed by a comprehensive review of both traditional open surgery and endovascular repair, based on current evidences and the authors' institutional experience. Along with long-term oral antibiotic suppression and aggressive adjunctive procedures, endovascular repair for uncomplicated infected aortic aneurysms could be a definite treatment alternative to traditional open surgery in the endovascular era.

show abstract

Endovascular therapy for infected aortic aneurysms

Abstract: Endovascular therapy, as a definite treatment for infected aortic aneurysms, provided excellent short- and medium-term results in patients without fistula complications. However, a poorer outcome was evident in patients with fistula complications.

Cited by 76 publications

References 26 publications

Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: A Scientific Statement From the American Heart Association

Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: A Scientific Statement From the American Heart Association

Pseudoaneurismas em associacao com infeccao pelo virus da imunodeficiencia humana: relato de dois casos

Infected Aortic Aneurysms

Contact Info

Product

Resources

About