False aneurysm due to an infected aortic anastomosis

Roesch, C.Burling; Bond, J.W.

doi:10.1016/0002-9610(60)90257-9

The American Journal of Surgery

1960

DOI: 10.1016/0002-9610(60)90257-9

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False aneurysm due to an infected aortic anastomosis

C.Burling Roesch¹,

J.W. Bond²

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1971

1980

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Cited by 3 publications

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“…These have been related to infection (Martin, Kirklin, and DuShane, 1956;Roesch and Bond, 1960;Oldham et al, 1973), unfavourable anatomy, inadequacies of technique, and, in small children, the problem of growth failure at the suture line (Parsons and Astley, 1966).…”

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“…Aneurysms can occur in the region of a coarctation repair due to infection on the suture line (Martin et al, 1956;Roesch and Bond, 1960;Davis, Fell, and Taylor, 1965) when the problems of management have much in common with the spontaneously occurring mycotic aneurysm (Khazei and Cowley, 1967;Oldham et al, 1973) although the unpredictable early regression of collaterals should influence the surgical tactics in the postoperative variety. Aneurysms can also occur at the site where a clamp was applied to the aorta (Gazzaniga, 1966) or can involve the area of the suture line without identifiable aetiology (Blickman, 1949;Frederiksen, Poulsen, and Davidsen, 1961).…”

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Late complications of surgery for coarctation of the aorta.

Ross¹,

Monro²

1975

Thorax

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. (1975). Thorax, 30,[31][32][33][34][35][36][37][38][39]. Late complications of surgery for coarctation of the aorta. The problem of the patient who has had one operation for coarctation of the aorta and who then requires another because of a late complication at or near the coarctation site is a demanding one. The safety of aortic cross-clamping at the second operation depends on the adequacy or otherwise of the collateral circulation, and this in turn depends on the presence or absence of residual or recurrent aortic obstruction. Three illustrative cases are described in which there was complete, incomplete, and no aortic obstruction respectively at the time of reoperation, two of the cases presenting the additional complication of local aneurysm formation. The various aspects of management of such individuals are discussed, and the relevant literature has been reviewed in an attempt to provide a systematic approach to these difficult patients.The methods for assessing collateral circulation are both clinical and radiological with trial clamping of the aorta and pressure measurement as the most reliable ultimate test. A pressure of 50 mmHg in the distal aorta is accepted as indicating an adequate peripheral circulation, but it is recommended that the trial clamping should always include both the left subclavian artery and any particularly large local collaterals. The use of a perfusion technique to sustain the distal tissues is also recommended, although local bypass shunts have a place when their use is dictated in the interests of safety for the patient.From the early days of coarctation surgery late complications have been recognized and recorded (Owens and Swan, 1963). These have been related to infection (Martin, Kirklin, and DuShane, 1956;Roesch and Bond, 1960;Oldham et al., 1973), unfavourable anatomy, inadequacies of technique, and, in small children, the problem of growth failure at the suture line (Parsons and Astley, 1966).The question of late reoperation is often not an easy one and the second operation itself can be difficult and dangerous. Apart from the local hazards in the region of the previous repair, which can include aneurysm formation, dense adhesion to surrounding structures, and abnormal thinning of the aortic wall (Cerilli and Lauridsen, 1965), the most serious risk in reoperation is that of spinal cord damage and consequent paralysis (Brewer et al., 1972). This risk is related to the efficiency of the collateral circulation when the aorta is clamped or to the efficiency of the method 31 chosen to protect the distal tissues when aortic blood flow is interrupted. The state of the collateral circulation itself at the time of the second operation reflects the presence or absence of residual or recurrent aortic obstruction and its duration and degree when present.This communication describes the problem presented by three patients, all requiring late second operation, who had respectively total, partial, and no obstruction to the aortic lumen at the time of their reoperation. The three pa...

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confidence: 99%

mentioning

confidence: 99%

Late complications of surgery for coarctation of the aorta.

Ross¹,

Monro²

1975

Thorax

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Surgical considerations of infection following operations involving the descending thoracic aorta

1980

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Infection in the region of aortic repair is a dreaded complication and is well known to occur after abdominal aortic operations when prosthetic grafts communicate with groin incisions. Although the incidence of this complication is now less than 1% in these cases, it has varied from 1.3% to 6.0% and is associated with a mortality rate varying between 25% and 75%. Principles of treatment in such cases include appropriate antibiotic therapy, removal of infected prosthetic grafts, and restoration of distal circulation when necessary to avoid peripheral ischemia. The latter has been necessary in over 50% of cases and has been accomplished (a) rarely by insertion of a new graft, (b) by local reconstruction using autogenous tissue, and (c) more commonly by closing the involved aortic and arterial openings and performing an extra-anatomic bypass. Although little has been written about this problem occurring after operations for lesions of the descending thoracic aorta, such problems are known to occur. This report is concerned with a detailed review of the 9 reported cases treated surgically and 2 cases that the authors treated. Analysis of this material indicates that the principles learned from treating infected operative sites in the abdominal aorta apply to similar lesions occurring in the descending thoracic aorta.Infection in the region of repair is one of the most dreaded complications that occurs after operation involving the aorta. Most of these patients succumb to sepsis, vascular wound disruption, and exsanguination. Considerable experience has been documented with this complication in patients submitted to abdominal aortic operations both because of the numbers of operations performed and their susceptibility to infection. Susceptibility is related to a number of factors, including location and method of operation. Infection has occurred most frequently after operations employing prosthetic grafts placed in wounds that communicate with skin of potentially contaminated areas, i.e., aortofemoral artery bypass graft. The reported incidence of graft infection over the years after such abdominal aortic operation varies from 1.3% to 6.0% and the mortality rate varies from 25% to 75% [1][2][3][4][5]. The present incidence of graft infection is probably less than 1%; however, the mortality rate probably ranges from 20% to 50% [6]. Infection has been controlled for long periods of time in some of these cases by proper drainage and suppressive antibiotic therapy; however, long-term survival has been associated most often with antibiotic therapy and graft removal. The latter procedure frequently has required some form of arterial reconstruction to maintain distal arterial circulation [7].The incidence of infection following operations for lesions of the descending thoracic aorta is clearly much lower than that reported following abdominal aortic operation, since there are few reports regarding this problem. A lower incidence of infection at this level is expected since the aortic repair is not performed in a wound that...

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False aneurysm due to Mucor following repair of a coarctation with a Dacron prosthesis

Callard

Wright

Wray

et al. 1971

The Journal of Thoracic and Cardiovascular Surgery

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False aneurysm due to an infected aortic anastomosis

Cited by 3 publications

References 3 publications

Late complications of surgery for coarctation of the aorta.

Late complications of surgery for coarctation of the aorta.

Surgical considerations of infection following operations involving the descending thoracic aorta

False aneurysm due to Mucor following repair of a coarctation with a Dacron prosthesis

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