Improved results with conventional management of infrarenal aortic infection

Yeager, Richard A.; Taylor, Lloyd M.; Moneta, Gregory L.; Edwards, James M.; Nicoloff, Alexander D.; McConnell, Donald B.; Porter, John M.

doi:10.1016/s0741-5214(99)70178-3

Cited by 151 publications

(116 citation statements)

References 15 publications

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“…First, an extra-anatomic bypass is performed and next, an excision of the infected graft with débridement is done. 4,85,92,93,101 Revascularization by axillobifemoral bypass of the lower extremities is ideally performed before ‡References clInIcal stateMents anD GuIDelInes excision of the infected aortic graft to minimize ischemia. Either during the same procedure or preferably at least 24 to 48 hours after revascularization, a complete excision of the infected graft is performed.…”

Section: Intra-abdominalmentioning

confidence: 99%

“…The 24-to 48-hour waiting period before graft excision can reduce lower extremity ischemia and associated limb loss. 4,6,85,92,93,101 Reilly et al 97 reported 26% mortality when graft excision was performed during the same procedure.A 2-stage procedure should be considered only in patients who are stable hemodynamically. In patients who present with hemorrhage from a ruptured graft, emergency intervention is necessary to control bleeding, and extra-anatomic revascularization of the lower extremities is performed after bleeding from the aortic stump is controlled.…”

mentioning

confidence: 99%

“…This procedure, first performed in the 1960s, was accepted as the standard of care against which other procedures were measured. 5,83,[92][93][94][95][96][97][98][99] In selected patients, it is still considered to be the treatment of choice. However, the major disadvantages of extra-anatomic bypass followed by graft excision are lower short-and long-term patency rates of the bypass graft; a 2-stage, lengthy surgical procedure; relatively high rate of amputation of the lower extremity; risk of rupture of the stump at the aortic suture line, with potentially life-threatening hemorrhage; and difficulty establishing an extra-anatomic revascularization route in the inguinal region.…”

mentioning

confidence: 99%

“…8,11,27 In the past, the "gold standard" management of these patients was extra-anatomic bypass surgery followed by graft excision. 5,83,[92][93][94][95][96][97][98][99]111 In selected patients, that might still be the procedure of choice; however, because of the high rates of mortality and potential complications, including limb loss, numerous studies have suggested that alternative surgical options might be preferable to extra-anatomic bypass and graft excision. For patients with aortoenteric fistula caused by methicillin-sensitive S aureus or less virulent microorganisms, such as coagulase-negative staphylococci, streptococci, susceptible enterococci, or susceptible enteric gram-negative bacilli, graft excision and in situ reconstruction with either cryopreserved or fresh arterial allograft, venous autograft, or rifampin-bonded synthetic graft are reasonable.…”

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confidence: 99%

See 3 more Smart Citations

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

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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...

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Section: Intra-abdominalmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

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

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“…And this procedure also has potential risk of infection of the axillobifemoral bypass grafts. 18) Though Yeager et al 19) reported an acceptable operative risk and long-term limb salvage rates, overall perioperative mortality rate was 20% after treatment of infrarenal aortic infection.…”

Section: ) Surgical Treatmentmentioning

confidence: 99%

Infected Aneurysm: Current Management

Kim

2010

Annals of Vascular Diseases

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Infrascrotal, Perineal, Femorofemoral Bypass for Arterial Graft Infection at the Groin

Caliò¹,

D’Urso²,

Giacobbi³

et al. 2004

Arch Surg

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Hypothesis: Infrascrotal, perineal, femorofemoral bypass is an acceptable procedure for treating infection of a prosthetic arterial graft limited to a unilateral groin. Design: A consecutive sample clinical study with a mean follow-up of 29 months. Setting: The surgical department of an academic tertiary care center and an affiliated secondary care center. Patients: Nineteen patients with a mean age of 68 years with prosthetic graft infection at the outflow anastomosis on a femoral artery at the Scarpa triangle underwent an infrascrotal, perineal, femorofemoral bypass, with excision of the graft material limited at the groin. The recipient artery was the profunda femoris artery in 12 cases, the superficial femoral in 5, and the distal common femoral artery in 2. Main Outcome Measures: Cumulative survival, recurrence of sepsis, primary graft patency, and limb salvage rates expressed by standard life-table analysis. Results: Postoperative mortality rate was 5%. Cumulative (SE) survival rate was 65% (11.6%) at 3 years. Cumulative (SE) rate of freedom from recurrent sepsis was 88% (8.6%) at 3 years. Cumulative (SE) primary patency and limb salvage rates were 86% (9.4%) and 91% (7.9%), respectively, at 3 years. Conclusion: Femorofemoral bypass with an infrascrotal perineal approach is a valuable procedure for the treatment of femoral arterial graft infection limited at a unilateral groin.

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Improved results with conventional management of infrarenal aortic infection

Cited by 151 publications

References 15 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

Infected Aneurysm: Current Management

Infrascrotal, Perineal, Femorofemoral Bypass for Arterial Graft Infection at the Groin

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