In situ allograft replacement of infected infrarenal aortic prosthetic grafts: Results in forty-three patients

Kieffer, Édouard; Bahnini, Amine; Koskas, Fabien; Ruotolo, Carlo; Blevec, Dominique Le; Plissonnier, Didier

doi:10.1016/0741-5214(93)90420-q

Cited by 227 publications

(101 citation statements)

References 19 publications

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“…1, [4][5][6] In addition to sepsis, gastrointestinal tract bleeding can occur, which ranges from minimal to massive with potential exsanguination. Depending on the location of the enteric fistula, bleeding can manifest as hematemesis, hematochezia, or melena.…”

Section: Intracavitarymentioning

confidence: 99%

“…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][2][3][4][5][6] Graft infection is most common after emergency procedures and after reoperation.…”

Section: Frequencymentioning

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.…”

Section: Intra-abdominalmentioning

confidence: 99%

“…In a patient who has undergone reconstructive surgery for abdominal aortic aneurysm, the development of sepsis with otherwise unexplained polymicrobial enteric bacteremia is highly suggestive of a VGI with duodenal erosion. Rarely, a VGI can cause a fistulous communication with the colon, with a similar presentation and polymicrobial enteric bacteremia.1, [4][5][6] In addition to sepsis, gastrointestinal tract bleeding can occur, which ranges from minimal to massive with potential exsanguination. Depending on the location of the enteric fistula, bleeding can manifest as hematemesis, hematochezia, or melena.…”

mentioning

confidence: 99%

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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: Intracavitarymentioning

confidence: 99%

Section: Frequencymentioning

confidence: 99%

Section: Intra-abdominalmentioning

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

show abstract

“…Аневризматическая дегенерация и разрыв трансплантата развивались в 3% случаев. Полу-ченные результаты в той или иной степени со-гласуются с данными других исследователей [28,43]. Немногочисленные сообщения, касающиеся использования нативных артериальных транс-плантатов, вероятно, не могут в полной мере охарактеризовать их эффективность.…”

Section: варианты хирургического леченияunclassified

Paraprosthetic Infection in Vascular Surgery: Current State of the Problem

Романович¹,

Khryshchanovich²

2017

Novosti Khirurgii

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Инфицирование синтетического сосудистого протеза после выполнения экстренных и плановых ар-териальных реконструктивных вмешательств является наиболее опасным осложнением в ангиохирургии. Подобное послеоперационное осложнение встречается у 0,2-5% пациентов, а частота летальных исходов варьирует от 25% до 88% случаев, при этом риск потери нижней конечности достигает 60%. В статье изложе-ны этиология, симптоматика, клиническая картина и диагностика нагноения синтетического протеза после артериальных реконструктивных вмешательств. Подробно описаны существующие методы лечения парапро-тезной инфекции, обсуждены преимущества и недостатки каждого из них. Приведены ближайшие и отдален-ные результаты различных вариантов хирургической тактики при инфицировании синтетических сосудистых протезов. Высокий уровень осложнений и ампутаций, связанных с экстраанатомическим шунтированием, требует поиска альтернативных подходов к хирургическому лечению парапротезной инфекции. Достоинства-ми реконструктивных операций in situ являются адекватная реваскуляризация нижних конечностей и лучшие отдаленные результаты лечения по сравнению с экстраанатомическим шунтированием. В обзоре проводится сравнительный анализ биологических и синтетических материалов наиболее часто применяемых в мировой практике для повторных реконструктивных вмешательств: синтетических сосудистых протезов с покрытием, аутовенозных трансплантатов, криоконсервированных и нативных артериальных аллографтов. Ключевые слова: аорта, диагноз, трансплантат, инфекция, протез, результаты лечения, осложненияInfection of synthetic vascular grafts after the emergency and scheduled arterial reconstructive operations is considered to be the most dangerous complication in vascular surgery. Postoperative wound suppuration occurred in 0.2-5% of patients and mortality rate varies from 25% to 88% of cases; the risk to lose the lower limbs reaches 60%. The article presents the etiology, symptoms, clinical presentation and diagnosis of synthetic prosthesis suppuration after the arterial reconstructive surgery. The existing treatment methods of the infected synthetic vascular grafts are described in details; the advantages and disadvantages of then each are discussed. Immediate and long-term results of various kinds of surgical treatment of local prosthetic graft infection have been presented. Then short-term high complications and amputation rates related to extra-anatomic bypass requires a search for alternative technique for infective paraprosthetic leakage repair. The advantages of reconstruction-associated procedure in situ are the adequate lower-limb revascularization and the best long-term treatment results compared with extra-anatomic bypass. This article reviews the currently available biological and synthetic graft materials routinely used in world practice for the repeated reconstructive surgeries: coated synthetic vascular prostheses, autovenous grafts, native and cryopreserved arterial allografts.

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Complex Aortofemoral Prosthetic Infections

et al. 1999

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Background: With increasing experience, we have encountered patients with complex aortofemoral prosthetic infections in whom extra-anatomic bypass (EAB) is not an option. Hypothesis: Autogenous superficial femoropopliteal vein (SFPV) aortic reconstruction provides a limb-saving and lifesaving alternative with acceptable morbidity and mortality. Design: Retrospective review. Setting: University-based county, private, and Veterans Affairs hospitals. Patients: Seventeen patients with infected aortofemoral bypasses in whom conventional EAB was impossible because of infection of previously placed EAB, massive groin and/or thigh sepsis, or both. Main Outcome Measures: Morbidity and mortality. Results: Multiple previous operations were common (mean, 4 per patient) and included EAB (n = 11), replacement aortofemoral bypass (n = 4), prosthetic

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In situ allograft replacement of infected infrarenal aortic prosthetic grafts: Results in forty-three patients

Abstract: Although complete protection against persistent or recurrent infection has not been achieved and late deterioration may be expected, in situ allograft replacement seems to be a major advance in the management of infected infrarenal aortic prosthetic grafts.

Cited by 227 publications

References 19 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

Paraprosthetic Infection in Vascular Surgery: Current State of the Problem

Complex Aortofemoral Prosthetic Infections

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