“In situ” endografting in the treatment of arterial and graft infections

Haidar, Georges M.; Hicks, Taylor D.; Strosberg, David S.; El-Sayed, Hosam F.

doi:10.1016/j.jvs.2016.12.134

Cited by 24 publications

(22 citation statements)

References 43 publications

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“…However, operative mortality of 20–50% and survival rate of 50% at 24 months is reported [2, 4]. Aortoenteric fistula should be suspected if Gram-negative bacteria are present [2, 4]. Several different microorganisms were isolated in our patient, all commonly present in the digestive tract.…”

Section: Discussionmentioning

confidence: 87%

“…Heterogenecity of the patient population, different surgical methods and multitude of microbes involved make it difficult to compare studies [2]. However, operative mortality of 20–50% and survival rate of 50% at 24 months is reported [2, 4]. Aortoenteric fistula should be suspected if Gram-negative bacteria are present [2, 4].…”

Section: Discussionmentioning

confidence: 99%

“…Antibiotics may have suppressed but not eradicated the patient's infection. Life-long appropriate antibiotic therapy for any patient receiving a graft in an infected field is recommended [4]. …”

Section: Discussionmentioning

confidence: 99%

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Non-curative surgery for aortoenteric fistula

Hansen

Amundsen

Reikvam

et al. 2017

Journal of Surgical Case Reports

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Graft infection with secondary aortic fistula is a rare complication following implantation of aortic prostheses, frequently occurring after emergency procedures and reoperations. The condition is associated with considerable morbidity and mortality. Curative treatment consists of explantation of the infected graft followed by fistula revision and implantation of a new graft in combination with antimicrobial therapy. Non-curative treatment with aortic stentgraft and long-term substitution treatment with antibiotics may be an option in cases where graft explantation is deemed too risky. We present an elderly patient with aortoenteric fistula following surgery for ruptured abdominal aortic aneurysm. Implantation of an aortic stentgraft and fistula revision was performed but the original aortic prosthesis was not explanted. The aortoenteric fistula recurred twice, but the patient has survived more than 12 years following non-curative surgery with good quality of life.

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Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

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Non-curative surgery for aortoenteric fistula

Hansen

Amundsen

Reikvam

et al. 2017

Journal of Surgical Case Reports

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“…It's a bridging or staging solution till stabilization of the patient condition and identifying an indication for the operation, like in our case. However bridging therapy is not a curative option [12].…”

Section: Discussionmentioning

confidence: 99%

Management of an Aortic Graft Infection after Endovascular Aneurysm Repair

Elfeky¹

2019

AVS

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A 77-years-old hypertensive patient who underwent EVAR for an enlarging 7-cm Abdominal Aortic Aneurysm (AAA) Using a Lombard Aorfix Graft. Protective embolization of the patient inferior mesenteric artery.The post-operative CT Angiography confirmed a successful treatment of the aneurysm without need of further intervention. The patient attends for follow up controls afterward. Twenty-one months after the EVAR, the patient admitted due to abdominal pain and elevated infection parameters for further investigations.An abdominal CT scan is done and demonstrated a remarkable contrast enhancement of the aneurysm wall and periaortic fluid collections ( Figure 1). An empirical antibiotic therapy was started with Meropenem. The following days started the patients to develop high fever. The blood cultures revealed infection with Staphauereus; accordingly the antibiotic was changed to Linezolid.For both diagnostic and potentially therapeutic purposes, CT guided drainage of the periaortic fluid collections was done ( Figure 2).Two days later we decided to operate the patient. A complete surgical excision of the infected aortic stent was done. The intraoperative findings were remarkable for inflamed aneurysmal sac with thick purulent exudates surrounding the loosely incorporated graft (Figure 3). AbstractIntroduction: Endovascular Aneurysm Repair (EVAR) is currently considered the predominant treatment for Abdominal Aortic Aneurysm (AAAs), especially in a high-risk patient, providing a low early morbidity and mortality compared with open repair. A very low number of EVAR patients suffer complications, ranging from 0.7% related to local-vascular or implant-related complications to 11% for systemic complications. Endograft infection after EVAR represents one of the most serious complications. Although the incidence of Endograft infection is rare and below 1% it is often associated with high mortality and morbidity rates.The therapeutic options are limited and should be individualized based on patient's general condition and comorbidities. The common clinical presentations are acute or chronic sepsis. The treatment options of Endograft infections classified either to remove the graft and it is considered the gold Standard approach, or bridging therapy and conservative treatment for patients which not suitable for surgery. Till now there is no evidence to prove the superiority of a treatment method over the other.The in-situ arterial reconstruction is preferred because of the low mortality and morbidity rate in comparison with extra anatomical bypass like axillo-bifemoral bypass.We report a case of infected Aortic graft after EVAR. The sequence of events in this case sheds light upon the importance of synchronization between conservative treatment, endovascular intervention and surgical intervention to achieve better results in terms of mortality and morbidity. The patient provided written informed consent to the publication Objective: The sequence of events in this case report sheds light upon the importance of synchronization b...

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“…Stent-Graft und Stabilisierung des Patienten kann dann die definitive Versorgung des Patienten geplant werden. Aufgrund der hohen Re-Infektionsrate hat sich die alleinige Bridging-Therapie bei kurativem Ansatz nicht bewährt [25].…”

Section: Eine Konservative Therapie Ist Nur Bei Multimorbidenunclassified