In situ versus extra-anatomic reconstruction for primary infected infrarenal abdominal aortic aneurysms

Lee, Chun-Hui; Hsieh, Hung-Chang; Ko, Po‐Jen; Li, Hao-Jui; Kao, Tsung-Chu; Yu, Sheng‐Yueh

doi:10.1016/j.jvs.2010.12.032

Cited by 52 publications

(41 citation statements)

References 38 publications

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“…Thoracic and abdominal aortic MAs are relatively uncommon and account for 0.7% to 4.5% of all aortic aneurys ms. 8,26,72,90,125,[189][190][191] The most common locations are in the abdominal aorta (≈70%) and thoracic aorta (≈30%); visceral MAs are rare (accounting for <1%). 8,72,125,189,190 Because most intra-abdominal MAs occur in patients with severe atherosclerosis, men predominate over women by 3:1.…”

Section: Thoracic and Abdominal Aortic Masmentioning

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

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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: Thoracic and Abdominal Aortic Masmentioning

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

“…To avoid prosthetic graft placement in the contaminated field and to restore the aortic flow with a remote route, extra-anatomical reconstruction is an attractive alternative to in situ reconstruction [9,87,92,93]. Extra-anatomical reconstruction also includes excision of the infected aorta and debridement of the surrounding contaminated tissue, with aortic stump closure and aortic revascularization through a noninfected pathway.…”

Section: Extra-anatomical Reconstructionmentioning

confidence: 99%

“…Late vascular complications, mostly a prosthetic graft infection, developed in up to 30% of the survivors [9-14, 16, 17, 77, 112-118]. Although the late outcomes are similar between in situ and extra-anatomical reconstruction, the latter is related to higher vascular complications, including aortic stump disruption (8-19%) and limb amputation (17-27%) [91][92][93][94][95]. Re-infection of the prosthetic graft is also possible in patients undergoing extraanatomical reconstruction [93,95].…”

Section: Traditional Open Repairmentioning

confidence: 99%

Infected Aortic Aneurysms

Lin¹,

Kan²

2017

Aortic Aneurysm

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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.

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“…Potential operative approaches include aortic ligation with extra-anatomic bypass, in situ reconstruction, and endovascular repair. Traditionally, aortic ligation with extra-anatomic bypass, such as axillary-femoral bypass grafting, has been advocated in cases of infrarenal aneurysms to avoid late infective complications [5,16]. Unfortunately, extra-anatomic bypass has been associated with higher rates of peri-operative complications and decreased long-term patency.8 Previous studies, for example, have reported a 20% risk of aortic stump disruption, a 20% to 29% amputation rate, and a 20% risk of reinfection [4,17].…”

Section: Case Reportmentioning

confidence: 99%

“…Unfortunately, extra-anatomic bypass has been associated with higher rates of peri-operative complications and decreased long-term patency.8 Previous studies, for example, have reported a 20% risk of aortic stump disruption, a 20% to 29% amputation rate, and a 20% risk of reinfection [4,17]. In situ graft reconstruction, on the other hand, has been shown in multiple studies to be a safe and durable option, with no significant difference in graft-related complications or long-term survival [4, 16,18]. To further reduce the risk of infection, most authors recommend use of a rifampin-soaked graft and buttressing of repair with an omental flap, if technically feasible [5,19].…”

Section: Case Reportmentioning

confidence: 99%

Ruptured Mycotic Aortic Aneurysm Secondary to Escherichia Coli Bacteremia in an HIV-Positive Patient

Ward¹,

Ruddy²

2017

J Clin Case Rep

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Mycotic aortic aneurysms are an aggressive form of degenerative remodeling reported more commonly in immunosuppressed patients. These aneurysms carry a high risk of progression to rupture, fulminant sepsis, and death, and therefore require prompt operative intervention. The human immunodeficiency virus (HIV) has also been associated with a broad spectrum of vascular disease, including development of aneurysms, however these have typically been identified in the peripheral vasculature. We report the case of a 71-year-old, HIV-positive male who presented with Escherichia coli bacteremia and aortitis which rapidly progressed to a ruptured infrarenal mycotic aortic aneurysm. He was managed successfully with open debridement and in situ implantation of a rifampin-soaked prosthetic graft as well as long-term antibiotic therapy. Here, we review the epidemiology, pathophysiology, and optimal surgical treatment of mycotic aortic aneurysms.

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In situ versus extra-anatomic reconstruction for primary infected infrarenal abdominal aortic aneurysms

Cited by 52 publications

References 38 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 Aortic Aneurysms

Ruptured Mycotic Aortic Aneurysm Secondary to Escherichia Coli Bacteremia in an HIV-Positive Patient

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