Incidence, Management, and Outcomes of Aortic Graft Infection

Shiraev, Timothy; Barrett, Sean; Heywood, Sean; Mirza, Wasif; Hunter-Dickson, Mitchell; Bradshaw, Camilla; Hardman, David; Neilson, Wendell; Bradshaw, Stephen

doi:10.1016/j.avsg.2019.01.027

Cited by 27 publications

(27 citation statements)

References 33 publications

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“…The surgical management of AGI depended on the degree and extent of infection. It was generally believed that if the graft and autologous tissue were still surrounded by healthy autologous tissue, the survival rate was higher if the vascular prosthesis not removed [8,9]. For this case, the graft was not infected and existing prosthetic grafts could be salvaged, so only debridement was performed and the vascular graft not replaced.…”

Section: Discussionmentioning

confidence: 99%

Perigraft abscess after DeBakey type-1 aortic dissection: a case report

Lin

Yang

2020

J Cardiothorac Surg

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Background: Perigraft abscess is a rare condition which constitutes a small proportion of aortic graft infection (AGI). Early diagnosis is very important for timely intervention and improving the survival rate of patients because of its significant morbidity and mortality. Case presentation: A 24-year-old young male patient with a history of complicated total arch replacement using elephant trunk technique for acute DeBakey type-1 aortic dissection 6 months before visited our hospital with the chief complaint of persistent fever. Antibiotic treatment in local hospital was ineffective. Echocardiography showed liquid dark area around the aortic graft, and a computerized tomography angiography (CTA) was done for further evaluation of periaortic fluid collection which showed findings to suggest perigraft abscess. The patient underwent surgical debridement of the abscess and was found to have an abscess around the aortic graft which was drained followed by antibiotic treatment. The patient was discharged to his local hospital and recovered well at 2 month follow-up appointment. Conclusion: This is a very rare case of aortic abscess around the graft that could successfully be managed by graftconserving surgery, and it emphasizes the significance of early diagnosis of perigraft abscess in patients with aortic dissection surgery.

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Section: Discussionmentioning

confidence: 99%

Perigraft abscess after DeBakey type-1 aortic dissection: a case report

Lin

Yang

2020

J Cardiothorac Surg

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“…While this is higher than one would expect, it must be taken into consideration that 2 of those patients were diagnosed with aortitis, a condition that is associated with unfavorable outcome. 37…”

Section: Discussionmentioning

confidence: 99%

Open Conversion After Endovascular Aneurysm Sealing: Technical Features and Clinical Outcomes in 44 Patients

et al. 2020

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Purpose To evaluate the technical features and clinical results after open conversion for complications following endovascular aneurysm sealing (EVAS). Materials and Methods From July 2013 to February 2020, 44 patients (mean age 72±8 years; 36 men) underwent an open conversion due to EVAS complications in a single center. Data were collected on patient characteristics, reasons for conversion, characteristics and duration of the procedure, condition of the polymer, blood loss, time in the intensive care unit (ICU), and intra/postoperative complications. The main outcome measure was mortality at 30 days and in follow-up. Data are presented as the median (IQR) and absolute range. Results On average, the open conversion took place 3 years after the initial EVAS implantation [median 37 months (IQR 23, 50); range 0–64]. Most patients were converted due migration (82%), aneurysm growth (77%), and/or endoleak (75%), with 21 patients (48%) having all 3 events. Less frequent diagnoses were aneurysm rupture (n=7), aortic infection (n=3), technical failure during implantation (n=2), and graft thrombosis (n=1). The majority of patients (n=26) were asymptomatic and converted electively, but 9 were operated on urgently and 9 emergently (7 late rupture and 2 due to technical failure). The median procedure duration was 178 minutes (IQR 149, 223; range 87–417), the median blood loss was 1100 mL (IQR 600, 2600; range 300–5000). Polymer degradation was mentioned in the operative reports of 18 cases (41%). Patients stayed a median of 3 days (IQR 2, 7; range 1–35) in the ICU, while the median length of stay in the hospital was 14 days (IQR 10, 20; range 0–93). The 30-day mortality was 23% (n=10). During a median follow-up of 3 months (IQR 0, 11; range 0–38), no additional deaths occurred, but 12 patients suffered from an adverse event. There were 3 cases of wound dehiscence after laparotomy, 2 cases of leg ischemia, 2 cases of renal failure, and individual cases of urinary obstruction, urinoma, paralytic ileus, gastrointestinal bleeding, and postoperative delirium. A non-elective setting was associated with a significantly increased mortality of 33% in urgent cases and 56% in emergent cases (p=0.007). Based on these results an algorithm for the management of EVAS complications was developed. Conclusion The significantly increased mortality associated with nonelective conversions highlights the need for active surveillance. The presented algorithm offers a structured tool to avoid emergency conversions.

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“…The surgical management of AGI depended on the degree and extent of infection. It was generally believed that if the graft and autologous tissue were still surrounded by healthy autologous tissue, the survival rate was higher if the vascular prosthesis not removed [7,8] . For this case, the graft was not infected, existing prosthetic grafts could be salvaged, so only debridement was performed and the vascular graft not replaced.…”

Section: Discussionmentioning

confidence: 99%

Perigraft abscess after DeBakey type-1 aortic dissection: a case report

Lin

Yang

2020

Preprint

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Background Perigraft abscess is a rare condition which constitutes a small proportion of aortic graft infection (AGI), early diagnosis is very important for timely intervention and improving the survival rate of patients because of its significant morbidity and mortality. Case presentation A 24-year-old young male patient with a history of complicated total arch replacement using the elephant trunk technique for acute DeBakey type-1 aortic dissection 6 months before visited our hospital with the chief complaint of persistent fever. Antibiotic treatment in local hospital was ineffective. Echocardiography showed liquid dark area around the aortic graft, and a computerized tomography angiography (CTA) was done for further evaluation of periaortic fluid collection which showed findings to suggest perigraft abscess. The patient underwent surgical debridement of the abscess and was found to have an abscess around the aortic graft which was drained followed by antibiotic treatment. The patient was discharged to his local hospital and recovered well at 2 month follow-up appointment. Conclusion This is a very rare case of aortic abscess around the graft that could successfully be managed by graft-conserving surgery, and it emphasizes the significance of early diagnosis of perigraft abscess in patients with aortic dissection surgery.

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Incidence, Management, and Outcomes of Aortic Graft Infection

Cited by 27 publications

References 33 publications

Perigraft abscess after DeBakey type-1 aortic dissection: a case report

Perigraft abscess after DeBakey type-1 aortic dissection: a case report

Open Conversion After Endovascular Aneurysm Sealing: Technical Features and Clinical Outcomes in 44 Patients

Perigraft abscess after DeBakey type-1 aortic dissection: a case report

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