Infected Endoluminal Stent-Graft: Implications for Endotension, Late Endoleaks, and Prophylactic Antibiotics

Ferrar, D; Roberts, Andrew; Lawrence-Brown, Michael; McLellan, Duncan; Semmens, James B.

doi:10.1583/05-1646.1

Cited by 14 publications

(10 citation statements)

References 15 publications

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“…This is thought to be owing to compression of surrounding structures and the local inflammatory response to such complications. Bacterial colonisation of aortic thrombus (which is retained during endovascular stenting) has also been proposed as a source of graft infection 2. This patient had several risk factors including an emergent procedure and a postoperative endoleak.…”

Section: Discussionmentioning

confidence: 99%

Aorto-oesophageal fistula following TEVAR: an unusual cause of mediastinal air

et al. 2013

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Aorto-oesophogeal fistula (AEF) following thoracic endovascular aneurysm repair (TEVAR) has an incidence of 1.7%. Patients often present with constitutional symptoms or haematemesis and the condition is frequently fatal. We present a 79-year-old man who underwent TEVAR to exclude a ruptured 5.3 cm aneurysm. He re-presented with persistent fever and haematemesis and initially underwent oesophogastroduodenoscopy and biopsy to exclude oesophageal carcinoma. Following CT scanning AEF was diagnosed and extra-anatomical reconstruction was performed. Two months later he suffered a sudden and unexpected large bleed into his ventilator circuits from his tracheostomy and died. Haematemesis following TEVAR should raise clinical suspicion of AEF. Early and accurate diagnosis is paramount in view of the high attendant mortality. CT should be considered the initial investigation of choice.

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Section: Discussionmentioning

confidence: 99%

Aorto-oesophageal fistula following TEVAR: an unusual cause of mediastinal air

et al. 2013

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“…O paciente pode apresentar-se com febrícula e sintomas frustros em casos iniciais ou de pequena repercussão sistêmica; porém, também pode apresentar-se com abscesso localizado, pseudoaneurisma, fístula aortoentérica, bacteremia e sepse [20][21][22][23][24][25][26][27][28] . Alguns pacientes com endopróteses em aneurisma de aorta podem manifestar endotensão inexplicada, a qual pode associar-se à endoprótese infectada 29 . Ao se avaliarem apenas pacientes submetidos ao implante de endopróteses aorto-ilíacas, observam-se abscessos retroperitoniais em 29%; fístula inguinal em 14,5%; embolia sép-tica em 11,3% e choque hemorrágico em 9,6% dos casos infectados 14 .…”

Section: Aspectos Clínicosunclassified

“…Alguns autores advogam o uso de profilaxia antimicrobiana nos procedimentos percutâneos subsequentes ao implante de endoprótese e que poderiam contaminá-la, especialmente nas primeiras semanas, quando a proteção neointimal ainda não se desenvolveu por completo 29 .…”

Section: Profilaxiaunclassified

Infecção em endoprótese

Lichtenfels¹,

Frankini

Cardozo³

et al. 2011

J. vasc. bras.

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A infecção de próteses endovasculares (stents e endopróteses), ao contrário da cirurgia convencional, permanece pouco divulgada e estudada [1][2][3][4] . Devido ao fato de a grande maioria dos procedimentos endovasculares serem realizados pela via percutânea e de forma minimamente invasiva, a infecção sempre foi considerada uma complicação rara e de proporções menores em comparação à cirurgia convencional 5 . No entanto, com a expansão dos métodos endovasculares e a sua massificação, bem como o uso cada vez mais frequente de endopróteses e stents recobertos, os problemas infecciosos vêm se tornando um problema que merece atenção especial 6,7 . Chalmers et al., em 1993, relataram o primeiro caso com suspeita de infecção em um dispositivo endovascular (stent) 8 . Em 1999, publicou-se o primeiro caso confirmado de infecção de endoprótese 9 . Apesar dos avanços recentes na área endovascular, a patogênese das infecções de stents e endopróteses permanece pouco estudada [10][11][12][13] . Existem poucos estudos na literatura com dados referentes às taxas de incidência de infecção em stents e endopróteses. Estudos da década de 1990 afirmavam que as endopróteses estariam mais expostas à contaminação bacteriana por se encontrarem no lúmen vascular, podendo apresentar, dessa forma, taxas elevadas de infecção [10][11][12][13] . Fiorani et al., em estudo multicêntrico recente, encontraram taxa de 0,4% de infecção em endopróteses aortoilía-cas 14 . Em comparação com a cirurgia aberta, encontra-se menor incidência de infecção em cirurgias endovasculares (0,4 versus 1,3%) 15,16 . Autores afirmam que as taxas de incidência de infecção de endoprótese são subestimadas devido ao acompanhamento mais curto dos pacientes submetidos à cirurgia endovascular, bem como à expectativa de vida ResumoA infecção envolvendo endopróteses é uma complicação pouco frequente, associada a elevadas taxas de mortalidade. A apresentação clínica é geralmente tardia, podendo variar de sintomas inespecíficos até complicações graves como pseudoaneurisma e fístula aortoentérica. O diagnóstico envolve alto índice de suspeição e investigação com exames de imagem e laboratoriais. O tratamento segue os preceitos da infecção de prótese em cirurgia convencional, indicando-se, para a maioria dos pacientes, a excisão cirúrgica acompanhada da revascularização in situ ou extra-anatômica. O tratamento conservador fica reservado para casos selecionados.Palavras-chave: Prótese vascular; infecção; cirurgia geral. AbstractInfection involving stent grafts is an infrequent complication associated with high mortality rates. The clinical presentation is usually delayed and it may vary from nonspecific symptoms to severe complications such as pseudoaneurysm and aorto-enteric fistula. The diagnosis involves a high index of suspicion and investigation with imaging and laboratory exams. The treatment follows the precepts of graft infection in conventional surgery, and surgical excision is recommended for most patients, followed by in situ or extra-anatomic revascularization. Conse...

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“…Another rare cause could be aortic stent infection, an uncommon but life-threatening complication that was first published in 1999. [58][59][60] Researchers have suggested that the diagnosis of stent-graft infection should be considered in all cases of unexplained endotension. 59 Hygroscopic fluid accumulation may be possible, and much is yet to be understood about the behavior of the thrombus in the excluded aneurysm sac.…”

Section: Endotension and Endoleakmentioning

confidence: 99%

Type II Endoleaks:When Is Intervention Indicated and What Is the Index of Suspicion for Types I or III?

Lawrence-Brown¹,

Sun

Semmens³

et al. 2009

Journal of Endovascular Therapy

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One of the principal reasons for failure of endovascular aneurysm repair (EVAR) is the occurrence of endoleaks, which regardless of size or type can transmit systemic pressure to the aneurysm sac. There is little debate that type I endoleaks (poor proximal or distal sealing) are associated with continued risk of aneurysm rupture and require treatment. Similarly, with type III endoleak, there is agreement that the defect in the device needs to be addressed; however, what to do with type II endoleaks and their effect on long-term outcome are not so clear. Aneurysm sac change is a primary parameter for determining the presence of an endoleak and assessing its impact. While diameter measurement has been the most commonly used method for determining sac changes, volume measurement has now been proven superior for monitoring structural changes in the 3-dimensional sac. Determining the source of an endoleak and the direction of flow are necessary for proper classification; however, while computed tomographic angiography has high sensitivity and specificity for detecting endoleaks, it is limited in its ability to show the direction of flow. Contrast-enhanced duplex ultrasound, on the other hand, is better able to quantify flow and characterize endoleaks. Flow is evidence of pressure, and increasing intrasac pressure increases wall tension, thus inducing progressive aneurysm expansion until rupture. Hence, determining intrasac pressure is becoming a vital component of endoleak assessment. All endoleaks can create systemic pressure inside the aneurysm sac, and there are a variety of intrasac pressure transducers being evaluated to assess this effect. A clinical pathway for patients with suspected type II endoleaks is based on a combination of imaging and pressure measurements. Imaging alone requires at least two interval examinations to determine the trend, while pressure measurements give immediate reassurance or an indication to intervene. Although still under development, pressure measurement is destined for general use and will provide a scientific basis for the management of type II endoleaks.

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Infected Endoluminal Stent-Graft: Implications for Endotension, Late Endoleaks, and Prophylactic Antibiotics

Cited by 14 publications

References 15 publications

Aorto-oesophageal fistula following TEVAR: an unusual cause of mediastinal air

Aorto-oesophageal fistula following TEVAR: an unusual cause of mediastinal air

Infecção em endoprótese

Type II Endoleaks:When Is Intervention Indicated and What Is the Index of Suspicion for Types I or III?

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