Infection of endovascular abdominal aortic aneurysm stent graft after urosepsis: case report and review of the literature

Veger, Hugo T.C.; Joosten, P.P. Hedeman; Thoma, Sylvia; Visser, Michel J.T.

doi:10.1258/vasc.2011.cr0294

Cited by 3 publications

(2 citation statements)

References 11 publications

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“…In the literature, potential risk factors for endograft infection include adjunctive endovascular procedures during the primary implantation, immunesuppression, the treatment of pseudoaneurysms, and infected central venous catheters. [19] Veger et al [20] discovered that prophylactic administration may decrease the likelihood of bacteremia before stent graft insertion. Additionally, the authors also postulated that poor intraluminal healing of stent grafts, as observed in several explant studies, may result in higher susceptibility to episodes of bacteremia than for patients for whom prosthetic vascular grafts were inserted during open repair.…”

Section: Discussionmentioning

confidence: 99%

Endovascular stent-grafting infection in active Behçet’s disease concomitant with familial Mediterranean fever

Çoşkun¹

2013

Turk Gogus Kalp Dama

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Yirmi dokuz yaşında bir yıldır Behçet hastalığı öyküsü olan erkek hasta karın ve sırt ağrısı yakınmasıyla bölgemizdeki bir hastaneye başvurdu. Tıbbi öyküsünde 16 yıldır ailevi Akdeniz ateşi (AAA) vardı. Torakoabdominal bilgisayarlı tomografide abdominal aortta, infrarenal düzeyde, dev bir sakküler anevrizma saptandı. Hasta merkezimize sevk edildi. Yerleştirilen endovasküler stent-greftten sonraki izleminde endovasküler stent-greft enfeksiyonuna rastlandı. Takibin dördüncü ayında retroperitoneal bölgede gelişen bir apsenin endovasküler yöntemle drenajı sırasında meydana gelen bir rüptür sonucu acilen ameliyata alınarak, aksillobifemoral baypas ile greft implantasyonu yapıldı. Bu olgu, aktif Behçet hastalığı ve AAA varlığında abdominal aort anevrizmasının acil tedavisinde endovasküler stent-greftlemenin, aktif Behçet hastalığına bağlı anevrizmanın cerrahi tedavisi çok riskli olduğundan, geçerli bir alternatif tedavi olduğunu ortaya koydu. Ancak bu olgu endovasküler stent-greftlemenin imünosüpresif ilaç tedavisi almakta olan aktif Behçet hastalarında yüksek risk taşıdığını da göstermiş oldu. Abdominal aort anevrizmasının endovasküler onarımı sonrası gelişen endovasküler protez enfeksiyonu dramatik bir olay olup tanı ve tedavisi ileri derecede karmaşık ve multidisipliner yaklaşım gerektirir. Anah tar söz cük ler: Abdominal aort anevrizması; Behçet hastalığı; ailesel Akdeniz ateşi; greft enfeksiyonu.

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Section: Discussionmentioning

confidence: 99%

Endovascular stent-grafting infection in active Behçet’s disease concomitant with familial Mediterranean fever

Çoşkun¹

2013

Turk Gogus Kalp Dama

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“…This disruption leads to a false aneurysm formation, sepsis, graft enteric fistula, hemorrhage, limb loss, or death 2 , 19. Late graft infections may also occur due to bacterial seeding on the luminal surface after bacteremia caused by dental extraction or dental foci manipulation, urinary tract manipulation, urosepsis, or endovacscular invasive procedures 2 , 19 , 25…”

Section: Discussionmentioning

confidence: 99%

Late infra-renal aortic graft infection: a fearsome complication

Campos¹,

Silva²,

Luccia³

et al. 2013

ACR

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Since the 1950s, aortic graft infections (AGIs) constitute one of the most feared complications after reconstructive vascular surgery. This complication is not frequent, ranging from 1% to 2% in the recently reported series; however, the high rate of death and morbidity after therapeutic attempts justifies its dreadful fame. The majority of cases occur during the first month after surgery. Staphylococcus aureus is the cause of 70% of the early infection cases. Late infections, on the other hand, are even rarer, showing a strong relationship with low virulence microorganisms, where Staphylococcus epidermidis is the main cause. Gram-negative bacteria are also observed in late infections, mainly when an aortic or graft enteric fistula is present. Treatment modalities are plenty, but still debatable. The authors report a case of a woman who was operated on 6 years ago for a reconstructive aortic aneurysm with the implantation of an infrarenal Dacron graft in the aorto bifemoral position. She looked for medical assistance with a 2-month history of weight loss, abdominal/back pain, and fever. Her clinical status rapidly deteriorated. A computed tomography of the abdomen disclosed the diagnosis of an AGI. The patient was promptly treated with antibiotics. Surgery was undertaken to explant the infected graft and another graft was placed into the axillobifemoral position. Culture from the infections site was negative. After surgery the patient quickly developed refractory septic shock and died immediately post-operatively

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How To Diagnose and Manage Infected Endografts after Endovascular Aneurysm Repair

Setacci

Chisci

Setacci

et al. 2014

aorta

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The prevalence of endograft infections (EI) after endovascular abdominal aortic aneurysm repair is below 1%. With the growing number of patients with aortic endografts and the aging population, the number of patients with EI might also increase. The diagnosis is based on an association of clinical symptoms, imaging, and microbial cultures. Angio-computed tomography is currently the gold-standard technique for diagnosis. Low-grade infection sometimes requires nuclear medicine imaging to make a correct diagnosis. There is no good evidence to guide management so far. In the case of active gastrointestinal bleeding, pseudoaneurysm, or extensive perigraft purulence involving adjacent organs, an invasive treatment should always be attempted. In the other cases (the majority), when there is not an immediate danger to the patient's life, a conservative management is started with a proper antimicrobial therapy. Any infectious cavity can be percutaneously drained. Management depends on the patient's condition and a tailored approach should always be offered. In the case of a patient who is young, has a good life expectancy, or in whom there is absence of significant comorbidities, a surgical attempt can be proposed. Surgical techniques favor, in terms of mortality, patency, and reinfection rate, the in situ reconstruction. Choice of technique relies on the center and the operator's experience. Long-term antibiotic therapy is always required in all cases, with close monitoring of the C-reactive protein.

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Infection of endovascular abdominal aortic aneurysm stent graft after urosepsis: case report and review of the literature

Cited by 3 publications

References 11 publications

Endovascular stent-grafting infection in active Behçet’s disease concomitant with familial Mediterranean fever

Endovascular stent-grafting infection in active Behçet’s disease concomitant with familial Mediterranean fever

Late infra-renal aortic graft infection: a fearsome complication

How To Diagnose and Manage Infected Endografts after Endovascular Aneurysm Repair

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