Is Endovascular Repair of Mycotic Aortic Aneurysms a Durable Treatment Option?

Clough, Rachel E.; Black, S.; Lyons, Oliver T; Zayed, Hany; Bell, Rebecca; Carrell, Tom; Waltham, Matthew; Sabharwal, Tarun; Taylor, P. R.

doi:10.1016/j.jvs.2009.02.221

Cited by 28 publications

(43 citation statements)

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“…In these patients, Vallejo and others reported that a combination (hybrid) of in situ reconstruction and EVT might be necessary. 190,228,[241][242][243][244][245][246][247][248] Subsequent explantation of EVT devices is especially challenging in patients with hybrid procedures and might not be technically feasible. Vallejo and colleagues 190 recommended EVT or hybrid procedures only in selected patients and concluded that open in situ repair remains the surgical management of choice.…”

Section: Clinical Statements and Guidelinesmentioning

confidence: 99%

“…After initial placement of the EVT device, explantation of the device and open surgical resection of the aortic MA and reconstruction may be considered in patients who can tolerate an open procedure. 189,227,228,[241][242][243][244][245][246][247][248] There are insufficient data to recommend EVT as the procedure of choice for patients with aortic MA (Figure 8 …”

Section: Clinical Statements and Guidelinesmentioning

confidence: 99%

“…In patients with free or contained rupture, EVT may be considered to stabilize hemodynamics and as a bridge to subsequent open in situ repair (Figure 8). 190,227,228,[241][242][243][244][245][246][247][248] recommendation for Management of rupture or contained rupture of aortic Ma Aortoenteric Fistulae With Duodenum. Primary aortoenteric fistulae into the duodenum associated with aortic MA are less common than are secondary aortoenteric fistulae, which result from erosion of an aortic vascular graft placed for repair of abdominal aortic aneurysm or occlusive disease.…”

Section: Additional Factors In Management Of Aortic Mamentioning

confidence: 99%

See 2 more Smart Citations

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: Clinical Statements and Guidelinesmentioning

confidence: 99%

Section: Clinical Statements and Guidelinesmentioning

confidence: 99%

Section: Additional Factors In Management Of Aortic Mamentioning

confidence: 99%

See 1 more Smart Citation

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

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“…[10][11][12][13] The crucial question of durability therefore remains unanswered. The aim of this European multicenter collaboration was to study the durability of endovascular treatment of MAA, by assessing the late infectionrelated complications and long-term survival.…”

Section: Editorial See P 2129 Clinical Perspective On P 2142mentioning

confidence: 99%

Endovascular Treatment of Mycotic Aortic Aneurysms

et al. 2014

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Background-Mycotic aortic aneurysm (MAA) is a rare and life-threatening disease. The aim of this European multicenter collaboration was to study the durability of endovascular aortic repair (EVAR) of MAA, by assessing late infectionrelated complications and long-term survival. Methods and Results-All EVAR treated MAAs, between 1999 and 2013 at 16 European centers, were retrospectively reviewed. One hundred twenty-three patients with 130 MAAs were identified. Mean age was 69 years (range 39-86), 87 (71%) were men, 58 (47%) had immunodeficiency, and 47 (38%) presented with rupture. Anatomic locations were ascending/arch (n=4), descending (n=34), paravisceral (n=15), infrarenal aorta (n=63), and multiple (n=7). Treatments were thoracic EVAR (n=43), fenestrated/branched EVAR (n=9), and infrarenal EVAR (n=71). Antibiotic was administered for mean 30 weeks. Mean follow-up was 35 months (range 1 week to 149 months). Six patients (5%) were converted to open repair during follow-up. Survival was 91% (95% confidence interval, 86% to 96%), 75% (67% to 83%), 55% (44% to 66%), and 41% (28% to 54%) after 1, 12, 60, and 120 months, respectively. Infection-related death occurred in 23 patients (19%), 9 after discontinuation of antibiotic treatment. A Cox regression analysis demonstrated non-Salmonellapositive culture as predictors for late infection-related death. Conclusions-Endovascular

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“…Pagrindiniai ligos simptomai yra nespecifiniai -skausmas, bendras silpnumas, dėl to MA dažnai įtariama pavėluotai [12]. Patologijai įtarti labai padeda čiuopiama atsiradusi pulsuojanti masė (dažnai rankose arba kojose), tačiau kitų lokalizacijų MA diagnostikai ypač svarbūs vaizdiniai tyrimai.…”

Section: įVadasunclassified

Mikotinės Aneurizmos: Literatūros Apžvalga

Stanevičiūtė

Rakauskas

Sudikas

2014

Medicinos Teorija Ir Praktika

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SANTRAUKAReikšminiai žodžiai: mikotinė aneurizma, infekcinė aneurizma, bakterinė infekcija, endovaskulinis gydymas, chirurginis gydymas. Mikotinė aneurizma -tai aneurizma su mikrobiologiškai patvirtinta infekcija arterijos sienelėje. Mikotinės aneurizmos sudaro 1,3-2,3 proc. visų arterinių aneurizmų. Dažniausiai pažeidžiamos pilvo aorta ir šlaunies arterija. Mikotinės aneurizmos atsiranda dėl greta arterijos esančio septinio židinio, septinės embolijos, taip pat dėl septicemijos metu į arterijos sienelę patekusio infekcijos sukėlėjo. Predisponuojantys veiksniai tokiai aneurizmai atsirasti: cukrinis diabetas, rūkymas, šeiminė mikotinių aneurizmų anamnezė, imunosupresantų vartojimas, inkstų nepakankamumas. Mikotinių aneurizmų prognozė paprastai būna bloga, nes tokios aneurizmos linkusios greitai augti ir plyšti. Dažniausia mirties priežastis -sepsis. Diagnozei nustatyti svarbi echoskopija ir kompiuterinė tomografija. Gydymas susideda iš aneurizmos rekonstrukcijos (chirurginiu arba endovaskuliniu būdu) ir antibiotikų terapijos. Dėl gana nedidelio paplitimo mikotinių aneurizmų problema tebėra mažai tyrinėta. Šiame straipsnyje aptariami diskusiniai klausimai ir gydymo perspektyvos remiantis naujausia moksline literatūra. ABSTRACTKey words: mycotic aneurysm, infectious aneurysm, bacterial infection, endovascular repair, open repair. Mycotic aneurysm is an aneurysm with microbiologically confirmed infection of the arterial wall. It is a rather uncommon, though life-threatening disease, which makes up only 1.3-2.3 % of all the aneurysms. Mycotic aneurysms most commonly manifest in abdominal aorta and iliac artery. Mycotic aneurysms may form in the presence of adjacent infection (for example, an abscess), septic embolism or arise due to contamination of the arterial wall during septicemia. Predisposing factors are diabetes, smoking, immunosuppression, renal failure and positive family history. Main diagnostic tools are ultrasound and computer tomography. Patients with mycotic aneurysms usually have poor prognosis because these aneurysms have a tendency to enlarge and rupture. Most common cause of death is sepsis. Treatment of mycotic aneurysm involves the repair of the aneurysm (either surgically or endovasculary) and antibiotic therapy. Due to relatively low prevalence of mycotic aneurysms many questions concerning best treatment option remain unanswered. This article reviews newest scientific articles on mycotic aneurysms and discusses treatment alternatives. ĮVADASMikotinė aneurizma (MA) -tai aneurizma su mikrobiologiškai patvirtinta infekcija arterijos sienelėje. Mikotines aneurizmas, kaip infekcinio endokardito (IE) komplikaciją, pirmą kartą aprašė seras Williamas Osleris 1851 m. Terminas "mikotinė aneurizma" dėl asociacijos su grybeline infekcija iki šių dienų neretai klaidina įvairių medicinos sričių specialistus, kadangi grybelinė infekcija niekada nebuvo pagrindinis MA sukėlėjas [1]. Pastarojo dešimtmečio literatūros šaltiniuose terminas "mikotinė aneurizma" vartojamas aprašant bet kokią aneurizmą, kuri išs...

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Is Endovascular Repair of Mycotic Aortic Aneurysms a Durable Treatment Option?

Cited by 28 publications

References 0 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

Endovascular Treatment of Mycotic Aortic Aneurysms

Mikotinės Aneurizmos: Literatūros Apžvalga

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