Management of Aortic Infections: Role of Open Surgery and the Value of Multidisciplinary Team Approach

Sallam, Morad; Lyons, Oliver; Donati, Tommaso

doi:10.1007/978-3-319-94761-7_34

Cited by 2 publications

(4 citation statements)

References 83 publications

(96 reference statements)

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“…30 Others have also adopted the stabilize and 'bridge to repair' concept. 4,30 While peri-operative mortality for EVAR may be lower than OAR, pre-operative sepsis is indicative of a poor outcome for EVAR. 6 Consequently, some authors propose the temporary 'bridge' of EVAR followed by ISR and explant, or even as a definitive management protocol in SAEF with bleeding in the absence of significant sepsis.…”

Section: Discussionmentioning

confidence: 99%

“…found utility in EVAR as a bridge to stabilizing a patient until they could undergo OAR, with all AEF successfully sealed and a 0% 30‐day mortality 30 . Others have also adopted the stabilize and ‘bridge to repair’ concept 4,30 . While peri‐operative mortality for EVAR may be lower than OAR, pre‐operative sepsis is indicative of a poor outcome for EVAR 6 .…”

Section: Discussionmentioning

confidence: 99%

“…Vascular graft infections occur in 1%–4% of patients after abdominal aortic operations. Of these, 30% are complicated by secondary aorto‐enteric fistulae (SAEF), 1–4 an abnormal communication between the aorta and adjacent bowel, associated with high morbidity and mortality 5–8 . The incidence of SAEF is 0.3%–1.6% after aortic prosthetic reconstruction, and it most commonly presents with sepsis or ‘herald’ bleeding, followed by catastrophic gastro‐intestinal haemorrhage 9–12 .…”

Section: Introductionmentioning

confidence: 99%

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Management of secondary aorto‐enteric fistulae: a multi‐centre study

Narayanan

Hanna

Okamura-Kho

et al. 2023

ANZ Journal of Surgery

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BackgroundSecondary aorto‐enteric fistulae (SAEF) are a rare, complex and life‐threatening complication following aortic repair. Traditional treatment strategy has been with open aortic repair (OAR), with emergence of endovascular repair (EVAR) as a potentially viable initial treatment option. Controversy exists over optimal immediate and long‐term management.MethodsThis was a retrospective, observational, multi‐institutional cohort study. Patients who had been treated for SAEF between 2003 and 2020 were identified using a standardized database. Baseline characteristics, presenting features, microbiological, operative, and post‐operative variables were recorded. The primary outcomes were short and mid‐term mortality. Descriptive statistics, binomial regression, Kaplan–Meier and Cox age‐adjusted survival analyses were performed.ResultsAcross 5 tertiary centres, a total of 47 patients treated for SAEF were included, 7 were female and the median (range) age at presentation was 74 years (48–93). In this cohort, 24 (51%) patients were treated with initially with OAR, 15 (32%) with EVAR‐first and 8 (17%) non‐operatively. The 30‐day and 1‐year mortality for all cases that underwent intervention was 21% and 46% respectively. Age‐adjusted survival analysis revealed no statistically significant difference in mortality in the EVAR‐first group compared to the OAR‐first group, HR 0.99 (95% CI 0.94–1.03, P = 0.61).ConclusionIn this study there was no difference in all‐cause mortality in patients who had OAR or EVAR as first line treatment for SAEF. In the acute setting, alongside broad‐spectrum antimicrobial therapy, EVAR can be considered as an initial treatment for patients with SAEF, as a primary treatment or a bridge to definitive OAR.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Management of secondary aorto‐enteric fistulae: a multi‐centre study

Narayanan

Hanna

Okamura-Kho

et al. 2023

ANZ Journal of Surgery

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“…Depending on the location of the graft, up to 70% mortality with VGI is reported, and graft infections in the lower limbs frequently lead to amputation. No arterial graft is designed to ever be removed, and doing so mandates major surgery to remove the graft and then reconstruct the blood supply to downstream tissues (45). The economic burden associated with VGI is £541M per year in the United States alone (46).…”

Section: Vascular Graft and Endograft Infectionmentioning

confidence: 99%

Radiometal chelators for infection diagnostics

Akter

Lyons²,

Mehra³

et al. 2023

Front. Nucl. Med.

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wInfection of native tissues or implanted devices is common, but clinical diagnosis is frequently difficult and currently available noninvasive tests perform poorly. Immunocompromised individuals (for example transplant recipients, or those with cancer) are at increased risk. No imaging test in clinical use can specifically identify infection, or accurately differentiate bacterial from fungal infections. Commonly used [18F]fluorodeoxyglucose (18FDG) positron emission computed tomography (PET/CT) is sensitive for infection, but limited by poor specificity because increased glucose uptake may also indicate inflammation or malignancy. Furthermore, this tracer provides no indication of the type of infective agent (bacterial, fungal, or parasitic). Imaging tools that directly and specifically target microbial pathogens are highly desirable to improve noninvasive infection diagnosis and localization. A growing field of research is exploring the utility of radiometals and their chelators (siderophores), which are small molecules that bind radiometals and form a stable complex allowing sequestration by microbes. This radiometal-chelator complex can be directed to a specific microbial target in vivo, facilitating anatomical localization by PET or single photon emission computed tomography. Additionally, bifunctional chelators can further conjugate therapeutic molecules (e.g., peptides, antibiotics, antibodies) while still bound to desired radiometals, combining specific imaging with highly targeted antimicrobial therapy. These novel therapeutics may prove a useful complement to the armamentarium in the global fight against antimicrobial resistance. This review will highlight current state of infection imaging diagnostics and their limitations, strategies to develop infection-specific diagnostics, recent advances in radiometal-based chelators for microbial infection imaging, challenges, and future directions to improve targeted diagnostics and/or therapeutics.

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Management of Aortic Infections: Role of Open Surgery and the Value of Multidisciplinary Team Approach

Cited by 2 publications

References 83 publications

Management of secondary aorto‐enteric fistulae: a multi‐centre study

Management of secondary aorto‐enteric fistulae: a multi‐centre study

Radiometal chelators for infection diagnostics

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