The management of the infected aortic prosthesis: A current decade of experience

Sharp, William J.; Hoballah, Jamal J.; Mohan, Chilukuri K.; Kresowik, Timothy F.; Martinasevic, Mario; Chalmers, R. T. A.; Corson, John D.

doi:10.1016/s0741-5214(94)70009-5

Cited by 102 publications

(60 citation statements)

References 23 publications

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“…8,11,27 In the past, the "gold standard" management of these patients was extra-anatomic bypass surgery followed by graft excision. 5,83,[92][93][94][95][96][97][98][99]111 In selected patients, that might still be the procedure of choice; however, because of the high rates of mortality and potential complications, including limb loss, numerous studies have suggested that alternative surgical options might be preferable to extra-anatomic bypass and graft excision. For patients with aortoenteric fistula caused by methicillin-sensitive S aureus or less virulent microorganisms, such as coagulase-negative staphylococci, streptococci, susceptible enterococci, or susceptible enteric gram-negative bacilli, graft excision and in situ reconstruction with either cryopreserved or fresh arterial allograft, venous autograft, or rifampin-bonded synthetic graft are reasonable.…”

Section: Graft Excision and In Situ Reconstructionmentioning

confidence: 99%

“…4,[92][93][94][95][96][97][98][99]111 The primary reason for this recommendation is because of the risk of recurrent infection that can occur with in situ reconstruction. 4,[92][93][94][95][96][97][98][99]111 The major disadvantages of extra-anatomic bypass grafting and graft excision are as follows: (1) a 2-stage procedure is required; (2) conduit failure with amputation of lower extremities has been observed in 20% to 30% of patients; (3) blood supply is decreased with ischemia to the inferior mesenteric and internal iliac arteries; and (4) residual infection of the aortic stump with blowout occurs in 10% to 20% of patients. 4 Theoretically, the risk of recurrent infection should be lower with this procedure, because the VGI is resected with no in situ reconstruction in an infected tissue bed; however, in the meta-analysis published by O'Connor et al, 4 the infection rate was highest with this procedure, followed by rifampin-bonded, then arterial allograft, and lowest with venous autograft.…”

Section: Extensive Intra-abdominal Abscess or Gross Purulence Around mentioning

confidence: 99%

“…This procedure, first performed in the 1960s, was accepted as the standard of care against which other procedures were measured. 5,83,[92][93][94][95][96][97][98][99] In selected patients, it is still considered to be the treatment of choice. However, the major disadvantages of extra-anatomic bypass followed by graft excision are lower short-and long-term patency rates of the bypass graft; a 2-stage, lengthy surgical procedure; relatively high rate of amputation of the lower extremity; risk of rupture of the stump at the aortic suture line, with potentially life-threatening hemorrhage; and difficulty establishing an extra-anatomic revascularization route in the inguinal region.…”

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confidence: 99%

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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: Graft Excision and In Situ Reconstructionmentioning

confidence: 99%

Section: Extensive Intra-abdominal Abscess or Gross Purulence Around mentioning

confidence: 99%

mentioning

confidence: 99%

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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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“…The standard treatment for an infected graft is surgical removal combined with extraanatomic bypass and appropriate anti biotictherapy [2][3][4][5][6]. The mortalityrateassoci ated with this classic approach varies between 23% and 64% in some series [2,4,[6][7][8].…”

Section: Niection Of An Aortic Vascular Graftmentioning

confidence: 99%

Aortic graft infection: the value of percutaneous drainage.

Bélair¹,

Soulez²,

Oliva³

et al. 1998

American Journal of Roentgenology

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treated by primary percutaneous drainage with patients who initially underwent surgery. MATERIALS AND METHODS. A retrospective reviewof 23 consecutive patientstreated for aortic graft infection was performed. Eleven patients were initially treated with per cutaneous drainage and 12 were treated with surgery. The morbidity, mortality, and postproce dural reintervention rates and clinical outcome were analyzed for each group.RESULTS.Theseptic process resolved in nine(82%)of 11patients treated withpercutane ous drainage. Of these nine patients, four were treated with percutaneous drainage alone. Drainage was followed by removal of the infected prosthetic graft in the remaining five pa tients. In the surgical group, sepsis resolved in only four patients (33%) (p = .036). No penpro cedural deaths occurred in the percutaneous drainage group, whereas six patients in the surgical group died in the penoperative period (p = .014). The purpose of our study was to compare the efficiencyof primary percutaneous drain age with classic surgical treatment of patients with aortic graft infections. CONCLUSION. Percutaneous drainage canbeusedasaninitialformof treatment in the Materials and MethodsOur study group included 23 consecutive pa tients (three women and 20 men) treated for in fected aortic grafts between January 1985 and January 1997 in our institution. To be included in thestudy, patients hadto fulfilltwospecific crite na: presence of a fluid collection surrounding the graft above the inguinal ligament shown on cross sectional imaging or during surgery and clinical evidence of a septic state (fever, WBC > 10,000/ mm3 [10 x l0@Ill,or discharge of pus at the in guinal incision). Patients presenting with local groin infection without evidence of a retroperito neal fluidcollection were excluded from the study.Patients were distributed in two groups on the basis of the initial treatment technique. The treat ment method was decided on a case-by-case basis by the referring physician without randomization and included a group composed of 11 patients mi tially treated with percutaneous drainage (age.65.9 Â± 9.32 years; I I men) and a second group of I2 patients initially treated with surgical interven tion (age, 68.75 Â± 9.68 years; 9 men; 3 women).In the percutaneous drainagegroup,nineof 11 patients received a multitherapeuticantibiotic regi men and two had a single drug prescribed.The dis tribution and types of antibiotics prescribed to patientsin the percutaneousdrainagegroup were as follows:ampicillin(n = I), cefazolin(n = I), cefo taxime (n = I), cefoxitine (n = I), cefuroxime (n = I), ciprofloxacin(n = 3), clindamycin(n = 2), cloxacil lin sodium (n = 2), ceftazidime (n = I), gentamicin (n = I), imipenem (n = 2), metronidazole (n = 5), netilmicin sulfate (n = 3), penicillin (n = I), piper

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“…Die hohe Revisionswahrscheinlichkeit drückt sich in der hohen sekundären Offenheit von 65% im gleichen Zeitraum aus [5,58]. Andere Autoren berichten allerdings über deutlich günstigere Ergebnisse mit einer primären 5-Jahres-Offenheitsrate von 64-73% [58,60,70]. Der Versuch, eine infizierte Prothese allein mit lokalen Maßnahmen zu erhalten, kann bei später und umschriebener Infektion möglich, bei Patienten mit hohem OP-Risiko sinnvoll sein (s. oben).…”

Section: > Es Besteht Die Tendenz Zur Orthotopen Rekonstruktion Mit Bunclassified

Postoperative complications in vascular surgery

Diener

Larena-Avellaneda

Debus

2009

Chirurg

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The increase in numbers of vascular operations is due to a worldwide increase in vascular disease and diabetes. As a result of demographic changes, most of the vascular patients are comorbid and are therefore associated with multiple risk factors. Complications of vascular surgery can be divided into systemic, local non-vascular and vascular complications. Systemic complications are primarily caused by the patients' comorbidity. The prevalence of additional coronary heart disease and cerebral sclerosis accounts for approximately 40-60%, concomitant relevant stenoses of the renal arteries are documented in the literature in 23-42% of the cases. Special attention is paid to diabetes and its end-stage complications. Failure of wound healing, infection of the wound and lymphatic fistulas are the most common non-vascular complications. Inguinal incisions often give rise to a failure of wound healing caused by subcutaneous lymphatic vessels and because of the proximity to the anogenital region. Asepsis, atraumatic operative techniques and perioperative antimicrobial prophylaxis lead to a reduction of surgical site infections and healing delay. Failing grafts or infection of the bypass are the most common vascular complications. Early graft failures are often caused by inappropriate handling or operation techniques and long-term failure is often related to the bypass material. However, in peripheral vascular surgery, autologous veins are superior to synthetic grafts and provide advantages in cases of infection. Removal of an infected synthetic graft is discussed as well as in-situ or extra-anatomical reconstructions. This article reviews the postoperative complications of vascular surgery and their management.

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The management of the infected aortic prosthesis: A current decade of experience

Cited by 102 publications

References 23 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

Aortic graft infection: the value of percutaneous drainage.

Postoperative complications in vascular surgery

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