The Results of In Situ Prosthetic Graft Replacement for Infected Aortic Disease

Han, Youngjin; Kwon, Tae-Won; Park, Sang Jun; Jeong, Min-Jae; Choi, Kyunghak; Ko, Gi‐Young; Lee, Sang‐Oh; Cho, Yong‐Pil

doi:10.1007/s00268-018-4533-x

Cited by 14 publications

(10 citation statements)

References 45 publications

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“…Mortality rates up to 5e49% after in situ grafting versus 24e50% after extraanatomical bypass have been reported. 702,706,707,704,708 Infection related complications may occur in 0e20% after in situ grafts and older data suggest an equally high complication rate after extra-anatomical bypass, with the most feared being late aortic stump rupture in up to 20%. 321 No reliable comparative data exist between the various open surgical techniques.…”

Section: Mycotic Aaamentioning

confidence: 99%

Editor's Choice – European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms

Wanhainen¹,

Verzini²,

Herzeele³

et al. 2019

European Journal of Vascular and Endovascular Surgery

1,959

1,522

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Section: Mycotic Aaamentioning

confidence: 99%

Editor's Choice – European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms

Wanhainen¹,

Verzini²,

Herzeele³

et al. 2019

European Journal of Vascular and Endovascular Surgery

1,959

1,522

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“…Some researchers have advocated surgical protocols for infected AAA [ 9 13 ]. We have previously reported our principles for treating infected aortic disease, including primary infected AAA, infected aortic prosthetic grafts, and infected aortic stent grafts [ 10 11 ]. These studies showed favorable outcomes for in situ prosthetic graft bypasses with omental wrappings [ 10 11 19 20 ].…”

Section: Discussionmentioning

confidence: 99%

“…We have previously reported our principles for treating infected aortic disease, including primary infected AAA, infected aortic prosthetic grafts, and infected aortic stent grafts [ 10 11 ]. These studies showed favorable outcomes for in situ prosthetic graft bypasses with omental wrappings [ 10 11 19 20 ]. We applied the same surgical principles to all cases of infected stent grafts in this study.…”

Section: Discussionmentioning

confidence: 99%

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Clinical outcomes of in situ graft reconstruction in treating infected abdominal aortic stent grafts following endovascular aortic aneurysm repair: a single-center experience

et al. 2023

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Purpose This study aimed to review our experience with the explantation of infected endovascular aneurysm repair (EVAR) grafts. Methods This single-center, retrospective, observational study analyzed the data of 12 consecutive patients who underwent infected aortic stent graft explantation following EVAR between January 1, 2010 and December 31, 2019, of which 11 underwent in situ graft reconstruction following graft removal. The presentation symptoms, infection route, original pathology of abdominal aortic aneurysms (AAA), graft materials, and clinical outcomes were analyzed. Results Six patients underwent total explantation, whereas 5 underwent removal of only the fabric portions. For in situ reconstructions, prosthetic grafts and banked allografts were used in 8 and 3 patients, respectively. Four mechanisms of graft infection were noted in 11 patients: 4 had bacteremia from systemic infections, 3 had persistent infections following EVAR of primary infected AAA, 3 had ascending infections from adjacent abscesses, and 1 had an aneurysm sac erosion resulting in an aortoenteric fistula. No infection-related postoperative complications or reinfections occurred during the mean 65.27-month (standard deviation, ±52.51) follow-up period. One patient died postoperatively because of the rupture of the proximal aortic wall pseudoaneurysm that had occurred during forceful bare stent removal. Conclusion Regardless of graft material, in situ graft reconstruction is safe for interposition in treating an infected aortic stent graft following EVAR. In our experience, the residual bare stent is no longer a risk factor for reinfection. Therefore, it is important not to injure the proximal aortic wall when removing the bare stent by force.

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“…The optimal strategy is supposed to rebuild the trunk of artery to maximize blood supply for limb salvage. In situ arterial reconstruction often failed to restore aortic blood ow in the setting of infected groin, which was attribute to uncontrolled infection and erosion-related bleeding 11,12 . In this regard, the bypass strategy was proposed.…”

Section: Discussionmentioning

confidence: 99%

A Hybrid Technique to Treat Inguinal wound Infection after Arterial Surgery with Lateral Femoral Bypass and Intra-incisional Negative Pressure wound Therapy

Zhang

et al. 2021

Preprint

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Background: Patients with the inguinal wound infection after arterial surgery remains clinical challenge. Sustaining lymphatic leakage have been shown as a common and potentially serious complication. However, it remains clinical challenge for surgery to deal with this tough problem. Methods: This study describes a hybrid technique of using radical debridement, lateral femoral bypass (LFB) and intra-incisional negative pressure wound therapy (iNPWT) for single-staged treatment of complex inguinal wound infection after arterial surgery (IWI-AS).Results: Between January 2017 and June 2021, 5 IWI-AS cases treated with this new method were identified. Of the patients, 3 were males and 2 were females. The average age was 49.4 years (range, 33 to 77 years). 4 cases suffered emergent operations due to the sudden bleedings. after vascular bypass reconstructions and an average of 2.2 (range:1-3) iNWPT, all cases achieved wound healing at an average duration of 4.6 weeks (range: 3-6weeks). Moreover, all cases showed no bacterial growth and grafts patency as indicated by doppler ultrasound or CT angiography postoperatively. One case did not receive bypass imaging evaluation at postoperative 12 months. Weakness of quadriceps femoris was observed in one case. Conclusion: single-staged therapy of LFB and iNPWT hybridization is a technically handy and effective method for treatment of inguinal wound infection after arterial surgery.

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The Results of In Situ Prosthetic Graft Replacement for Infected Aortic Disease

Abstract: In situ graft replacement of PIAAA and IASG is feasible with acceptable outcomes, but the outcome for IAPG is questionable.

Cited by 14 publications

References 45 publications

Editor's Choice – European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms

Editor's Choice – European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms

Clinical outcomes of in situ graft reconstruction in treating infected abdominal aortic stent grafts following endovascular aortic aneurysm repair: a single-center experience

A Hybrid Technique to Treat Inguinal wound Infection after Arterial Surgery with Lateral Femoral Bypass and Intra-incisional Negative Pressure wound Therapy

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