A new method for the treatment of graft infection in the thoracic aorta: in situ preservation

Nakajima, Nobuyuki; Masuda, Masahisa; Ichinose, Masaharu; Ando, Motomi

doi:10.1016/s0003-4975(99)00358-6

Cited by 45 publications

(40 citation statements)

References 7 publications

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“…Recently, alternative surgical approaches such as in situ graft replacement [1], [8]–[16] or graft retention with thorough debridement have been more commonly used, in particular in patients with thoracic-aortic and peripheral-arterial PVGI [6], [17], [18]. In the published literature to date, removal and replacement of the graft is still considered the standard surgical approach in most patients with PVGI [19]–[25].…”

Section: Introductionmentioning

confidence: 99%

Surgical and Antimicrobial Treatment of Prosthetic Vascular Graft Infections at Different Surgical Sites: A Retrospective Study of Treatment Outcomes

et al. 2014

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ObjectiveLittle is known about optimal management of prosthetic vascular graft infections, which are a rare but serious complication associated with graft implants. The goal of this study was to compare and characterize these infections with respect to the location of the graft and to identify factors associated with outcome.MethodsThis was a retrospective study over more than a decade at a tertiary care university hospital that has an established multidisciplinary approach to treating graft infections. Cases of possible prosthetic vascular graft infection were identified from the hospital's infectious diseases database and evaluated against strict diagnostic criteria. Patients were divided into groups according to the locations of their grafts: thoracic-aortic, abdominal-aortic, or peripheral-arterial. Statistical analyses included evaluation of patient and infection characteristics, time to treatment failure, and factors associated specifically with cure rates in aortic graft infections. The primary endpoint was cure at one year after diagnosis of the infection.ResultsCharacterization of graft infections according to the graft location did show that these infections differ in terms of their characteristics and that the prognosis for treatment seems to be influenced by the location of the infection. Cure rate and all-cause mortality at one year were 87.5% and 12.5% in 24 patients with thoracic-aortic graft infections, 37.0% and 55.6% in 27 patients with abdominal-aortic graft infections, and 70.0% and 30.0% in 10 patients with peripheral-arterial graft infections. In uni- and multivariate analysis, the type of surgical intervention used in managing infections (graft retention versus graft replacement) did not affect primary outcome, whereas a rifampicin-based antimicrobial regimen was associated with a higher cure rate.ConclusionsWe recommend that future prospective studies differentiate prosthetic vascular graft infections according to the location of the grafts and that rifampicin-based antimicrobial regimens be evaluated in clinical trials involving vascular graft infections caused by staphylococci.

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Section: Introductionmentioning

confidence: 99%

Surgical and Antimicrobial Treatment of Prosthetic Vascular Graft Infections at Different Surgical Sites: A Retrospective Study of Treatment Outcomes

et al. 2014

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“…Some of these early-onset cases, however, have only slight increases in white blood cell count and CRP, and no symptoms. 1,[3][4][5][6] Late prosthetic graft infection may occur 20 years postoperatively or later; in these late-onset cases, SSI is unlikely to be involved in the mechanism of development. 4) Shiono et al 7) studied the relationship between periodontal disease and infectious endocarditis and reported that oral pathogenic bacteria causing oral lesions were also detected from cardiac valve tissues, vegetation, and blood at a high frequency.…”

Section: Discussionmentioning

confidence: 99%

“…The results of a similar approach reported by Coselli et al 1,3,13) were favorable, as represented by an 88% early survival rate and no recurrence. Nakajima et al 14) took the same approach using povidone iodine packing and reported both a 100% survival rate and a 100% recurrence prevention rate. These methods have been used until recent years for the treatment of prosthetic vascular graft infection.…”

Section: Discussionmentioning

confidence: 99%

A Case of an Aortic Abscess around the Elephant Trunk

Fujii

Kawasaki

Katayanagi

et al. 2015

ATCS

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A 52-year-old male patient with a history of total arch replacement using the elephant trunk technique for acute aortic dissection 4 years before visited our hospital with the chief complaint of persistent fever. Chest computed tomography (CT) suggested prosthetic vascular graft infection, which was treated surgically after chemotherapy. The first surgery consisted of debridement of an abscess around the vascular graft and in the aorta around the elephant trunk, and thoracic descending aorta replacement and vacuum-assisted closure (VAC) in view of the risk of bleeding from the peripheral region of the elephant trunk. One week later, omental filling was performed as the second step. This is a very rare case of aortic abscess around the elephant trunk that could successfully be managed by graft-conserving treatment.

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“…However, this type of surgery cannot be performed in all patients. In recent years, an increasing body of published evidence suggests that a more conservative, nonresectional, graft-sparing surgical strategy with open surgical disinfection followed by omentum flap coverage of the infected ascending and arch prosthetic graft is gaining wider acceptance as a more feasible and more effective treatment therapy with excellent immediate and midterm outcomes (Coselli et al 1990; Coselli et al 1999; Hargrove and Edmunds 1984; Nakajima et al 1999; LeMaire and Coselli 2007). This case report contributes the ongoing discussion on this important topic and may help to pay cardiac surgeons’ attention on modern knowledge-based treatment strategies, and also thus avoid in selected patients unnecessary high-risk aortic redo procedures for infected ascending and arch prosthetic grafts.…”

Section: Introductionmentioning

confidence: 99%

Successful surgical in situ treatment of prosthetic graft infection by staged procedure after Bentall operation and total aortic arch replacement

et al. 2014

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We report a case of a 29-year-old Marfan patient who developed prosthetic graft infection 10 months after Bentall operation and successive replacement of the remaining ascending aorta and the entire aortic arch for acute aortic dissection. Instead of an aggressive high-risk aortic redo procedure with removal and replacement of the infected prosthetic graft we elected a staged graft-sparing surgical approach. After 18 months of close follow-up the patient is in good condition and free from infectious sequela. This case and our review of the literature suggest that open extensive disinfection followed by tissue flap coverage is highly effective in controlling thoracic aortic prosthetic graft infection and may be considered as first-line treatment in such high-risk aortic arch redo patients.

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A new method for the treatment of graft infection in the thoracic aorta: in situ preservation

Cited by 45 publications

References 7 publications

Surgical and Antimicrobial Treatment of Prosthetic Vascular Graft Infections at Different Surgical Sites: A Retrospective Study of Treatment Outcomes

Surgical and Antimicrobial Treatment of Prosthetic Vascular Graft Infections at Different Surgical Sites: A Retrospective Study of Treatment Outcomes

A Case of an Aortic Abscess around the Elephant Trunk

Successful surgical in situ treatment of prosthetic graft infection by staged procedure after Bentall operation and total aortic arch replacement

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