Abdominal Aortic Graft Infection

Tsapralis, Dimitrios; Charalampopoulos, Anestis; Lazaris, Andreas M.

doi:10.5772/18514

Cited by 6 publications

(13 citation statements)

References 69 publications

(63 reference statements)

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“…Possible routes for graft infection include perioperative contamination, hematogenous spread from a distant site, and mechanical erosion of the endograft or aneurysmal sac coils 1-51; reported sources of endograft infection include infection (groin, urinary or other) at index operation, contaminated index operation, and endoleak at index operation 33. Aortic graft infections may also be related with a non-evacuated thrombus, atherosclerotic plaques, persistent endoleak, presence of an aortoenteric fistula 8, 11, 20, 21, and suboptimal sterility conditions in the interventional radiology suites 18.…”

Section: Pathogenesismentioning

confidence: 99%

“…However, despite the advances in operative techniques and perioperative management of patients with abdominal aortic aneurysms or occlusive aorto-iliac disease, there are many early and late complications related to aortic graft repair. One of the most devastating complication is infection of the aortic graft accounting for an incidence ranging from just under 1% to as high as 6%, with an overall incidence of approximately 4%, and an associated perioperative and overall mortality of 12% and 17.5-20%, respectively 1 .…”

Section: Introductionmentioning

confidence: 99%

“…Hence, this minimally invasive procedure has emerged as an appealing treatment option, as compared to conventional open surgery, with comparatively better early outcomes and lower perioperative mortality and morbidity rates 3 . However, there has been no reason to believe that endovascular aortic stent grafts would be immune from septic complications 1 , 4 . The rate of EVAR infections is unclear 6 .…”

Section: Introductionmentioning

confidence: 99%

“…Even though the reported incidence of EVAR infection is very low (mean, 0.4%; range, 0.2-0.7%) 5 , 6 , it represents a devastating complication with an estimated mortality ranging from 27.4% to 36.4% 6 . Skin contamination during interventional procedures, which occur in up to 10-20%, and hematogenous graft seeding may occur 1 - 6 .…”

Section: Introductionmentioning

confidence: 99%

“…To enhance the literature, we searched PubMed using as search terms [endograft] or [aortic graft] or [EVAR] and [spondylitis] aiming to summarize the pathogenesis and diagnosis, and to discuss the treatment and outcome of the patients with these rare and complex infections. Our literature search showed 67 studies (original and review articles) on endograft infections and spondylitis 1 - 57 . These studies were read and evaluated for continuous tissues transmitted spondylitis from infected aortic grafts.…”

Section: Introductionmentioning

confidence: 99%

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Spondylitis transmitted from infected aortic grafts: a review

Megaloikonomos

Antoniadou

Dimopoulos

et al. 2017

J. Bone Joint Infect.

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Graft infection following aortic aneurysms repair is an uncommon but devastating complication; its incidence ranges from <1% to 6% (mean 4%), with an associated perioperative and overall mortality of 12% and 17.5-20%, respectively. The most common causative organisms are Staphylococcus aureus and Escherichia coli; causative bacteria typically arise from the skin or gastrointestinal tract. The pathogenetic mechanisms of aortic graft infections are mainly breaks in sterile technique during its implantation, superinfection during bacteremia from a variety of sources, severe intraperitoneal or retroperitoneal inflammation, inoculation of bacteria during postoperative percutaneous interventions to manage various types of endoleaks, and external injury of the vascular graft. Mechanical forces in direct relation to the device were implicated in fistula formation in 35% of cases of graft infection. Partial rupture and graft migration leading to gradual erosion of the bowel wall and aortoenteric fistulas have been reported in 30.8% of cases.Rarely, infection via continuous tissues may affect the spine, resulting in spondylitis. Even though graft explantation and surgical debridement is usually the preferred course of action, comorbidities and increased perioperative risk may preclude patients from surgery and endorse a conservative approach as the treatment of choice. In contrast, conservative treatment is the treatment of choice for spondylitis; surgery may be indicated in approximately 8.5% of patients with neural compression or excessive spinal infection. To enhance the literature, we searched the related literature for published studies on continuous spondylitis from infected endovascular grafts aiming to summarize the pathogenesis and diagnosis, and to discuss the treatment and outcome of the patients with these rare and complex infections.

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Section: Pathogenesismentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Spondylitis transmitted from infected aortic grafts: a review

Megaloikonomos

Antoniadou

Dimopoulos

et al. 2017

J. Bone Joint Infect.

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Aortic Graft Infection

Ladizinski

Sankey

2014

J GEN INTERN MED

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Infección de prótesis aortobiilíaca tras bacteriemia polimicrobiana. A propósito de un caso

et al. 2014

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La infección de las prótesis vasculares es una de las complicaciones más temidas de los cirujanos vasculares, ya que conllevan una gran morbimortalidad. La incidencia de infección de las prótesis aortobiilíacas se ha calculado entre el 0,2-1,3% según las series 1,2 . Se pueden clasificar en precoces o tardías, según la infección sea objetivada en menos de 4 meses o más de 4 meses, respectivamente 1,2 . Así, las infecciones precoces suelen ser debidas a microorganismos muy virulentos (Staphylococcus aureus [S. aureus], Klebsiella, Escherichia coli [E. coli], Pseudomonas...) manifestándose por fiebre, bacteriemia, infección de la herida, sepsis entre otros; en cambio, las infecciones tardías suelen ser secundarias a patógenos de baja virulencia (como Staphylococcus epidermidis [S. epidermidis]) con una clínica más larvada. Las infecciones por Cándida son raras y aparecen principalmente en paciente inmunodeprimidos. Las infecciones por Salmonella son excepcionales 2 . El diagnóstico requiere la asociación de técnicas de imagen, que permite localizar la infección mediante signos directos e indirectos y microbiológicas, * Autor para correspondencia.Correo electrónico: africaduque@hotmail.com (A. Duque-Santos). para realizar un diagnóstico positivo de la misma y un tratamiento antibiótico ajustado. Las técnicas de imagen preferidas son el angio-TC y la gammagrafía con leucocitos marcados 2,3 .A continuación presentamos el caso de un varón de 70 años intervenido de un aneurisma de aorta yuxtarrenal de 6,5 cm de diámetro, realizándose un bypass aortobiilíaco con prótesis de PTFE de 18 x 9 cm. Año y medio después, es ingresado por dolor lumbar incapacitante, fiebre alta de 3 días de evolución asociado a sensación distérmica y síndrome constitucional de 2 meses de evolución. Como antecedente destacable cabe resaltar un episodio de gastroenteritis autolimitada 4 meses antes. Tras toma de hemocultivos, se inicia antibioterapia con piperacilina/tazobactam 4/0,5 gr cada 8 horas; siendo sustituido por ceftriaxona 2 gramos/8 horas durante 8 semanas al obtener hemocultivos positivos para Salmonella enteritidis (S. enteritidis) grupo D. Durante el ingreso, se realizan TC y RMN lumbares que objetivan espondilodiscitis L3-L4 con absceso epidural y paravertebral ( fig. 1), por lo que es intervenido para drenaje de las colecciones periaórticas, desbridamiento del foco de espondilodiscitis (con toma de biopsias que demuestran las esterilidad del hueso en ese momento) y reconstrucción mediante injerto óseo. La ausencia de contacto del foco de espondilodiscitis con la prótesis objetivada durante la cirugía, junto con gammagrafía con leucocitos marcados y 0003-3170/$ -see front matter © 2012 SEACV. Publicado por Elsevier España, S.L.U. Todos los derechos reservados. http://dx.

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Abdominal Aortic Graft Infection

Cited by 6 publications

References 69 publications

Spondylitis transmitted from infected aortic grafts: a review

Spondylitis transmitted from infected aortic grafts: a review

Aortic Graft Infection

Infección de prótesis aortobiilíaca tras bacteriemia polimicrobiana. A propósito de un caso

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