Alternative approach for management of infected aortic grafts

Darling, R. Clement; Resnikoff, Michael; Kreienberg, Paul B.; Chang, Benjamin; Paty, Philip S.K.; Leather, Robert P.; Shah, Dhiraj M.

doi:10.1016/s0741-5214(97)70326-4

Cited by 33 publications

(18 citation statements)

References 11 publications

(2 reference statements)

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“…In our series, this was actually identified in cases 1 and 2, but was not identified in case 8. The results of partial graft removal in the previous reports are as follows: perioperative mortality, 0%-13%; major amputation, 0%-13% 14,24,47,49 (Table 4B). …”

Section: Discussionmentioning

confidence: 90%

“…No stump blowout occurred in any patient. Beside the axillary artery as an inflow source after aortic graft excision, the descending thoracic aorta or noninfected proximal aorta (in-line technique) 23,24 has been also used. The follow-up results of 16 patients using the in-line technique by Darling et al 24 were as follows: perioperative mortality, 0%; major amputation, 0%; new graft infection, 0%; new graft failure 25%; aortic stump blowout, 8%.…”

Section: Discussionmentioning

confidence: 99%

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Treatment for Aortic Graft Infection

et al. 2001

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Nine patients with an aortic graft infection presented after undergoing aortic grafting. Seven of 9 patients underwent an initial aortic reconstruction in our hospital. The incidence of aortic graft infection was 1.5% (7/456). There were 6 cases of paraprosthetic infection and 3 cases of aortointestinal fistulas. The treatments consisted of a complete graft excision and an axillofemoral bypass in 6 patients, a complete graft excision alone, a partial graft excision and a femorofemoral bypass, and the preservation of the graft with omental wrapping and irrigation in 1 each. Broad-spectrum antibiotics were intravenously administered to all patients and were then replaced by selective antibiotics for the responsible organisms. All surviving patients received antibiotics orally for 3-6 months. The early postoperative mortality rate was 11.1%. Aortoduodenal fistula occurred in 1 patient with graft excision alone. Graft thrombosis occurred in 2 patients with an axillofemoral bypass. No late graft infection or stump blowout occurred in any patient. We believe that a complete excision of the infected graft as well as the maintenance of distal tissue perfusion is necessary. However, based on the condition of the patient, the appearance of the operating field, and the difficulty of a repeat operation, we would like to stress the importance of selecting the best and safest treatment plan for each case.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Treatment for Aortic Graft Infection

et al. 2001

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“…Infection can also develop after percutaneous stent angioplasty but in low rates (0.5%). [14,15] Early graft infections usually affect extracavitary grafts, while majority of late infections involve cavitary (i.e., aortic) grafts. [16] …”

Section: Epidemiologymentioning

confidence: 99%

Current Management of Vascular Infections

Ktenidis¹,

Giannopoulos²

2012

Vascular Surgery - Principles and Practice

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“…Alternative therapies include partial or total graft excision, in situ prosthetic replacement after debridement, or in situ allograft replacement. 11,12 All of these techniques have mortality rates ranging from 30% to 70% and extensive morbidity, with amputation rates approaching 30%. [13][14][15][16][17] In studies that reported results of extra-anatomic bypass for abdominal aortic graft infection, the overall patency is ϳ65% at 3 years.…”

Section: Betweenmentioning

confidence: 99%

“…14 It has been shown that in situ bypass grafts for severe aortic graft infection were followed by 100% reinfection and 38% mortality rates. Some authors 12,23,24 have noted a high rate of suture line breakdown, patch rupture, and bleeding when new autologous tissue patches or grafts are placed in an infected field. On the other hand, Farkas et al 25 have observed that positive cultures of benign aneurysms are not related to increased risk of secondary graft sepsis.…”

Section: Betweenmentioning

confidence: 99%