Antibiotic irrigation and conservative surgery for major aortic graft infection

Morris, G.E.; Friend, Peter J.; Vassallo, Diana; Farrington, M.; Leapman, Stephen B.; Quick, Clive R.G.

doi:10.1016/0741-5214(94)90179-1

Cited by 68 publications

(27 citation statements)

References 31 publications

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“…In these series [25,26], the treatment consisted of sur gical dÃ©bridement and drainage followed by antibiotic or povidoneâ€"iodine irrigation and muscle flap coveragewith appropriate IV an tibiotic therapy. This approach has also been used to treat patients with extensive aortic graft infection with satisfactory results [1,26,27]. In a study by Morris et al [1], 10 patients were treated with surgical placement of a drainage catheter in the periprosthetic fluid collection combined with aggressive IV and local antibiotic therapy obviating excision of the infectedvascularprosthesis.…”

Section: Discussionmentioning

confidence: 99%

“…This approach has also been used to treat patients with extensive aortic graft infection with satisfactory results [1,26,27]. In a study by Morris et al [1], 10 patients were treated with surgical placement of a drainage catheter in the periprosthetic fluid collection combined with aggressive IV and local antibiotic therapy obviating excision of the infectedvascularprosthesis. Sevenof the 10patients respondedto this treatment, which is really a surgical variant of percutaneous drainage.…”

Section: Discussionmentioning

confidence: 99%

“…Thesurgical procedure carries a high mortality rate (50% in our series) with the main causesof death being recurrent sep sis, secondary hemorrhage, and cardiac events [2,19]. Conventional surgical treat ment is also associated with prolonged hospi tal stays, multiple reinterventions that vary between 1.4 and 2.6 per patient, and a signifi cant rate of distal limb amputation (11â€"37%) [1,20]. Sequentialtreatment(extraanatomic bypass followed by graft excision) has been proposed as an alternative treatment in these patients; however, a significant infection rate (20â€"22%) of extraanatomic bypassgrafts has been reported [4,6,21], and this sequential treatment method has not been successful in reducing mortality rates [4].…”

Section: Discussionmentioning

confidence: 99%

“…Therapeuticoptions are limited after establishingthe diagnosisand depend on the site of the infection, its extent, and the medical statusof the patient. Infection localized to the groin or the distal end of an aortobifemoral graft can sometimes be con trolled with aggressive surgical ddbridement and IV antibiotic therapy [1,17]. When the in fectious process is more extensive, involving either the iliac or aortic portion ofthe graft, the standardtreatment has been surgical excision of the infected graft and extraanatomic bypass [2â€"7, 17â€"191.…”

Section: Discussionmentioning

confidence: 99%

“…is an infrequent complication of by pass surgery with an average mci dence of 2% [1]. The standard treatment for an infected graft is surgical removal combined with extraanatomic bypass and appropriate anti biotictherapy [2][3][4][5][6].…”

Section: Niection Of An Aortic Vascular Graftmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%