Aortic graft infection: the value of percutaneous drainage.

Abstract

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 ± 9.32 years; I I men) and a second group of I2 patients initially treated with surgical interven tion (age, 68.75 ± 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

Successful treatment using percutaneous drainage for aortic arch prosthetic graft infection

“…Coselli et al [3] emphasized the importance of graft coverage and elimination of dead space with viable tissue flaps. Percutaneous drainage prior to an open surgical repair or the treatment of abdominal or thoracoabdominal aortic graft infection has been reported [4][5][6]. To the best of our knowledge, although percutaneous drainage of an abdominal aortic aneurysm sac has been previously reported, drainage of an abscess located at the aortic arch is rare.…”

Do infected vascular grafts always need to be removed? management of an infected aortic graft with endovascular stent grafting.

“…Previously, the use of percutaneous drainage was shown to be a successful primary therapy, with resolution of sepsis in 82% of patients compared with only 33% in the surgical group, although fluid collection was inaccurately measured in 67% of the patients in the surgical group (6). In addition, 45% of the patients in the percutaneous drainage group required open surgery due to abdominal aortic aneurysm, ruptured abdominal aortic aneurysm, or thoracoabdominal aneurysm, with no deaths reported within 30 days and one death occurring by the one-year follow-up (6). Aggressive drainage has been used as either the sole treatment or a bridge to surgical management, with an appropriate survival rate (4, 7).…”

Aortic Graft Preservation by Debridement and Omental Wrapping

“…9,10 Even percutaneous drainage followed by surgery has been reported. 11 A more recent review of a mixed group of nine patients, for whom major surgery was contraindicated, demonstrated that survival could be obtained by conservative management, although this group did have adjunctive procedures such as partial graft excision in three patients and percutaneous drains with three times daily instillation of antibiotics. 12 Seven of the nine patients survived, with only one case of amputation and no recurrent infection over a mean of 7.6 years of follow-up.…”