Endovascular stent graft repair for infected thoracic aortic pseudoaneurysms—a durable option?

Ting, Acw; Cheng, Stephen W.K.; Ho, Pei; Poon, Jensen T. C.

doi:10.1016/j.jvs.2006.05.055

Cited by 87 publications

(62 citation statements)

References 17 publications

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“…In these patients, Vallejo and others reported that a combination (hybrid) of in situ reconstruction and EVT might be necessary. 190,228,[241][242][243][244][245][246][247][248] Subsequent explantation of EVT devices is especially challenging in patients with hybrid procedures and might not be technically feasible. Vallejo and colleagues 190 recommended EVT or hybrid procedures only in selected patients and concluded that open in situ repair remains the surgical management of choice.…”

Section: Clinical Statements and Guidelinesmentioning

confidence: 99%

“…After initial placement of the EVT device, explantation of the device and open surgical resection of the aortic MA and reconstruction may be considered in patients who can tolerate an open procedure. 189,227,228,[241][242][243][244][245][246][247][248] There are insufficient data to recommend EVT as the procedure of choice for patients with aortic MA (Figure 8 …”

Section: Clinical Statements and Guidelinesmentioning

confidence: 99%

“…In patients with free or contained rupture, EVT may be considered to stabilize hemodynamics and as a bridge to subsequent open in situ repair (Figure 8). 190,227,228,[241][242][243][244][245][246][247][248] recommendation for Management of rupture or contained rupture of aortic Ma Aortoenteric Fistulae With Duodenum. Primary aortoenteric fistulae into the duodenum associated with aortic MA are less common than are secondary aortoenteric fistulae, which result from erosion of an aortic vascular graft placed for repair of abdominal aortic aneurysm or occlusive disease.…”

Section: Additional Factors In Management Of Aortic Mamentioning

confidence: 99%

See 2 more Smart Citations

Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: A Scientific Statement From the American Heart Association

Wilson¹,

Bower²,

Creager³

et al. 2016

Circulation

358

307

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The use of synthetic material for reconstructive vascular surgery was first reported during the early 1950s. Infection involving vascular graft prostheses is an infrequent but devastating complication of reconstructive vascular graft surgery and is associated with a high morbidity and, in some situations, mortality. Improvements in surgical techniques and graft design, including the use of native venous or arterial tissue, have reduced the frequency of infection and severity of complications from vascular graft infection (VGI). However, these advances have also led to more frequent vascular graft procedures occurring in a patient population with multiple underlying comorbidities that would have previously disqualified them as candidates for vascular reconstructive surgery. Underlying comorbidities, such as diabetes mellitus or immune compromise, increase the risk of infection and serious infection-related complications. The major complications of VGI include sepsis, amputation, disruption of infected anastomotic suture line with rupture or pseudoaneurysm formation, embolization of infected thrombi, reinfection of reconstructed vascular grafts, enteric fistulae to the small or large bowel, bacteremic spread of infection to other sites, and death. VGIs can be categorized broadly into those that occur in an extracavitary location, primarily in the groin or lower extremities, or in an intracavitary location, primarily within the abdomen or less commonly within the thorax. frequencyThe frequency of VGI depends on the anatomic location of the graft. The infection rate is 1.5% to 2% for most extracavitary grafts and as high as 6% with vascular grafts in the groin. [1][2][3][4][5][6][7][8][9] For intracavitary grafts, the infection rate is ≈1% to 5%. 1-6 Graft infection is most common after emergency procedures and after reoperation. [1][2][3][4]10 Aortic graft erosion or fistulous communication into the duodenum or other areas of the bowel reportedly occurs in 1% to 2% of patients after aortic reconstruction. 11,12 MicrobiologyThe microbiological cause of VGI has evolved over the years. 1 In early published studies, Staphylococcus aureus was the predominant microorganism recovered. 1,13 Improvements in surgical technique, administration of prophylactic antistaphylococcal antimicrobial therapy, and other factors have resulted in a changing microbiological epidemiology. Vascular graft surgery performed on patients with multiple underlying comorbidities and the increased frequency of emergency procedures have contributed to the changing spectrum of infection. Other factors such as changes in hospital flora, surgery in patients with complicated vascular anatomy, and multiple revisions of previous vascular surgery have resulted in a more diverse microbio- clInIcal stateMents anD GuIDelInes logical spectrum of infection, which includes multidrugresistant strains, polymicrobial infection, and Candida species. Gram-positive cocci accounts for at least two thirds of VGIs. 1,13 Infections caused by coagulase-negative staphylococ...

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Section: Clinical Statements and Guidelinesmentioning

confidence: 99%

Section: Clinical Statements and Guidelinesmentioning

confidence: 99%

Section: Additional Factors In Management Of Aortic Mamentioning

confidence: 99%

See 1 more Smart Citation

Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: A Scientific Statement From the American Heart Association

Wilson¹,

Bower²,

Creager³

et al. 2016

Circulation

358

307

View full text Add to dashboard Cite

show abstract

“…5 The use of emergency stenting of iliac false aneurysm has been an effective treatment of ruptured iliac artery pseudo-aneurysm in our case. Ting et al 6 reported a successful endovascular stent repair of infected thoracic aortic pseudo-aneurysms under intravenous antibiotic cover followed by life-long oral antibiotics with a longterm follow-up (> 30 months) in three of their eight patients. Others have also reported a successful cover stent exclusion of external artery MRSA-infected pseudoaneurysm followed by 3 months of oral antibiotics.…”

Section: Discussionmentioning

confidence: 99%

Endovascular treatment of bleeding external iliac artery pseudo-aneurysm following control of haemorrhage with Sengstaken tube during revision total hip arthroplasty

Makar¹,

Salem²,

McGee³

et al. 2007

Ann R Coll Surg Engl

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“…Though in cases of severe local inflammation, with or without haemorrhage, this technique can serve as bridging therapy. [60] Stent or stent-graft infections in the thoracic aorta are extremely rare. They are usually met in the literature as complications of systemic specific infections such as TBC or brucellosis.…”

Section: Infection Of Thoracic Aortamentioning

confidence: 99%

Current Management of Vascular Infections

Ktenidis¹,

Giannopoulos²

2012

Vascular Surgery - Principles and Practice

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Endovascular stent graft repair for infected thoracic aortic pseudoaneurysms—a durable option?

Abstract: Endovascular stent graft repair is effective and may be a durable option for infected pseudoaneurysms of the thoracic aorta.

Cited by 87 publications

References 17 publications

Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: A Scientific Statement From the American Heart Association

Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: A Scientific Statement From the American Heart Association

Endovascular treatment of bleeding external iliac artery pseudo-aneurysm following control of haemorrhage with Sengstaken tube during revision total hip arthroplasty

Current Management of Vascular Infections

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