Graft infection after endovascular abdominal aortic aneurysm repair

Laser, Adriana; Baker, Nicole; Rectenwald, John E.; Eliason, J.L.; Criado-Pallares, Enrique; Upchurch, Gilbert R.

doi:10.1016/j.jvs.2010.11.111

Cited by 107 publications

(128 citation statements)

References 9 publications

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“…8,213,256,[275][276][277][278] Infections associated with endovascular abdominal repair are reportedly lower, ≈1%, than for TEVAR (up to 5%). 8,213,256,[275][276][277][278] The higher TEVAR infection rates could relate to the complexity of thoracic compared with aortic EVT, higher patient comorbidity, and a small increased risk of fistulous communication with the bronchus or esophagus. Infection of endovascular devices falls into 2 broad categories: those that occur in association with repair of uninfected aortic aneurysms and those that are used for treatment of MA, including MAs associated with aortic, enteric, or aortobronchial fistulae.…”

Section: Additional Factors In Management Of Aortic Mamentioning

confidence: 99%

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

Wilson¹,

Bower²,

Creager³

et al. 2016

Circulation

337

303

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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: Additional Factors In Management Of Aortic Mamentioning

confidence: 99%

“…213,251,256,[275][276][277][278][279] A small number of patients with infected EVT devices did not undergo explantation because they were considered medically or surgically unfit to undergo explantation and reconstruction. The mortality rate in these patients ranged from 36% to 100%.…”

Section: Additional Factors In Management Of Aortic Mamentioning

confidence: 99%

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

Wilson¹,

Bower²,

Creager³

et al. 2016

Circulation

337

303

View full text Add to dashboard Cite

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“…The incidence of endograft infection after EVAR has been reported in major series as 0.2% to 0.9%, 7,8,[12][13][14][15] although the actual rate is difficult to estimate. 19 Those percentages might rise, given the projected increases in numbers of EVAR procedures.…”

Section: Discussionmentioning

confidence: 99%

“…7 For these reasons, less invasive treatments have been recommended for patients who have severe underlying diseases. [7][8][9][10][11][12][13] Results in those cases seem somewhat inferior to those in complete excision. Hart and colleagues 20 found a 13% rate of recurrent infection in patients who underwent complete graft excision and a 27% rate in those who underwent partial graft salvage.…”

Section: Discussionmentioning

confidence: 99%

“…5,6 Although one of the least frequent causes of reintervention is infection (incidence, <1% of EVAR cases), [7][8][9] it is associated with high mortality rates for surgically and conservatively treated patients. [10][11][12][13][14][15] Bloodstream infections caused by carbapenemase-producing Klebsiella pneumoniae (CPKP) are typically associated with a mortality rate of 13% to 58%, and few therapeutic options are available. 16,17 We present what we think is the first case of aortic endograft infection caused by colistin-resistant CPKP, report the therapeutic regimen and surgical course in a 62-year-old patient, and discuss the relevant medical literature.…”

mentioning

confidence: 99%

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Open Conversion after Aortic Endograft Infection Caused by Colistin-Resistant, Carbapenemase-Producing Klebsiella pneumoniae

Montelione¹,

Menna²,

Sirignano³

et al. 2016

Texas Heart Institute Journal

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A Multi‐Bioactive Nanomicelle‐Based “One Stone for Multiple Birds” Strategy for Precision Therapy of Abdominal Aortic Aneurysms

et al. 2022

Advanced Materials

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AAAs are characterized by the abdominal aortic diameter ≥3 cm or having ≥50% increase in the largest diameter of the abdominal aorta. [3] The estimated prevalence of AAA is 4-8% among people over 65 years old. [3b,4] Most individuals with AAAs are asymptomatic, but rupture of AAA results in mortality as high as 90%. [3a,5] Therefore, AAA is a serious and lethal aortic disease. The natural process of AAA is implicated by the continuous enlargement of the infrarenal aorta, and the turbulent blood flow in the aortic lumen promotes the formation of intraluminal thrombus. [3,6] Once the aneurysm diameter is larger than 5.5 cm, the risk of AAA rupture remarkably increases. [3b] Thus far, surgical intervention, including open surgery and endovascular aneurysm repair (EVAR), remains the only available choice for effective management of AAA. [7] Nevertheless, the surgical intervention of AAA has shown various post-operative complications, such as infection, [8] endoleak, [9] cardiopulmonary events, [10] acute kidney injury [11] and spinal cord injury. [2,12] Moreover, ≈20-30% patients require re-intervention after surgery owing to reperfusion and associated secondary aneurysm rupture, leading to reduced patient compliance as well as increased surgical risk and mortality. [2,3] Besides, surgical treatment is not suitable for Abdominal aortic aneurysm (AAA) remains a lethal aortic disease in the elderly. Currently, no effective drugs can be clinically applied to prevent the development of AAA. Herein, a "one stone for multiple birds" strategy for AAA therapy is reported. As a proof of concept, three bioactive conjugates are designed and synthesized, which can assemble into nanomicelles. Cellularly, these nanomicelles significantly inhibit migration and activation of inflammatory cells as well as protect vascular smooth muscle cells (VSMCs) from induced oxidative stress, calcification and apoptosis, with the best effect for nanomicelles (TPTN) derived from a conjugate defined as TPT. After intravenous delivery, TPTN efficiently accumulates in the aneurysmal tissue of AAA rats, showing notable distribution in neutrophils, macrophages and VSMCs, all relevant to AAA pathogenesis. Whereas three examined nanomicelles effectively delay expansion of AAA in rats, TPTN most potently prevents AAA growth by simultaneously normalizing the pro-inflammatory microenvironment and regulating multiple pathological cells. TPTN is effective even at 0.2 mg kg −1 . Besides, TPTN can function as a bioactive nanoplatform for site-specifically delivering and triggerably releasing anti-aneurysmal drugs, affording synergistic therapeutic effects. Consequently, TPTN is a promising multi-bioactive nanotherapy and bioresponsive targeting delivery nanocarrier for effective therapy of AAA and other inflammatory vascular diseases.

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Graft infection after endovascular abdominal aortic aneurysm repair

Cited by 107 publications

References 9 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

Open Conversion after Aortic Endograft Infection Caused by Colistin-Resistant, Carbapenemase-Producing Klebsiella pneumoniae

A Multi‐Bioactive Nanomicelle‐Based “One Stone for Multiple Birds” Strategy for Precision Therapy of Abdominal Aortic Aneurysms

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