Management of early graft infections in the ascending aorta and aortic arch: a comparison between graft replacement and graft preservation techniques

Umminger, Julia; Krueger, Heike; Beckmann, Erik; Kaufeld, Tim; Fleißner, Felix; Haverich, Axel; Shrestha, Malakh; Martens, Andreas

doi:10.1093/ejcts/ezw150

Cited by 46 publications

(56 citation statements)

References 21 publications

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“…Importantly, graft preservation was curative in patients with patent grafts, no sepsis, local bleeding or pseudoaneurysm, suggesting that this technique is more suitable for less severe infections 13 . Umminger et al showed that graft sparing was comparable to graft replacement in terms of in-hospital mortality although the time interval from the initial surgery was shorter in the graft-sparing group and some patients in the graft-sparing group required a second operation due to graft degeneration or infection that could not be treated with antibiotic irrigation 14 . They concluded that sparing is only effective when the diagnosis and treatment are prompt and aggressive.…”

Section: Managementmentioning

confidence: 99%

Management of Vascular Graft Infection

Ward

Howard²

2020

JNDS

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This case report focuses on the risk factors, diagnosis, and management of vascular graft infections. A complex and intriguing case is presented and the latest evidence on aetiology and management of this challenging condition are summarised. The contention regarding the diagnostic criteria for graft infection is addressed, and how different imaging modalities and genetic or systemic biomarkers could aid this diagnostic process. Key management challenges are also discussed. Firstly, the difficulties of penetration and efficacy of antimicrobials and the issues surrounding biofilm formation. Secondly, the different surgical options such as graft preservation with partial excision or muscle flap coverage, or excision and revascularisation. Further, the type of explant and the latest innovations in the field of biological grafts are considered. Overall, this case report brings to the fore the lack of structured guidelines and level 1 evidence for the diagnosis and management of vascular graft infection, and calls for a more structured, unified, multi-disciplinary approach.

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Section: Managementmentioning

confidence: 99%

Management of Vascular Graft Infection

Ward

Howard²

2020

JNDS

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Section: рис 3 кт-данные больных с ипаunclassified

“…Современная диагностика ИПА проводится с помощью МСКТ аорты с контрастированием, позитронно-эмиссионной томографии (ПЭТ) органов грудной клетки, трансторакальной ЭхоКГ [14]. При относительно ранних манифестациях ИПА рекомендовано МСКТ аорты с контрастированием, а при появлении симптомов ИПА в отсроченный период -ПЭТ, так как ПЭТ КТ может давать ложноположительный результат ввиду наличия физиологического воспалительного компонента в раннем послеоперационном периоде [14]. При диагностике ИПА на МСКТ аорты с контрастированием определяются следующие признаки: 1) жидкость вокруг протеза аорты плотностью менее 20 HU, 2) пузырьки газа, 3) потеря нормальной структуры тканей в средостении и парапротезной области с увеличением толщины мягких тканей между протезом и муфтой из стенки аорты более 5 мм, 4) наличие ложных аневризм [15].…”

Section: рис 3 кт-данные больных с ипаunclassified

“…В исследовании немецких ученых 2016 г. госпитальная летальность при протез-сохраняющей технологии хирургического лечения ИПА составила 2 (14%) из 14 пациентов, причиной смерти больных явилась полиорганная недостаточность [14]. В нашем исследовании уровень госпитальной летальности был сходным (20%).…”

Section: рис 3 кт-данные больных с ипаunclassified

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Surgical treatment of aortic graft infections

Charchyan¹,

Shestakov²,

Galeev³

et al. 2018

Kardiol. serdechno-sosud. khir.

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Частота глубоких инфекционных осложнений после кардиохирургических операций сохраняется на достаточно высоком уровне-0,5-4%, смертность при этом осложнении-до 50% [1]. Частота инфекций протеза аорты (ИПА) при вмешательстве на грудной аорте достигает 1-3% [2, 3], летальность-25-75%, а лечение в большинстве случаев сложное и длительное [4]. Фатальные осложнения при

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“…(i) Autologous: FV, GSV, and arm veins (ii) Nonautologous: homografts, xenografts, and allografts (b) Prosthetic grafts include Dacron, PTFE, and polyurethane [8] The common clinical practice is the use of in situ replacement, whereas extra-anatomical replacement is less frequently performed [9] [10]. In the nonautologous allografts, either fresh or cryopreserved allografts were used.…”

Section: Introductionmentioning

confidence: 99%

Systematic Review and Meta: Analysis of Aortic Graft Infections following Abdominal Aortic Aneurysm Repair

Niaz

Rao

Carey

et al. 2020

International Journal of Vascular Medicine

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Introduction. Aortic graft infection (AGI) is a rare complication following AAA repair and is associated with high morbidity and mortality. Management is variable, and there are no evidence-based guidelines. The aim of this study was to systematically review and analyse management options for AGI. Methods. Data was collected between July and August 2018. A full HDAS search was conducted on the following databases: MEDLINE, EMBASE, CINAHL, and PUBMED. Meta-analysis was conducted using RevMan 5 software. Results. 1,365 patient outcomes were assessed (10 cohort studies and 12 comparative studies). The most common treatment was in situ replacement of the graft (ISR) followed by extra-anatomical replacement (EAR). Various grafts were used for ISR, such as fresh/cryopreserved allograft, venous graft, and prosthetic grafts. No graft material was shown to be superior. Axillobifemoral graft was the commonest type of EAR used. In the majority of cohort studies, ISR was the main treatment for AGI. There was no significant difference in the overall mortality rate (ISR n = 70/176 vs. EAR n = 47/126, OR 0.93 [95% CI 0.36-2.36], P = 0:87). Graft occlusion rate was significantly lower in the ISR group vs. the EAR group (n = 14/115 vs. n = 29/60 OR 0.16 [95% CI 0.07-0.36], P < 0:001). There was no significant difference in the amputation rate between the surgical treatments (ISR n = 9/141 vs. EAR n = 8/82, OR 0.75 [95% CI 0.07-8.39], P = 0:82). Discussion. In situ replacement is the preferred method of treatment as it had lower rates of occlusion. Further strong evidence is required, such as a multicentre trial to establish a management pathway for the condition.

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Management of early graft infections in the ascending aorta and aortic arch: a comparison between graft replacement and graft preservation techniques

Cited by 46 publications

References 21 publications

Management of Vascular Graft Infection

Management of Vascular Graft Infection

Surgical treatment of aortic graft infections

Systematic Review and Meta: Analysis of Aortic Graft Infections following Abdominal Aortic Aneurysm Repair

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