Management of prosthetic graft infection after surgery of the thoracic aorta: Removal of the prosthetic graft is not necessary

Akowuah, Enoch; Narayan, Pradeep; Angelini, Gianni D; Bryan, Alan J.

doi:10.1016/j.jtcvs.2007.02.055

Cited by 45 publications

(41 citation statements)

References 6 publications

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“…We found no studies describing which treatment should be primarily performed between the infected aortic graft and the orthotopic infection source of the graft infection, although prompt removal of the infected graft and re-replacement is recommended when the patient does not have mediastinitis. 1,2) Our two patients recovered without severe complications, and re-infection of the graft was not observed for more than 21 months, suggesting that early re-graft replacement should be initially perfo rmed even when the patient has an orthotopic source of graft infection.…”

Section: Fig 2 Plain Computed Tomography (Ct) Increased Ct Densitymentioning

confidence: 77%

“…The early mortality with salvage of the prosthetic graft was recently reported as 9% to 25%. 1,5) In one study, mediastinal debridement was performed without removing the infected graft when the patient presented with a sternal wound infection. 1) …”

Section: Discussionmentioning

confidence: 99%

“…1,2) Removal of the infected graft and radical debridement have been considered mandatory. However, we sometimes encounter difficulties in performing prompt re-operation because of these high early mortalities when the patients' activities of daily living (ADL) are decreased because of neurological complications after the initial surgery.…”

Section: Introductionmentioning

confidence: 99%

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Treatment of Prosthetic Graft Infection after Thoracic Aorta Replacement

Tamaki

Terasaki

Wada

et al. 2014

ATCS

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Purpose: Prosthetic graft infection is a fatal complication after thoracic aorta replacement, and it is sometimes difficult to perform a prompt re-operation when the patient carries the infectious source of the graft. We evaluated the early and mid-term outcomes of aortic graft infection after thoracic aorta replacement, focusing on the timing of the surgery. Methods: This study included eight consecutive patients with thoracic graft infection from 1997 to 2011 among 513 patients of graft replacement during this period. We performed re-graft replacement in six patients. Of these six patients, emergency surgery was performed in two and scheduled surgery was performed in two. An unscheduled emergency surgery was required in two patients during the medical treatment of the infection source. Solo medical treatment was performed in two patients. Results: In-hospital mortality occurred in two of the eight patients (25%). Re-graft infection was not observed in the six patients who underwent re-graft replacement or the one patient who underwent medical treatment during the 1.5-to 14-year observation period. Conclusions: Prompt re-replacement of the infected graft should be performed even when an orthotopic infection source led to the graft infection. Medical treatment might be applicable when neither an abscess nor pseudoaneurysm is observed.

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Section: Fig 2 Plain Computed Tomography (Ct) Increased Ct Densitymentioning

confidence: 77%

Section: Discussionmentioning

confidence: 99%

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Treatment of Prosthetic Graft Infection after Thoracic Aorta Replacement

Tamaki

Terasaki

Wada

et al. 2014

ATCS

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“…Despite only a few reports on VAC therapy after thoracic aortic prosthetic replacement, its effectiveness after vascular prosthetic replacement has been reported. 17,18) While some authors reported one-step procedures of removal of infected and necrotic tissues, debridement, and filling procedure, followed by wound closure, 19) VAC therapy provides a more reliable approach with a reduction in bacterial load and multiple negative bacterial culture, followed by filling with omental or pedicled muscle flaps and wound closure. 20) In the present case, omental filling procedure was performed after negative bacterial culture of specimens obtained during the first surgery was confirmed.…”

Section: Discussionmentioning

confidence: 99%

A Case of an Aortic Abscess around the Elephant Trunk

Fujii

Kawasaki

Katayanagi

et al. 2015

ATCS

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A 52-year-old male patient with a history of total arch replacement using the elephant trunk technique for acute aortic dissection 4 years before visited our hospital with the chief complaint of persistent fever. Chest computed tomography (CT) suggested prosthetic vascular graft infection, which was treated surgically after chemotherapy. The first surgery consisted of debridement of an abscess around the vascular graft and in the aorta around the elephant trunk, and thoracic descending aorta replacement and vacuum-assisted closure (VAC) in view of the risk of bleeding from the peripheral region of the elephant trunk. One week later, omental filling was performed as the second step. This is a very rare case of aortic abscess around the elephant trunk that could successfully be managed by graft-conserving treatment.

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“…Limited surgical strategy involving extensive mediastinal debridement is reported in cases where infection is associated with sternal wound infection by low virulent pathogens. [59] Endovascular stent graft repair has been reported as an attractive and effective treatment option, but the persistence of infection is always a concern. Though in cases of severe local inflammation, with or without haemorrhage, this technique can serve as bridging therapy.…”

Section: Infection Of Thoracic Aortamentioning

confidence: 99%