Outcomes of Surgical Explantation of Infected Aortic Grafts After Endovascular and Open Abdominal Aneurysm Repair

Schaefers, Johannes Frederik; Donas, Konstantinos P.; Panuccio, Giuseppe; Kasprzak, Bernd; Heine, Benjamin; Torsello, Giovanni; Osada, Nani; Usai, Marco V.

doi:10.1016/j.ejvs.2018.07.021

Cited by 24 publications

(12 citation statements)

References 27 publications

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“…Surgery should be attempted as first line in young and fit patients and in those unlikely to be resolved by conservative management (i.e., extensive peri-graft purulence, pseudoaneurysm or suspected aorto-enteric fistula) (1)(2)(3)(4).…”

Section: Discussionmentioning

confidence: 99%

“… Surgical treatment consists on removal of the infected graft followed by revascularization techniques using synthetic, autologous or cryopreserved allografts either with in-situ reconstruction or with extraanatomical bypass techniques (1-4).  Long-term antibiotic therapy (at least 6 weeks) is always required, with close monitoring of CRP, especially in situations where complete removal of the endovascular material is not possible or associates a greater risk (1)(2)(3)(4).…”

Section: Discussionmentioning

confidence: 99%

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Arch replacement following endovascular arch repair for an infected stent: case report

López-Marco¹,

Jahangeer²,

Adams³

et al. 2022

J Vis Surg

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Endovascular graft infection is a rare but challenging complication that requires a tailored approach to remove the infected graft and restore the arterial circulation combined with long-term antibiotic therapy. We present a case with a previous endovascular repair of the aortic arch and descending thoracic aorta on a 78-year-old male deemed too high risk for surgery. Three years after the endovascular repair, he presented with fever of unknown origin and the diagnosis of stent graft infection was made based on clinical, microbiological and radiological criteria. The peri-graft infection within the arch had dislocated the stent branch on the innominate artery and caused and expanding aneurysm. Urgent surgical indication was made based on the radiological findings and he underwent a removal of the infected material followed by aortic arch and descending aorta reconstruction with a total arch replacement with a frozen elephant trunk device using cardiopulmonary bypass with moderate hypothermic circulatory arrest and antegrade cerebral perfusion. The patient made an uneventful recovery and is free of recurrence eighteen months after the operation. Treatment of endovascular graft infections require a tailored treatment after multidisciplinary team discussions. In this particular case, the patient was deemed too high risk for surgery in the first instance, but we demonstrated that with treated in highly specialised unit, uneventful recovery is possible even after a more complex aortic repair following the endovascular infection. Complex aortic repair benefits always from a specialised multi-disciplinary team discussion and referral to high volume centers in order to achieve best results.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Arch replacement following endovascular arch repair for an infected stent: case report

López-Marco¹,

Jahangeer²,

Adams³

et al. 2022

J Vis Surg

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“…[1][2][3][4] Mortality after infected abdominal EVAR is still significant despite the treatment used: 27 to 37% after surgery, 50% after endovascular, and 63% with conservative management. 5,6 Neisseria meningitidis appears as gram-negative cocci, oriented in pairs. Neisseria spp.…”

Section: Discussionmentioning

confidence: 99%

Endovascular Graft Infection by Neisseria meningitidis: A Rare but Fatal Infection

et al. 2020

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Endovascular graft infection is a rare but challenging complication that requires a tailored approach to remove the infected graft and restore the arterial circulation combined with long-term antibiotic therapy. We present a case surgically treated with explant of the graft and reconstruction of the thoracoabdominal aorta. Microbiological investigation revealed growth of Neisseria meningitidis, which is extremely rare in this location, and to our knowledge, has not been previously published in the literature.

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“…While aortitis due to Mycobacterium tuberculosis, Treponema pallidum, β-hemolytic group A streptococci, Pneumococcus and Hemophilus influenzae have become very rare since targeted antibiotic regimens have been introduced, the prevalence of aortic infections associated with intravenous drug abuse (mainly caused by Gram-positive bacteria such as Staphylococcus, Streptococcus, and Enterococcus) and intravascular interventions have increased (22). Aortic graft infections are serious complications of open and endovascular surgery, with an incidence rate of 0.6-3% that are associated with 30-60% perioperative mortality and severe complications such as limb amputation rates between 10% and 40% (23)(24)(25).…”

Section: Infectious Aortitismentioning

confidence: 99%

Aortitis – An Interdisciplinary Challenge

Shchetynska-Marinova

Amendt

Sadick

et al. 2021

In Vivo

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Outcomes of Surgical Explantation of Infected Aortic Grafts After Endovascular and Open Abdominal Aneurysm Repair

Cited by 24 publications

References 27 publications

Arch replacement following endovascular arch repair for an infected stent: case report

Arch replacement following endovascular arch repair for an infected stent: case report

Endovascular Graft Infection by Neisseria meningitidis: A Rare but Fatal Infection

Aortitis – An Interdisciplinary Challenge

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