Prosthetic graft infection after descending thoracic/ thoracoabdominal aortic aneurysmectomy: Management with in situ arterial allografts

Kieffer, Édouard; Sabatier, Jean; Plissonnier, Didier; Knosalla, Christoph

doi:10.1067/mva.2001.112314

Cited by 98 publications

(45 citation statements)

References 40 publications

(29 reference statements)

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“…[1][2][3] Aortic graft infection is a serious and life-threatening condition with a mortality rate of 20% to 40%, an amputation rate as high as 11%, and a reinfection rate of approximately 18%. [4][5][6] Factors associated with AGI are not clearly understood and require further delineation.…”

mentioning

confidence: 99%

The incidence and factors associated with graft infection after aortic aneurysm repair

Vogel

Symons

Flum

2008

Journal of Vascular Surgery

198

107

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The incidence of AGI was low, presented most commonly in the first postoperative year, and was similar among patients undergoing open AAA repair and EAVR. Patients with nosocomial infection had an earlier onset of AGI. The 2-year rate of AGI was significantly higher in patients who had blood stream septicemia and surgical site infection in the periprocedural hospitalization. These data may be helpful in directing surveillance programs for AIG.

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confidence: 99%

The incidence and factors associated with graft infection after aortic aneurysm repair

Vogel

Symons

Flum

2008

Journal of Vascular Surgery

198

107

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“…Infection of the prosthetic vascular graft is a rare but severe complication (1)(2)(3)(4). Death rates after vascular prosthetic graft infection range from 15% to 75%, amputation in up to 70% of cases, and reinfection in approximately 18% of patients (5)(6)(7)(8)(9)(10). The risk of complications increases with delayed treatment, which occurs often as a result of failure to diagnose, mainly in cases with a subtle, nonspecific clinical presentation.…”

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confidence: 99%

¹⁸F-FDG Uptake in Noninfected Prosthetic Vascular Grafts: Incidence, Patterns, and Changes over Time

et al. 2014

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18 F-FDG PET/CT is of value in the diagnosis of prosthetic vascular graft infection, but potential pitfalls related to tracer uptake in noninfected implants have been described. The current study assesses the incidence and patterns of 18 F-FDG uptake over time in noninfected grafts, in relationship to prosthetic material and location. Methods: A 12-y PET/CT database was retrospectively searched for cancer patients with prosthetic vascular grafts. Data retrieved from patient files included graft location, material, and time from surgery. Images were reviewed by 2 nuclear medicine physicians in consensus, with the presence and patterns (focal, diffuse homogeneous, inhomogeneous) of increased 18 F-FDG uptake in grafts recorded. The mean standardized uptake value in grafts (SUV-G) and mediastinum (SUV-M) was measured. The ratio of SUV-G to SUV-M (SUV-G/SUV-M) was calculated for each graft. Results: One hundred seven prostheses were identified in 102 studies in 43 cancer patients. Sixty-seven prostheses were made of Dacron, 33 of Gore-Tex, and 7 were native veins. No increased 18 F-FDG uptake was found in 9 grafts (native veins, 4; Gore-Tex, 3; Dacron, 2). There was diffuse homogeneous uptake in 68 and inhomogeneous uptake in 30 grafts. The homogeneous pattern was more prevalent in Gore-Tex whereas the inhomogeneous uptake was seen more in Dacron vascular grafts. None of the grafts demonstrated focal uptake. The SUV-G range was 0.4-6.3 (average, 1.9), and SUV-M range was 0.6-2.4 (average, 1.4). The intensity of uptake was significantly higher in Dacron (SUV-G 5 2.35 and SUV-G/ SUV-M 5 1.72) than in Gore-Tex (SUV-G 5 1.09, SUV-G/SUV-M 5 0.91) and native vein grafts (SUV-G 5 1.07, SUV-G/SUV-M 5 0.75) (P , 0.005). Native vein grafts showed a significant decrease in 18 F-FDG uptake over time whereas synthetic grafts showed no change in intensity for a follow-up of up to 16 y. Conclusion: Diffuse 18 F-FDG uptake was found in 92% of noninfected vascular prostheses, more in Dacron grafts than with other materials. The intensity of 18 F-FDG uptake of synthetic grafts did not change over time. With knowledge of the presence, patterns, and persistence of 18 F-FDG uptake in noninfected vascular prostheses, misinterpretation of PET/CT studies in patients referred for suspected prosthetic infection and in those assessed for diseases unrelated to their graft status can be avoided.

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“…In situ reconstructions in the aortic bed have been the logical choice, with varied results reported in small series. 2,3 In the presence of gross purulence, there is high risk of reinfection and anastomotic disruption of a new in situ prosthetic graft. In our earlier series of in situ prosthetic reconstruction of primary aortic infections, anastomotic rupture was a major complication of pararenal reconstructions.…”

Section: Discussionmentioning

confidence: 99%

Novel extra-anatomic intra-abdominal reconstruction for treatment of paravisceral aortic infection

Garg

Kalra²

2012

Journal of Vascular Surgery

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Adequate treatment of native or prosthetic aortic infection requires extensive surgical debridement and establishing flow to the extremities using extra-anatomic or in situ reconstruction, each with its inherent limitations. Infection of the paravisceral aortic segment precludes an axillofemoral bypass as the sole treatment because of inability to provide visceral perfusion. In situ autograft or allograft reconstructions could be limited by conduit availability or significantly prolonged operative time, or both. Placement of an antibiotic-soaked prosthetic in a field with gross purulence carries a high risk of reinfection. We describe a technique for extra-anatomic, intra-abdominal reconstruction using an antibiotic-soaked prosthetic graft to avoid the infected paravisceral aortic bed and achieve antegrade lower extremity and visceral vessel perfusion.

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Prosthetic graft infection after descending thoracic/ thoracoabdominal aortic aneurysmectomy: Management with in situ arterial allografts

Abstract: The use of in situ arterial allografts is a significant advance in the management of prosthetic graft infection after descending thoracic/thoracoabdominal aortic aneurysmectomy provided that reoperation is performed early.

Cited by 98 publications

References 40 publications

The incidence and factors associated with graft infection after aortic aneurysm repair

The incidence and factors associated with graft infection after aortic aneurysm repair

¹⁸F-FDG Uptake in Noninfected Prosthetic Vascular Grafts: Incidence, Patterns, and Changes over Time

Novel extra-anatomic intra-abdominal reconstruction for treatment of paravisceral aortic infection

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Prosthetic graft infection after descending thoracic/ thoracoabdominal aortic aneurysmectomy: Management with in situ arterial allografts

Abstract: The use of in situ arterial allografts is a significant advance in the management of prosthetic graft infection after descending thoracic/thoracoabdominal aortic aneurysmectomy provided that reoperation is performed early.

Cited by 98 publications

References 40 publications

The incidence and factors associated with graft infection after aortic aneurysm repair

The incidence and factors associated with graft infection after aortic aneurysm repair

18F-FDG Uptake in Noninfected Prosthetic Vascular Grafts: Incidence, Patterns, and Changes over Time

Novel extra-anatomic intra-abdominal reconstruction for treatment of paravisceral aortic infection

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¹⁸F-FDG Uptake in Noninfected Prosthetic Vascular Grafts: Incidence, Patterns, and Changes over Time