Spondylitis transmitted from infected aortic grafts: a review

Abstract

Graft infection following aortic aneurysms repair is an uncommon but devastating complication; its incidence ranges from <1% to 6% (mean 4%), with an associated perioperative and overall mortality of 12% and 17.5-20%, respectively. The most common causative organisms are Staphylococcus aureus and Escherichia coli; causative bacteria typically arise from the skin or gastrointestinal tract. The pathogenetic mechanisms of aortic graft infections are mainly breaks in sterile technique during its implantation, superinfection during bacteremia from a variety of sources, severe intraperitoneal or retroperitoneal inflammation, inoculation of bacteria during postoperative percutaneous interventions to manage various types of endoleaks, and external injury of the vascular graft. Mechanical forces in direct relation to the device were implicated in fistula formation in 35% of cases of graft infection. Partial rupture and graft migration leading to gradual erosion of the bowel wall and aortoenteric fistulas have been reported in 30.8% of cases.Rarely, infection via continuous tissues may affect the spine, resulting in spondylitis. Even though graft explantation and surgical debridement is usually the preferred course of action, comorbidities and increased perioperative risk may preclude patients from surgery and endorse a conservative approach as the treatment of choice. In contrast, conservative treatment is the treatment of choice for spondylitis; surgery may be indicated in approximately 8.5% of patients with neural compression or excessive spinal infection. To enhance the literature, we searched the related literature for published studies on continuous spondylitis from infected endovascular grafts aiming to summarize the pathogenesis and diagnosis, and to discuss the treatment and outcome of the patients with these rare and complex infections.

Spinal Infections: An Update

“…Secondary spinal infections due to direct inoculation can occur after spinal surgery or minimally invasive spinal procedures such as chemonucleolysis or discography, or after penetrating trauma in the spinal area [31][32][33][34][35][36][37][38]. Contiguous spread to the spine from an infection in an adjacent structure such as the aorta, the esophagus, or the bowel have been also reported [39,40].…”

Spondylodiscitis revisited

“…Infection in these cases may spread from adjacent infected tissues such as a ruptured oesophagus or an infected aortic graft. 46 , 47 …”

Infected abdominal aortic aneurysm graft complicated by lumbar discitis

“…One of the significant complications following surgery is the infection of the graft and/or the aneurysmal wall. Although, graft infection following aortic aneurysm repair is uncommon 1 and continuous spread of infection to the spine is rare, 2 , 3 it needs prompt and urgent management as it is threatening and may lead to graft/arterial interface disruption, haemorrhage, or sepsis. 4 …”