Surgical experience of 13 infected infrarenal aortoiliac aneurysms: Preoperative control of septic condition determines early outcome

The feasibility of endovascular aortic repair strategy in treating infected aortic aneurysms

“…To date, the widely accepted gold standard is to extensively resect the infected aorta, aggressively debride the periaortic tissues, and reconstruct the aortic flow using extra-anatomic or anatomic bypass prosthetic grafts. 4,7 The biggest advantage of open surgery is that extensive debridement and excision of infected aortic tissue is still the optimal way to eradicate the source of infection; however, even after aggressive debridement, it is difficult to ensure that no microinfected nidus remains or to guarantee that the new prosthetic grafts will not be reinfected. Even in the last decade, up to 30% to 40% in-hospital mortality, depending on the location of the aneurysm and the severity of systemic inflammation, has been reported after open surgical management.…”

“…Even in the last decade, up to 30% to 40% in-hospital mortality, depending on the location of the aneurysm and the severity of systemic inflammation, has been reported after open surgical management. 7 The rapidly burgeoning EVAR technique provides a less invasive alternative with favorable results in the management of infected aortic aneurysms on a very selected basis but is not done routinely. 10,13 Furthermore, comparison with conventional surgeries for treating this disease reveals that EVAR procedures give at least equivalent 24-month actual survival rates and actuarial aneurysm-related event-free rates.…”

“…ORSA is believed to be an extremely virulent species that is difficult to control using only antibiotics, although several successful cases have been reported. 7,15,16 Aggressive adjunct procedures after EVAR have been proposed as one of the explanations for the success of EVAR treatment of infected aortic aneurysms. 13 Our limited experience showed that most patients with an abscess adjacent to the psoas muscle can be temporarily treated by initial percutaneous CT-guided drainage and gradually controlled by subsequent antibiotics.…”

“…4,5 However, this surgical strategy continues to possess a high possibility of morbidity and death. 4,6,7 Endovascular aortic repairs (EVAR) for thoracic and abdominal aortic aneurysms have become widely accepted in the last 2 decades. 8,9 However, questions have been raised about the clinical application of EVAR in the setting of an infected aortic aneurysm.…”

Living-Donor Liver Transplant With an Interposition Graft of the Inferior Vena Cava for Hepatocellular Carcinoma: Beyond the Milan Criteria and Within the UCSF Criteria

“…12 Moreover, some reports have indicated that a prosthetic graft can be used without serious infectious complications in patients with an infected aortic aneurysm and/or a traumatic penetrating vascular wound. 13,14 Although it is known that graft infection is more common in a Dacron graft than in a polytetrafluoroethylene graft in the early postoperative period, a rifampicin-soaked vascular graft can effectively reduce the risk of graft-related bacterial infection. 15,16 Therefore, we chose a rifampicin-soaked Dacron graft as a conduit.…”