The changing management of primary mycotic aortic aneurysms

Vallejo, Nadia; Picardo, Natasha E.; Bourke, P.; Bicknell, Colin; Cheshire, Nicholas; Jenkins, Michael; Wolfe, John H.; Gibbs, Richard

doi:10.1016/j.jvs.2010.12.066

Cited by 63 publications

(40 citation statements)

References 26 publications

(35 reference statements)

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“…Thoracic and abdominal aortic MAs are relatively uncommon and account for 0.7% to 4.5% of all aortic aneurys ms. 8,26,72,90,125,[189][190][191] The most common locations are in the abdominal aorta (≈70%) and thoracic aorta (≈30%); visceral MAs are rare (accounting for <1%). 8,72,125,189,190 Because most intra-abdominal MAs occur in patients with severe atherosclerosis, men predominate over women by 3:1.…”

Section: Thoracic and Abdominal Aortic Masmentioning

confidence: 99%

“…8,72,125,189,190 Because most intra-abdominal MAs occur in patients with severe atherosclerosis, men predominate over women by 3:1. The average age is >65 years, and there is a strong association with cigarette smoking and diabetes mellitus.…”

Section: Thoracic and Abdominal Aortic Masmentioning

confidence: 99%

“…Staphylococci, including S aureus and coagulase-negative staphylococci, in recent years have emerged as the most common cause of aortic MA and account for roughly 50% to 60% of cases. 125,190,[197][198][199] Previously, gram-negative bacilli, especially nontyphoidal Salmonella, were more common than staphylococci, but now they account for at least 30% to 40% of cases. 125,[200][201][202] Salmonella enteritidis, Salmonella choleraesuis, and other nontyphoidal strains are more common causes of abdominal aortic MA in Asia.…”

Section: Microbiologymentioning

confidence: 99%

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Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: A Scientific Statement From the American Heart Association

Wilson¹,

Bower²,

Creager³

et al. 2016

Circulation

358

307

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The use of synthetic material for reconstructive vascular surgery was first reported during the early 1950s. Infection involving vascular graft prostheses is an infrequent but devastating complication of reconstructive vascular graft surgery and is associated with a high morbidity and, in some situations, mortality. Improvements in surgical techniques and graft design, including the use of native venous or arterial tissue, have reduced the frequency of infection and severity of complications from vascular graft infection (VGI). However, these advances have also led to more frequent vascular graft procedures occurring in a patient population with multiple underlying comorbidities that would have previously disqualified them as candidates for vascular reconstructive surgery. Underlying comorbidities, such as diabetes mellitus or immune compromise, increase the risk of infection and serious infection-related complications. The major complications of VGI include sepsis, amputation, disruption of infected anastomotic suture line with rupture or pseudoaneurysm formation, embolization of infected thrombi, reinfection of reconstructed vascular grafts, enteric fistulae to the small or large bowel, bacteremic spread of infection to other sites, and death. VGIs can be categorized broadly into those that occur in an extracavitary location, primarily in the groin or lower extremities, or in an intracavitary location, primarily within the abdomen or less commonly within the thorax. frequencyThe frequency of VGI depends on the anatomic location of the graft. The infection rate is 1.5% to 2% for most extracavitary grafts and as high as 6% with vascular grafts in the groin. [1][2][3][4][5][6][7][8][9] For intracavitary grafts, the infection rate is ≈1% to 5%. 1-6 Graft infection is most common after emergency procedures and after reoperation. [1][2][3][4]10 Aortic graft erosion or fistulous communication into the duodenum or other areas of the bowel reportedly occurs in 1% to 2% of patients after aortic reconstruction. 11,12 MicrobiologyThe microbiological cause of VGI has evolved over the years. 1 In early published studies, Staphylococcus aureus was the predominant microorganism recovered. 1,13 Improvements in surgical technique, administration of prophylactic antistaphylococcal antimicrobial therapy, and other factors have resulted in a changing microbiological epidemiology. Vascular graft surgery performed on patients with multiple underlying comorbidities and the increased frequency of emergency procedures have contributed to the changing spectrum of infection. Other factors such as changes in hospital flora, surgery in patients with complicated vascular anatomy, and multiple revisions of previous vascular surgery have resulted in a more diverse microbio- clInIcal stateMents anD GuIDelInes logical spectrum of infection, which includes multidrugresistant strains, polymicrobial infection, and Candida species. Gram-positive cocci accounts for at least two thirds of VGIs. 1,13 Infections caused by coagulase-negative staphylococ...

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Section: Thoracic and Abdominal Aortic Masmentioning

confidence: 99%

Section: Thoracic and Abdominal Aortic Masmentioning

confidence: 99%

Section: Microbiologymentioning

confidence: 99%

See 1 more Smart Citation

Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: A Scientific Statement From the American Heart Association

Wilson¹,

Bower²,

Creager³

et al. 2016

Circulation

358

307

View full text Add to dashboard Cite

show abstract

“…2 The gold standard for treatment is open surgical resection of the infected aorta, wide débride-ment of tissues and reconstruction to re-establish blood flow, but this approach is associated with high mortality (up to 40%). 3 Less invasive endovascular aortic repair shows a mortality benefit. 3 This treatment is generally used as a bridge for patients who are clinically stable, because stent placement without débridement presents an ongoing risk for infection.…”

mentioning

confidence: 99%

“…3 Less invasive endovascular aortic repair shows a mortality benefit. 3 This treatment is generally used as a bridge for patients who are clinically stable, because stent placement without débridement presents an ongoing risk for infection. Our patient's age made her a poor candidate for surgery; her definitive treatment was limited to endovascular repair and chronic suppressive antibiotics.…”

mentioning

confidence: 99%