Treatment of Infected Thoracic Aortic Prosthetic Grafts with the In Situ Preservation Strategy: A Review of its History, Surgical Technique, and Results

Management of thoracic aortic graft infections

“…Due to the high morbidity and mortality associated with reoperative surgery with aortic graft explanation, some centers have shifted toward primary efforts to preserve the existing graft with every attempt to eradicate surrounding infection . Several groups have reported acceptable outcomes, albeit limited and only in certain circumstances, with graft preservation techniques for ascending/arch prosthetic grafts using various methods of “surgical extensive disinfection” performed with tissue flap coverage . There have also been reports of successful utilization of surgical drainage with peri‐graft catheter placement with continuous antibiotic irrigation .…”

“…There have also been reports of successful utilization of surgical drainage with peri‐graft catheter placement with continuous antibiotic irrigation . Use of omentum for aortic graft coverage is commonly utilized during graft preservation efforts and the advantages include a rich blood supply with ample pliable tissue for coverage of the defect with intrathoracic transposition, an oxygen source for ischemic tissue, and the production of endothelial growth factor . However, omental flap coverage is not without complications, including the potential for compromised blood supply with resultant necrotic tissue, spread of intrathoracic infection to the abdomen, and diaphragmatic herniation .…”

“…Use of omentum for aortic graft coverage is commonly utilized during graft preservation efforts and the advantages include a rich blood supply with ample pliable tissue for coverage of the defect with intrathoracic transposition, an oxygen source for ischemic tissue, and the production of endothelial growth factor . However, omental flap coverage is not without complications, including the potential for compromised blood supply with resultant necrotic tissue, spread of intrathoracic infection to the abdomen, and diaphragmatic herniation . Select cases have shown good short and midterm survival with the use of IV antibiotics and graft preservation using irrigation/debridement and omental flap coverage via transposition after harvesting from an abdominal incision with subsequent diaphragmatic or substernal tunneling .…”

Perigraft abscess after DeBakey type-1 aortic dissection: a case report

“…The surgical management of AGI depended on the degree and extent of infection. It was generally believed that if the graft and autologous tissue were still surrounded by healthy autologous tissue, the survival rate was higher if the vascular prosthesis not removed [7,8] . For this case, the graft was not infected, existing prosthetic grafts could be salvaged, so only debridement was performed and the vascular graft not replaced.…”

A Case of an Aortic Abscess around the Elephant Trunk

“…2) Early prosthetic graft infection often starts with sternal wound infection-related symptoms such as fever, cold sweats, chills, precordial pain, and purulent discharge from the wound within 30 days postoperatively; this is a typical case associated with SSI. Some of these early-onset cases, however, have only slight increases in white blood cell count and CRP, and no symptoms.…”