An infection of an aortic prosthesis is a severe condition with high morbidity and mortality rates. Surgical treatment of an infected aortic graft or infected aortic stent-graft focuses on treatment of the infection and maintaining or restoring perfusion of the lower limbs. Over the years various reconstruction options have been introduced, each claiming to be the most successful in securing lower limb perfusion. Consensus about the optimum treatment strategy is lacking. The frail patient population and the relative rarity of the disease limits research on this topic which is an important reason for this lack of consensus. In order to determine which of the various treatment options is the most suitable to treat aortic graft infections, this systematic review was conducted of the available literature of the last 20 years. The search strategy and data collection were based on the guidelines of the Meta-analysis Of Observational Studies in Epidemiology (MOOSE). Appropriate inclusion and exclusion criteria were defined. A total of 862 possibly relevant papers were identified. After applying the in- and exclusion, data on mortality, morbidity and complications were extracted from a total of 93 papers. This review covers the various surgical treatment options available in the treatment of infected aortic (stent) grafts. Strategies concerning graft excision are discussed as are the advantages and disadvantages of the extra-anatomic reconstruction and its counterpart, the in situ reconstruction (using antibiotic-impregnated grafts, autologous vein grafts, fresh or cryopreserved allografts, and silver impregnated grafts). Available evidence was summarized and used to construct a clinical decision flowchart. All reconstruction options seem to have their pros and cons, and all have their use in specific situations. The treatment of infected aortic grafts must therefore be tailor-made.
[Show abstract][Hide abstract] ABSTRACT: Silver-coated grafts are designed to prevent vascular graft infections. Silver is a safe element but toxic effects have been reported. We describe two cases of possible localized argyria after silver graft implantation.
Two patients presented with perigraft groin collections after implantation of silver grafts. During reoperation, an ashen-grey necrotic substance was seen surrounding the grafts. The grafts were explanted and lower limb perfusion restored. Cultures were negative and both patients had uneventful recoveries.
Our cases are highly suggestive of a possible unique adverse effect: a combination of localized silver toxicity and neutrophilic mediated tissue destruction.
European journal of vascular and endovascular surgery: the official journal of the European Society for Vascular Surgery 09/2013; 46(5). DOI:10.1016/j.ejvs.2013.07.021 · 2.49 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background:
We report a 52-year-old male presenting with a graft-appendiceal fistula four years after placement of an aorto-bifemoral Dacron prosthesis.
After appendectomy and total graft removal, the patient was treated with an in-situ repair using a rifampicin-silver graft. This kind of repair has only been reported in an animal study.
This infected aortic graft was treated successfully with a rifampicin-silver graft with a follow-up of 15 months without complications.
In-situ repair of a graft-appendiceal fistula with a rifampicin-silver graft seems a promising strategy. The long-term outcome needs to be studied.
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