Management of abdominal endograft infection.
ABSTRACT Incidence, clinical presentation and management of aortic grafts infection after open surgical repair are well described in the literature. Infective complications involving endografts after endovascular aneurysm repair (EVAR) have been scarcely investigated, since more attention has been given to the technical aspects of the procedure, including endoleaks, device migration, neck dilatation, endotension and aneurysm rupture. Nevertheless, that is a rare but severe complication occurring after EVAR; potentially difficult to diagnose and treat. Since 1991 only 102 cases of abdominal endograft infections have been reported in the literature. Treatment of infected abdominal endografts is controversial. Although reports have shown that high-risk patients with infected stent grafts treated conservatively with antimicrobial therapy and percutaneous drainage can still survive, most authors agree that an infected endograft should be removed if patient's conditions allow intervention. Standard treatment for infected abdominal endografts includes complete graft excision and local debridement followed by extra-anatomical bypass revascularization or in situ reconstruction with an aortic-bisiliac or bifemoral graft (Dacron or PTFE) or with a homograft. Lower overall mortality was observed for surgical management by explantation of infected endograft followed by in situ replacement as compared to other surgical solutions, but no definitive conclusions can be drawn about the optimal treatment strategy for aortic reconstruction.
SourceAvailable from: Maja Weisser[Show abstract] [Hide abstract]
ABSTRACT: Little is known about optimal management of prosthetic vascular graft infections, which are a rare but serious complication associated with graft implants. The goal of this study was to compare and characterize these infections with respect to the location of the graft and to identify factors associated with outcome.PLoS ONE 11/2014; 9(11):e112947. DOI:10.1371/journal.pone.0112947 · 3.53 Impact Factor
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ABSTRACT: We present three cases of stent graft infection that were treated with preservation of the endograft. In the first patient, the contamination of the endograft was the consequence of a bleeding aortoenteric fistula, whereas, in the second patient, the endograft was implanted into a ruptured contaminated aortic aneurysm due to the patient's haemodynamic instability. In the third case, the presence of a consistent type Ia endoleak after a chimney graft procedure followed by secondary interventions led to an infection of the stent graft. In each case, a laparotomy was performed with debridement, followed by appropriate antibiotic therapy. The first patient suffered a fatal pulmonary embolism. The other two patients are alive 4 and 24 months after the diagnosis of endograft infection. In unstable patients or those with severe comorbidities who cannot tolerate endograft excision and aortic reconstruction, surgical debridement followed by appropriate antibiotic therapy can be a temporary or bridging solution.Annals of Vascular Surgery 10/2014; 28(7). DOI:10.1016/j.avsg.2014.02.005 · 1.03 Impact Factor
Article: Stent graft infection[Show abstract] [Hide abstract]
ABSTRACT: Infection involving stent grafts is an infrequent complication associated with high mortality rates. The clinical presentation is usually delayed and it may vary from nonspecific symptoms to severe complications such as pseudoaneurysm and aorto-enteric fistula. The diagnosis involves a high index of suspicion and investigation with imaging and laboratory exams. The treatment follows the precepts of graft infection in conventional surgery, and surgical excision is recommended for most patients, followed by in situ or extra-anatomic revascularization. Conservative treatment is reserved for selected cases.Jornal Vascular Brasileiro 03/2011; 10(1):50-54. DOI:10.1590/S1677-54492011000100009