Management of abdominal endograft infection

Department of Surgery, Vascular and Endovascular Surgery Unit, University of Siena, Siena, Italy.
The Journal of cardiovascular surgery (Impact Factor: 1.46). 02/2010; 51(1):33-41.
Source: PubMed


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.

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    • "The management of patients with infected aortic endografts must be based on the same fundamental principles as those analyzed above. The gold standard involves the explantation of the graft with subsequent reconstruction according to individualized parameters (Setacci et al., 2010). Some reports on the use of surgical or percutaneous placement of drains into the aneurysmal sac abscess contiguous to the graft in conjuction with irrigation of the perigraft area with antibiotic instilled through the drains and simultaneous systemic antibiotics administration, show promising results and have altered the approach to patients without signs of severe sepsis (Blanch et al., 2010; Pryluck et al., 2010). "
    Diagnosis, Screening and Treatment of Abdominal, Thoracoabdominal and Thoracic Aortic Aneurysms, 09/2011; , ISBN: 978-953-307-466-5
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    ABSTRACT: Objective Aortic stent greft infections (ASGI) are associated with significant morbidity and mortality. ASGI may exist as a seldom cause of fever.Case reportA 67 year-old male patient presented with fever, fatigue, chest pain and night sweats for a week. He had no infection sign except 3/6 systolic murmur. He admitted to the clinic with a prediagnosis of infective endocarditis. Combination therapy with ceftriaxon (2 g/day) + vancomycine (2 g/day) was administered. No vegetation was seen on neither transthoracic nor transesophageal ecocardiography. Methicillin-sensitive Staphylococcus aureus (MSSA) yielded in blood cultures. Antibiotherapy was changed to sulbactam-ampicilline (8 g/day). Then, we learned that the patient has an aortic stent placed due to aortic dissection. Contrast enhancement was detected in magnetic resonance imaging. Cardiovascular surgeons decided not to remove the stent because of increased mortality; therefore antimicrobial therapy was extended to 4 weeks. But soon after discharge from the hospital, the patient re-admitted with fever. Sulbactam-ampicilline was begun, and MSSA yielded in blood cultures again. Antibiotherapy was continued for an additional 6 weeks. No recurrent infection occurred during 6 months of follow-up.ConclusionASGI could be one of the causes of fever of unknown origin (FUO). Despite the recommended treatment of ASGI being surgery, long-term conservative antimicrobial treatment may be performed successfully in patients with high surgical risk.
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    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 01/2011; 10(1):50-54.
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