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.
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ABSTRACT: The patient was a 64-year-old man. He developed fever and lumbago 6 months after the EVAR. Because CT showed an abscess in the aortic aneurysm surrounding the stent graft, stent-graft infection was diagnosed, and treatment with intravenous antibiotics was initiated. However, the fever and inflammatory markers persisted; therefore, CT-guided drainage catheter placement was performed. After all the pus had been discharged, the fever subsided, and the inflammatory reaction was also suppressed. One year has elapsed since the treatment, and the patient continues to visit with no complaints. We report that stent-graft infection was relieved with antibiotics and drainage.Annals of Vascular Diseases 01/2012; 5(4):462-5.
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ABSTRACT: Vascular graft infection is a rare but serious complication of vascular reconstructive surgery. This in vitro study investigated the antimicrobial efficacy of a new, silver-triclosan collagen-coated polyester vascular graft compared with a silver collagen-coated polyester vascular graft alone during the first 24 hours. The antimicrobial efficacy of the investigated vascular grafts was assessed by performing a time-kill kinetic assay following Clinical and Laboratory Institute Standards-approved guidelines M26-A. For the purpose of the experimental study, the ATCC 33591 strain of methicillin-resistant Staphylococcus aureus (American Type Culture Collection, Manassas, Va) was used. All assays were repeated sixfold. Bacterial survival numbers were obtained at 1, 4, 8, 12, and 24 hours using a standard plate count procedure. Bactericidal activity was defined as a 3 log(10) reduction factor (logRF), according to the approved guideline M26-A. Both antimicrobial vascular grafts achieved >3 logRF and fulfilled the efficacy criterion for bactericidal activity but performed differently in their speed of antimicrobial action. The silver-triclosan vascular graft achieved 3.37 logRF after 8 hours, and the silver vascular graft showed a 4.19 logRF after 24 hours. The silver-triclosan graft yielded significantly lower colony-forming units/mL counts after 4 hours compared with the silver graft (4.29 × 10(4) vs 1.03 × 10(6); P = .031). Both antimicrobial collagen-coated polymer vascular grafts showed bactericidal activity against methicillin-resistant Staphylococcus aureus in vitro. Although the silver-triclosan vascular graft showed a faster antimicrobial efficacy, the silver graft exhibited its antimicrobial properties after 24 hours. Which concept will protect an implanted vascular prosthetic graft better from bacterial contamination and subsequent infection needs to be investigated further in in vivo animal and clinical studies.Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter 11/2011; 55(3):823-9. · 3.52 Impact Factor
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ABSTRACT: Both surgical and endovascular grafts have the rare risk of late secondary infection. Treatment varies based on the clinical setting, but in general the recommendations are that infected endografts be removed and reconstruction performed. In the abdominal aorta this may vary from homograft or other impregnated grafts to excision and extra-anatomic bypass. We discuss an unusual case which we believe serves as a useful review of this still debated area. A 58-year-old male presented with abdominal and back pain. Prior history was notable for human immunodeficiency virus positive status, pulmonary embolism (currently on Coumadin) and two years previously repair of a saccular infra-renal aneurysm with tube graft. The week prior to the onset of symptoms he suffered a noticeable scratch from his cat. Blood cultures were positive for pasturella multicoda. He was transferred to our institution and underwent resection and explantation, with homograft reconstruction. At one year he is alive and well.World journal of radiology. 01/2013; 5(1):17-19.