Recognition of an Infected Endoluminal Aortic Prosthesis Following Repair of Abdominal Aortic Aneurysm: Case Report and Review of the Literature
ABSTRACT Presentation of an infected endoaortic stent graft may be different from those with open aortic reconstruction and may be difficult to recognize. We report a case of an infected endoaortic stent graft for treatment of an abdominal aortic aneurysm (AAA). In this case, clinically significant endograft infection was not apparent on the initial computed tomography (CT) scan, however, serial CT scans demonstrated progressive AAA enlargement with increased inflammation. The white blood cell scan documented enhancement throughout the infrarenal aorta. The patient's condition was managed with total explantation of the endograft, AAA resection, and reconstruction with a cryopreserved aortic homograft. This report reviews the presentation, radiographic findings, and diagnosis of as well as literature on infected endoaortic stent grafts.
Article: Abdominal aortic endograft infection
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ABSTRACT: It is estimated that 1.7% of orthotopic liver transplant recipients will develop abdominal aortic aneurysms (AAAs) after transplantation. It has been observed that these aneurysms expand faster in transplant recipients; therefore, aggressive surveillance for AAAs in transplant recipients is required. Endovascular aneurysm repair is rapidly becoming the standard of care, especially in patients with previous abdominal surgery and other significant comorbidities. This article describes our experience with AAAs in orthotopic liver transplant recipients treated successfully by endovascular stent graft repair.Liver Transplantation 08/2005; 11(8):993-7. DOI:10.1002/lt.20505 · 3.79 Impact Factor
Article: Nonoperative approach to endotension[Show abstract] [Hide abstract]
ABSTRACT: The necessity of operative treatment of endotension after endovascular grafting of abdominal aortic aneurysms (endovascular aneurysm repair; EVAR) is under debate. The proposed causes of endotension and related treatment protocols are controversial. We report the outcome of a nonoperative approach to five patients with endotension after EVAR. From February 1997 to August 2004, 160 patients who underwent EVAR of an infrarenal abdominal aortic aneurysm were evaluated for the incidence of endotension. According to the endovascular protocol, plain radiographs, spiral computed tomography, and angiography were performed before and after surgery for follow-up. To detect endotension, spiral computed tomography was performed by using a delayed imaging technique after the infusion of contrast medium. Endotension was defined as an aneurysm sac enlargement after EVAR without evidence of endoleak. Aneurysm sac rupture was defined as discontinuity of the calcific rim of the aneurysmal sac and the presence of intra-aneurysmal fluid outside the sac. We found five (3.1%) patients with endotension. Three of these experienced aneurysmal sac rupture. Only one of the three was underwent operation on experiencing sudden intestinal occlusion due to intra-abdominal adhesions. This patient had no intra-abdominal or retroperitoneal bleeding or hematoma but died after intensive care as a result of non-aneurysm-related problems. Four patients with endotension are still being closely followed up according to our surveillance protocol, and they are doing clinically well. After rupture, clear shrinking of the aneurysm sac was seen in two patients. Endotension after EVAR may cause subsequent aneurysm rupture. Endotension is evidently not associated with endoleak I to III provided that the endovascular graft is maintained in appropriate position and that free endovascular flow is observed. We propose to consider a nonoperative approach in the clinically asymptomatic patient with aneurysm enlargement after EVAR if endoleak is excluded by well-performed imaging techniques.Journal of Vascular Surgery 09/2005; 42(2):194-9. DOI:10.1016/j.jvs.2005.02.050 · 2.98 Impact Factor