Recognition of an Infected Endoluminal Aortic Prosthesis Following Repair of Abdominal Aortic Aneurysm: Case Report and Review of the Literature
Oregon Health and Science University, Portland, Oregon, United StatesAnnals of Vascular Surgery (Impact Factor: 1.17). 12/2004; 18(6):750-4. DOI: 10.1007/s10016-004-0120-8
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.
Article: Nonoperative approach to endotension[Show abstract] [Hide abstract]
ABSTRACT: From February 1997 to August 2004, 160 patients in our hospital underwent EVAR of an infrarenal AAA performed by 1 endovascular group that consisted of 1 angioradiologist and 1 vascular surgeon. The devices used were Vanguard (Boston Scientific, Natick, Mass) in 48 cases (until November 1999), Zenith (Cook Inc, Bloomington, Ind) in 109 cases, Excluder (W.L. Gore, Flagstaff, Ariz) in 2 cases, and Talent (Medtronic Vascular, Santa Rosa, Calif) in 1 case. According to the endovascular protocol and surveillance program,12 plain radiographs, spiral CT, and angiography were performed before surgery to identify patients suitable for EVAR. Two or 3 days after the operation, a CT image was obtained for control. After 1 month of follow-up, CT was repeated. At the 6-month follow-up, CT and angiography were performed routinely, and at 12 months only CT was taken. Further follow-up involved yearly CT, as well as additional CT and angiography whenever desired by the clinician. Plain radiographs were obtained together with CT from the second or third follow-up year. CT scans were examined by an endovascular radiologist and vascular surgeons. Whenever endoleak was observed, additional CT, angiography, and treatment such as re-endografting of the leaking site were considered. For detection of endotension, high-resolution spiral CT was performed after infusion of 2 mg/kg contrast medium (300 mg of iodine per milliliter of iopromidum, Ultravist 300; Schering, Berlin, Germany) with delayed imaging (70-second delay after infusion before final imaging studies). The maximum aneurysm diameter was measured from the axial CT images. Endotension was defined as an increase in maximum aneurysm diameter more than 5 mm without any evidence of endoleak by standard protocol.
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