Abstract
Infection of a vascular prosthesis or endovascular stent-graft is probably the most serious complication that may occur after implantation and dramatically affects the patient’s outcome. The most common etiology of graft and/or prosthetic valve infection is usually wound-related infection, followed by seeding from distant infection sites (lung, urinary tract). Surgical treatment is almost always required but even after surgery, morbidity can be significant. Operative procedure must be tailored according to the individual patient and to the experience of the surgical team. Complete resection of the infected foreign material with débridement of the surrounding tissue gives most probably the best results. Orthotopic reconstruction is the best option for all thoracic and thoraco-abdominal pathologies and the use of coated prostheses, industrially fabricated bio-conduits, homografts or self-made vascular tubes from xenopericardial tissue has to be discussed from case to case. In some exceptional situations, endovascular stent-graft can be performed as bridging to a more complete treatment if general condition of the patient has to be stabilized.
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References
Berger P, Vaartjes I, Moll FL, De Borst GJ, Blankensteijn JD, Bots ML. Cumulative incidence of graft infection after primary prosthetic aortic reconstruction in the endovascular era. Eur J Vasc Endovasc Surg. 2015;49:581–5.
Vogel TR, Symons R, Flum DR. The incidence and factors associated with graft infection after aortic aneurysm repair. J Vasc Surg. 2008;47:264–9.
O’Connor S, Andrew P, Batt M, Becquemin JP. A systematic review and meta-analysis of treatments for aortic graft infection. J Vasc Surg. 2006;44(1):38–45.
Cernohorsky P, Reijnen MM, Tielliu IF, van Sterkenburg SM, van den Dungen JJ, Zeebregts CJ. The relevance of aortic endograft prosthetic infection. J Vasc Surg. 2011;54(2):327–33.
Lyons OT, Patel AS, Saha P, Clough RE, Price N, Taylor PR. A 14-year experience with aortic endograft infection: management and results. Eur J Vasc Endovasc Surg. 2013;46(3):306–13.
Greaves NS, Katsogridakis E, Faris B, Murray D. Prophylactic antibiotics for percutaneous endovascular procedures. Eur J Clin Microbiol Infect Dis. 2017;36:597–601.
Carrel T, Schmidli J. Management of vascular graft and endoprosthetic infection of the thoracic and thoraco-abdominal aorta. Multimed Man Cardiothorac Surg. 2011. doi:10.1510/mmcts.2010.004705.
Lyons OT, Baguneid M, Barwick TD, Bell RE, Foster N, Homer-Vanniasinkam S, et al. Diagnosis of aortic graft infection: a case definition by the management of aortic graft infection collaboration (MAGIC). Eur J Vasc Endovasc Surg. 2016;52:758–63.
Hargrove WC, Edmunds LH. Management of infected thoracic aortic prosthetic grafts. Ann Thorac Surg. 1984;37:72–7.
Coselli JS, Köksoy C, LeMaire SA. Management of thoracic aortic graft infections. Ann Thorac Surg. 1999;67:1990–3.
Fatima J, Duncan AA, de Grandis E, Oderich GS, Kalra M, Gloviczki P, et al. Treatment strategies and outcomes in patients with infected aortic endografts. J Vasc Surg. 2013;58(2):371–9.
LeMaire SA, Coselli JS. Options for managing infected ascending aortic grafts. J Thorac Cardiovasc Surg. 2007;134:839–43.
O’Connor S, Andrew P, Batt M, Becquemin JP. A systematic review and meta-analysis of treatments for aortic graft infection. J Vasc Surg. 2006;44:38–45.
Nakajima N, Masuda M, Ichinose M, Ando M. A new method for the treatment of graft infection in the thoracic aorta: in situ preservation. Ann Thorac Surg. 1999;67:1994–6.
Tossios P, Karatzopoulos A, Tsagakis K, Sapalidis K, Grosomanidis V, Kalogera A, Kouskouras K, Foroulis CN, Anastasiadis K. Treatment of infected thoracic aortic prosthetic grafts with the in situ preservation strategy: a review of its history, surgical technique, and results. Heart Lung Circ. 2014;23:24–31.
Umminger J, Krueger H, Beckmann E, Kaufeld T, Fleissner F, Haverich A, Shrestha M, Martens A. Management of early graft infections in the ascending aorta and aortic arch: a comparison between graft replacement and graft preservation techniques. Eur J Cardiothorac Surg. 2016;50:660–7.
Chervu A1, Moore WS, Gelabert HA, Colburn MD, Chvapil M. Prevention of graft infection by use of prostheses bonded with a rifampin/collagen release system. J Vasc Surg. 1991;14:521–4 (discussion 524–5).
Oderich GS, Bower TC, Hofer J, Kalra M, Duncan AA, Wilson JW, et al. In situ rifampin-soaked grafts with omental coverage and antibiotic suppression are durable with low reinfection rates in patients with aortic graft enteric erosion or fistula. J Vasc Surg. 2011;53:99–106, 7e1–7 (discussion 7).
Pupka A, Skora J, Janczak D, Plonek T, Marczak J, Szydelko T. In situ revascularisation with silver-coated polyester prostheses and arterial homografts in patients with aortic graft infection—a prospective, comparative, single-centre study. Eur J Vasc Endovasc Surg. 2011;41:61–7.
Goëau-Brissonière O, Leport C, Bacourt F, Lebrault C, Comte R, Pechère JC. Prevention of vascular graft infection by rifampicin bonding to a gelatin-sealed dacron graft. Ann Vasc Surg. 1999;5:408–12.
Zegelman M1, Guenther G, Waliszewski M, Pukacki F, Stanisic MG, Piquet P, Passon M, Halloul Z, Tautenhahn J, Claey L, Agostinho C, Simici D, Doebrich D, Mueller C, Balzer K. Results from the International Silver Graft Registry for high-risk patients treated with a metallic-silver impregnated vascular graft. Vascular. 2013;21:137–47.
Carrel TP, Berdat P, Englberger L, Eckstein F, Immer F, Seiler C, Kipfer B. Schmidli J. Aortic root replacement with a new stentless aortic valve xenograft conduit: preliminary hemodynamic and clinical results. J Heart Valve Dis. 2003;12:752–7.
Siniawski H, Lehmkuhl H, Weng Y, Pasic M, Yankah C, Hoffmann M, Behnke I, Hetzer R. Stentless aortic valves as an alternative to homografts for valve replacement in active infective endocarditis complicated by ring abscess. Ann Thorac Surg. 2003;75:803–8.
Carrel TP, Schoenhoff FS, Schmidli J, Stalder M, Eckstein FS, Englberger L. Deleterious outcome of no-react-treated stentless valved conduits after aortic root replacement: why were warnings ignored? J Thorac Cardiovasc Surg. 2008;136:52–7.
Reineke DC, Kaya A, Heinisch PP, Oezdemir B, Winkler B, Huber C, Heijmen RH, Morshuis W, Carrel TP, Englberger L. Long-term follow-up after implantation of the Shelhigh® No-React® complete biological aortic valved conduit. Eur J Cardiothorac Surg. 2016;50:98–104.
Calderon E, Spina A, Camurri N, Bellieni L, Bentini C, Pugliese P. Early failure of Shelhigh bioconduit in aortic position: an underestimated drawback. Berlin: Fifth Biennal Meeting of the Society of Heart Valve Disease; 2009.
Guenther SP, Reichelt A, Peterss S, Luehr M, Bagaev E, Hagl C, Pichlmaier MA, Khaladj N. Root replacement for graft infection using an all-biologic xenopericardial conduit. J Heart Valve Dis. 2016;25:440–7.
Guihaire J, Kloeckner M, Deleuze P. Exclusion of complex paraannular aortic abscess with the freestyle xenograft. Ann Thorac Surg. 2016;102:e373–5.
Schneider AW, Hazekamp MG, Versteegh MI, Bruggemans EF, Holman ER, Klautz RJ, Braun J. Stentless bioprostheses: a versatile and durable solution in extensive aortic valve endocarditis. Eur J Cardiothorac Surg. 2016;49:1699–704.
Bahnini A, Ruotolo C, Koskas F, Kieffer E. In situ fresh allograft replacement of an infected aortic prosthetic graft: eighteen months’ follow-up. J Vasc Surg. 1991;14:98–102.
Chiesa R, Astore D, Piccolo G, Melissano G, Jannello A, Frigerio D, et al. Fresh and cryopreserved arterial homografts in the treatment of prosthetic graft infections: experience of the Italian Collaborative Vascular Homograft Group. Ann Vasc Surg. 1998;12:457–62.
Zhou W, Lin PH, Bush RL, Terramani TT, Matsuura JH, Cox M, et al. In situ reconstruction with cryopreserved arterial allografts for management of mycotic aneurysms or aortic prosthetic graft infections a multi-institutional experience. Tex Heart Inst J 2006;33:14–8.
Vogt PR, Turina MI. Management of infected aortic grafts: development of less invasive surgery using cryopreserved homografts. Ann Thorac Surg. 1999;67:1986–9.
Minga Lowampa E, Holemans C, Stiennon L, Van Damme H, Defraigne JO. Late fate of cryopreserved arterial allografts. Eur J Vasc Endovasc Surg. 2016;52:696–702.
Czerny M, von Allmen R, Opfermann P, Sodeck G, Dick F, Stellmes A, et al. Self-made pericardial tube graft: a new surgical concept for treatment of graft infections after thoracic and abdominal aortic procedures. Ann Thorac Surg. 2011;92:1657–62.
Oda T, Minatoya K, Kobayashi J, Okita Y, Akashi H, Tanaka H, Kawaharada N, Saiki Y, Kuniyoshi Y, Nishimura K. Prosthetic vascular graft infection through a median sternotomy: a multicentre review. Interact Cardiovasc Thorac Surg. 2015;20:701–6.
Samoukovic G, Bernier PL, Lachapelle K.Successful. Treatment of infected ascending aortic prosthesis by omental wrapping without graft removal. Ann Thorac Surg. 2008;86:287–9.
Krabatsch I, Hetzer R. Infected ascending aortic prosthesis: successful treatment by thoracic transposition of the greater omentum. Eur J Cardio-thorac Surg. 1995;9:223–5.
Luciani N, Lapenna E, De Bonis M, Possati GF. Mediastinitis following graft replacement of the ascending aorta: conservative approach by omental transposition. Eur J Cardiothorac Surg. 2001;20:418–20.
Fujii T, Watanabe Y. Multidisciplinary treatment approach for prosthetic vascular graft infection in the thoracic aortic area. Ann Thorac Cardiovasc Surg. 2015;21:418–27.
Inoue H, Iguro Y, Yamamoto H, Ueno M, Higashi A, Tao K, et al. Palliative stent-graft insertion followed by an allograft replacement for an infected and ruptured aortic aneurysm. Ann Thorac Cardiovasc Surg. 2009;15:261–4.
Ito T, Kurimoto Y, Kawaharada N, Koyanagi T, Hashiguchi H, Yamashita A. Endovascular stent-grafting of anastomotic pseudoaneurysms following thoracic aortic surgery. Gen Thorac Cardiovasc Surg. 2009;57:528–33.
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Carrel, T., Englberger, L. & Schmidli, J. How to treat aortic graft infection? With a special emphasis on xeno-pericardial aortic tube grafts. Gen Thorac Cardiovasc Surg 67, 44–52 (2019). https://doi.org/10.1007/s11748-017-0839-0
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DOI: https://doi.org/10.1007/s11748-017-0839-0