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World Journal of Surgery

, Volume 42, Issue 9, pp 3035–3041 | Cite as

The Results of In Situ Prosthetic Graft Replacement for Infected Aortic Disease

  • Youngjin Han
  • Tae-Won KwonEmail author
  • Sang Jun Park
  • Min-Jae Jeong
  • Kyunghak Choi
  • Gi-Young Ko
  • Sang-Oh Lee
  • Yong-Pil Cho
Original Scientific Report

Abstract

Background

Infected aortic disease is a serious clinical condition associated with significant morbidity and mortality. This study reviewed the outcomes of in situ aortic replacement with a prosthetic graft for infected aortic disease, including primary infected abdominal aortic aneurysms (PIAAA), infected aortic prosthetic grafts (IAPG), and infected aortic stent grafts (IASG).

Methods

Twenty-eight consecutive patients who underwent in situ aortic replacement with a prosthetic graft for PIAAA, IAPG, and IASG at a single center from January 2001 to December 2015 were retrospectively analyzed. Demographics, clinical characteristics, medical management, surgical procedure, and clinical outcomes were included.

Results

Nineteen patients with a PIAAA, three with an IAPG following open repair of abdominal aortic aneurysm (AAA), and six with an IASG following endovascular aortic repair underwent in situ prosthetic graft replacement with infected tissue and graft removal. In-hospital mortality was 7.1% (2/28). One died of bleeding on postoperative day 12, and the other died of hepatic failure on postoperative day 32. Of six patients with an IASG, two had major complications that were related to barb injury at the proximal aorta. The reinfection rate was 14.3% (4 of 28) during a mean follow-up of 35.7 months (1–142 months). All new grafts of three patients with IAPG were reinfected. The other patient became reinfected after surgery for PIAAA with iatrogenic small bowel perforation that was not detected during surgery.

Conclusions

In situ graft replacement of PIAAA and IASG is feasible with acceptable outcomes, but the outcome for IAPG is questionable.

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Maeda H, Umezawa H, Goshima M et al (2011) Primary infected abdominal aortic aneurysm: surgical procedures, early mortality rates, and a survey of the prevalence of infectious organisms over a 30-year period. Surg Today 41:346–351CrossRefPubMedGoogle Scholar
  2. 2.
    Oderich GS, Panneton JM, Bower TC et al (2001) Infected aortic aneurysms: aggressive presentation, complicated early outcome, but durable results. J Vasc Surg 34:900–908CrossRefPubMedGoogle Scholar
  3. 3.
    Muller BT, Wegener OR, Grabitz K et al (2001) Mycotic aneurysms of the thoracic and abdominal aorta and iliac arteries: experience with anatomic and extra-anatomic repair in 33 cases. J Vasc Surg 33:106–113CrossRefPubMedGoogle Scholar
  4. 4.
    Fillmore AJ, Valentine RJ (2003) Surgical mortality in patients with infected aortic aneurysms. J Am Coll Surg 196:435–441CrossRefPubMedGoogle Scholar
  5. 5.
    Hobbs SD, Kumar S, Gilling-Smith GL (2010) Epidemiology and diagnosis of endograft infection. J Cardiovasc Surg (Torino) 51:5–14Google Scholar
  6. 6.
    Vogel TR, Symons R, Flum DR (2008) The incidence and factors associated with graft infection after aortic aneurysm repair. J Vasc Surg 47:264–269CrossRefPubMedGoogle Scholar
  7. 7.
    Wilson SE (2001) New alternatives in management of the infected vascular prosthesis. Surg Infect (Larchmt) 2:171–175 (discussion 175-177) CrossRefGoogle Scholar
  8. 8.
    Kwon TW, Kim HK, Moon KM et al (2010) In situ polytetrafluoroethylene graft bypass for primary infected aneurysm of the infrarenal abdominal aorta. World J Surg 34:1689–1695 https://doi.org/10.1007/s00268-010-0507-3 CrossRefPubMedGoogle Scholar
  9. 9.
    Young RM, Cherry KJ Jr, Davis PM et al (1999) The results of in situ prosthetic replacement for infected aortic grafts. Am J Surg 178:136–140CrossRefPubMedGoogle Scholar
  10. 10.
    Roy D, Grove DI (2000) Efficacy of long-term antibiotic suppressive therapy in proven or suspected infected abdominal aortic grafts. J Infect 40:184–187CrossRefPubMedGoogle Scholar
  11. 11.
    Laser A, Baker N, Rectenwald J et al (2011) Graft infection after endovascular abdominal aortic aneurysm repair. J Vasc Surg 54:58–63CrossRefPubMedGoogle Scholar
  12. 12.
    Arbatli H, DeGeest R, Demirsoy E et al (2003) Management of infected grafts and mycotic aneurysms of the aorta using cryopreserved homografts. Cardiovasc Surg 11:257–263CrossRefPubMedGoogle Scholar
  13. 13.
    Ohki S, Hirai H, Yasuhara K et al (2016) Aortoiliac artery reconstruction using bilateral reversed superficial femoral veins for an infected abdominal aortic aneurysm. Ann Vasc Dis 9:70–72CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Bandyk DF, Novotney ML, Johnson BL et al (2001) Use of rifampin-soaked gelatin-sealed polyester grafts for in situ treatment of primary aortic and vascular prosthetic infections. J Surg Res 95:44–49CrossRefPubMedGoogle Scholar
  15. 15.
    Kwon TW, Shin ES, Kim DK et al (2003) Ruptured abdominal aortic aneurysms due to Salmonella, not of typhi species. Ann Vasc Surg 17:464–467CrossRefPubMedGoogle Scholar
  16. 16.
    Park SJ, Kim MN, Kwon TW (2007) Infected abdominal aortic aneurysm caused by Brucella abortus: a case report. J Vasc Surg 46:1277–1279CrossRefPubMedGoogle Scholar
  17. 17.
    Hsu RB, Tsay YG, Wang SS et al (2002) Surgical treatment for primary infected aneurysm of the descending thoracic aorta, abdominal aorta, and iliac arteries. J Vasc Surg 36:746–750CrossRefPubMedGoogle Scholar
  18. 18.
    Lee CH, Hsieh HC, Ko PJ et al (2014) Treatment of infected abdominal aortic aneurysm caused by Salmonella. Ann Vasc Surg 28:217–226CrossRefPubMedGoogle Scholar
  19. 19.
    Vogt PR, Brunner-LaRocca HP, Lachat M et al (2002) Technical details with the use of cryopreserved arterial allografts for aortic infection: influence on early and midterm mortality. J Vasc Surg 35:80–86CrossRefPubMedGoogle Scholar
  20. 20.
    Dirven M, van der Jagt MF, Barendregt WB et al (2015) The efficacy of autologous femoro-popliteal vein reconstruction for primary aortic and aortic graft infection. Ann Vasc Surg.  https://doi.org/10.1016/j.avsg.2015.03.043 PubMedCrossRefGoogle Scholar
  21. 21.
    Heo SH, Kim YW, Woo SY et al (2017) Recent results of in situ abdominal aortic reconstruction with cryopreserved arterial allograft. Eur J Vasc Endovasc Surg 53:158–167CrossRefPubMedGoogle Scholar
  22. 22.
    Charlton-Ouw KM, Sandhu HK, Huang G et al (2014) Reinfection after resection and revascularization of infected infrarenal abdominal aortic grafts. J Vasc Surg 59:684–692CrossRefPubMedGoogle Scholar
  23. 23.
    Fatima J, Duncan AA, de Grandis E et al (2013) Treatment strategies and outcomes in patients with infected aortic endografts. J Vasc Surg 58:371–379CrossRefPubMedGoogle Scholar
  24. 24.
    O’Connor S, Andrew P, Batt M et al (2006) A systematic review and meta-analysis of treatments for aortic graft infection. J Vasc Surg 44:38–45CrossRefPubMedGoogle Scholar
  25. 25.
    Armstrong PA, Back MR, Wilson JS et al (2005) Improved outcomes in the recent management of secondary aortoenteric fistula. J Vasc Surg 42:660–666CrossRefPubMedGoogle Scholar
  26. 26.
    Biro G, Szabo G, Fehervari M et al (2011) Late outcome following open surgical management of secondary aortoenteric fistula. Langenbecks Arch Surg 396:1221–1229CrossRefPubMedGoogle Scholar
  27. 27.
    Coselli JS, Crawford ES (1990) Primary aortoesophageal fistula from aortic aneurysm: successful surgical treatment by use of omental pedicle graft. J Vasc Surg 12:269–277CrossRefPubMedGoogle Scholar
  28. 28.
    Kuniyoshi Y, Koja K, Miyagi K et al (2005) Graft for mycotic thoracic aortic aneurysm: omental wrapping to prevent infection. Asian Cardiovasc Thorac Ann 13:11–16CrossRefPubMedGoogle Scholar
  29. 29.
    Kitayama J, Morota T, Kaisaki S et al (2006) Complete coverage of in situ aortograft by total omental pedicle flap as the most reliable treatment of aortoesophageal fistula. Am J Surg 192:130–134CrossRefPubMedGoogle Scholar
  30. 30.
    Usatii A, Payne W, Santilli S (2013) Removal of an infected aortic endograft and open aortic reconstruction: technical remarks. Ann Vasc Surg 27:679–683CrossRefPubMedGoogle Scholar
  31. 31.
    Sternbergh WC 3rd, Conners MS 3rd, Money SR (2003) Explantation of an infected aortic endograft with suprarenal barb fixation. J Vasc Surg 38:1136CrossRefPubMedGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2018

Authors and Affiliations

  • Youngjin Han
    • 1
  • Tae-Won Kwon
    • 1
    Email author
  • Sang Jun Park
    • 2
  • Min-Jae Jeong
    • 1
  • Kyunghak Choi
    • 1
  • Gi-Young Ko
    • 3
  • Sang-Oh Lee
    • 4
  • Yong-Pil Cho
    • 1
  1. 1.Division of Vascular Surgery, Department of Surgery, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulRepublic of Korea
  2. 2.Department of SurgeryUniversity of Ulsan College of MedicineUlsanRepublic of Korea
  3. 3.Department of Radiology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulRepublic of Korea
  4. 4.Department of Infectious Diseases, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulRepublic of Korea

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