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Treatment of Aortic Graft Infection in the Endovascular Era

  • Rebecca Sorber
  • Michael J. Osgood
  • Christopher J. Abularrage
  • James H. BlackIII
  • Ying Wei LumEmail author
Intra-abdominal Infections, Hepatitis, and Gastroenteritis (T Steiner, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Intra-abdominal Infections, Hepatitis, and Gastroenteritis

Abstract

Purpose of Review

This review provides an overview of the current literature surrounding the medical and surgical treatment of aortic graft infection with particular focus on the role of endovascular aortic grafts in the changing demographics and management of these infections.

Recent Findings

Definitive therapy for aortic graft infection continues to include parenteral antibiotics and surgical explantation and revascularization procedures, which are historically vast operations and sources of significant operative stress. Surgical management has evolved to include more options for infection resistant in situ conduits, attempts at partial explantations, and use of endovascular therapy to temporize the urgent sequelae of these infections, such as aortoenteric fistula.

Summary

Aortic graft infection continues to be a significant and morbid complication of graft placement even with the advent of endovascular therapy, and its treatment will only increase in difficulty as a more frail population has gained access to complex aortic repair. In the future, more flexible revascularization and partial explantation options are keys, along with long-term suppressive antibiotics where appropriate.

Keywords

Aortic graft infection Endovascular infection Stent-graft infection Aortoenteric fistula Explantation In situ reconstruction 

Notes

Compliance with Ethical Standards

Conflict of Interest

Drs Sorber, Osgood, Abularrage, Black and Lum declare that they have no conflicts of interests.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Ali A, Modrall G, Hocking J, Valentine RJ, Spencer J, Eidt JF, et al. Long-term results of the treatment of aortic graft infection by in situ replacement with popliteal vein grafts. J Vasc Surg. 2009;50(1):30–9.CrossRefPubMedGoogle Scholar
  2. 2.
    Harlander-Locke M, Harmon LK, Lawrence PF, Oderich GS, McCready RA, Morasch MD, et al. The use of cryopreserved aortoiliac allograft for aortic reconstruction in the United States. J Vasc Surg. 2014;59(3):669–74.CrossRefPubMedGoogle Scholar
  3. 3.
    Oderich G, 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(1):99–106.CrossRefPubMedGoogle Scholar
  4. 4.
    Kilic A, Arnaoutakis DJ, Reifsnyder T, Black JH III, Abularrage CJ, Perler BA, et al. Management of infected vascular grafts. Vasc Med. 2016;21(1):53–60.CrossRefPubMedGoogle Scholar
  5. 5.
    Dua A, Upchurch GR, Lee JT, Eidt J, Desai SS. Predicted shortfall in open aneurysm experience for vascular surgery trainees. J Vasc Surg. 2014;60(4):945–9.CrossRefPubMedGoogle Scholar
  6. 6.
    Kilic A, Shah AS, Black JH III, Whitman GJR, Yuh DD, Cameron DE, et al. Trends in repair of intact and ruptured descending thoracic aortic aneurysms in the United States: a population-based analysis. J Thorac Cardiovasc Surg. 2014;147(6):1855–60.CrossRefPubMedGoogle Scholar
  7. 7.
    • Berger P, Vaartjes I, Moll FL, De Borst GJ, Bankensteijn JD, Bots ML. Cumulative incidence of graft infection after primary prosthetic aortic reconstruction in the endovascular era. Eur J Vasc Endovasc Surg. 2015;49(5):581–5. A comprehensive overview of trends in incidence of graft infection since the advent of endovascular therapy. CrossRefPubMedGoogle Scholar
  8. 8.
    Strosberg D, Oriowo BA, Davies MG, El Sayed HF. The role of endovascular in situ revascularization in the treatment of arterial and graft infections. Ann Vasc Surg. 2017;42:e15–299.CrossRefGoogle Scholar
  9. 9.
    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.CrossRefPubMedGoogle Scholar
  10. 10.
    Lyons O, 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.CrossRefPubMedGoogle Scholar
  11. 11.
    • Smeds M, Duncan AA, Harlander-Locke MP, Lawrence PF, Lyden S, Fatima J, et al. Treatment and outcomes of aortic endograft infection. J Vasc Surg. 2016;63(2):332–40. Outcomes of the treatment of graft infection particularly germane to aortic endografts, highlighting new challenges of these infections and comparing outcomes to the previous experience with aortic graft infection. CrossRefPubMedGoogle Scholar
  12. 12.
    Laser A, Baker N, Rectenwald J, Eliason JL, Criado-Pallares E, Upchurch GR Jr. Graft infection after endovascular abdominal aortic aneurysm repair. J Vasc Surg. 2011;54(1):58–63.CrossRefPubMedGoogle Scholar
  13. 13.
    Davila V, Stone W, Duncan AA, Wood E, Jordan WD Jr, Zea N, et al. A multicenter experience with the surgical treatment of infected abdominal aortic endografts. J Vasc Surg. 2015;62(4):877–83.CrossRefPubMedGoogle Scholar
  14. 14.
    Murphy E, Szeto WY, Herdrich BJ, Jackson BM, WAng GJ, Bavaria JE, et al. The management of endograft infections following endovascular thoracic and abdominal aneurysm repair. J Vasc Surg. 2013;58(5):1179–85.CrossRefPubMedGoogle Scholar
  15. 15.
    •• Hodgkiss-Harlow K, Bandyk DF. Antibiotic therapy of aortic graft infection: treatment and prevention recommendations. Semin Vasc Surg. 2011;24(4):191–8. An in-depth review of pathogens and antibiotic treatment and delivery strategies in all types of aortic graft infection. CrossRefPubMedGoogle Scholar
  16. 16.
    Lyons O, 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 grafic infection collaboration (MAGIC). Eur J Vasc Endovasc Surg. 2016;52(6):758–63.CrossRefPubMedGoogle Scholar
  17. 17.
    Liberatore M, Iurilli AP, Ponzo F, Prosperi D, Santini C, Baiocchi P, et al. Clinical usefulness of technetium-99m-HMPAO-labeled leukocyte scan in prosthetic vascular graft infection. J Nucl Med. 1998;39(5):875–9.PubMedGoogle Scholar
  18. 18.
    Sah B, Husmann L, Mayer D, Scherrer A, Rancic Z, Puippe G, et al., the Vasgra Cohort. Diagnostic performance of 18F-FDG-PET/CT in vascular graft infection. Eur J Vasc Endovasc Surg. 2015;49(4):455–64.Google Scholar
  19. 19.
    Shahani L. Vascular graft infections and role of PET/CT in patients with persistent bacteraemia. BMJ Case Reports. 2015;  https://doi.org/10.1136/bcr-2014-207678.
  20. 20.
    Semba C, Sakai T, Slonim SM, Razavi MK, Kee ST, Jorgensen MJ, et al. Mycotic aortic aneurysms of the thoracic aorta repair with use of endovascular stent-grafts. Journal of Vascular Interventional Radiology. 1998;9(1):33–40.CrossRefPubMedGoogle Scholar
  21. 21.
    Kan C, Lee HL, Yang YJ. Outcome after endovascular stent graft treatment for mycotic aortic aneurysm: a systematic review. J Vasc Surg. 2007;46(5):906–12.CrossRefPubMedGoogle Scholar
  22. 22.
    Razavi M, Razavi MD. Stent-graft treatment of mycotic aneurysms: a review of the current literature. Journal of Vascular Interventional Radiology. 2008;19(Suppl 6):S51–6.CrossRefPubMedGoogle Scholar
  23. 23.
    Haidar G, Hicks TD, Strosberg DS, El-Sayed HF, Davies MG. “In situ” endografting in the treatment of arterial and graft infection. J Vasc Surg. 2017;65(6):1824–9.CrossRefPubMedGoogle Scholar
  24. 24.
    Reilly L, Stoney RJ, Goldstone J, Ehrenfeld WK. Improved management of aortic graft infection: the influence of operation sequence and staging. J Vasc Surg. 1987;5(3):421–31.CrossRefPubMedGoogle Scholar
  25. 25.
    Berger P, Moll FL. Aortic graft infections: is there still a role for axillobifemoral reconstruction? Semin Vasc Surg. 2011;24(4):205–10.CrossRefPubMedGoogle Scholar
  26. 26.
    Aizawa K, Ohki S, Konishi H, Misawa Y. Extraanatomical ascending-abdominal aorta bypass with stump closure for aortic graft infection. Interact Cardiovasc Thorac Surg. 2008;7(4):646–7.CrossRefPubMedGoogle Scholar
  27. 27.
    Riesenman P, Farber MA. Management of a thoracic endograft infeciton through an ascending to descending extra-anatomic aortic bypass and endograft explantation. J Vasc Surg. 2010;51(1):207–9.CrossRefPubMedGoogle Scholar
  28. 28.
    Clagett G, Bowers BL, Lopez-Viego MA, Rossi MB, Valentine RJ, Myers SI, et al. Creation of a neo-aortoiliac system from lower extremity deep and superficial veins. Ann Surg. 1993;218(3):239–48.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Beck A, Murpy EH, Hocking JA, Timaran CH, Arko FR, Clagett GP. Aortic reconstruction with femoral-popliteal vein: graft stenosis incidence, risk and reintervention. J Vasc Surg. 2007;47(1):36–43.CrossRefPubMedGoogle Scholar
  30. 30.
    Ali A, McLeod N, Kalapatapu VR, Moursi MM, Eidt JF. Staging the neoaortoiliac system: feasibility and short-term outcomes. J Vasc Surg. 2008;48(5):1125–30.CrossRefPubMedGoogle Scholar
  31. 31.
    Simmons C, Ali AT, Foteh K, Abate MR, Smeds MR, Spencer HJ, et al. Unilateral inline replacement of infected aortofemoral graft limb with femoral vein. J Vasc Surg. 2017;65(4):1121–9.CrossRefPubMedGoogle Scholar
  32. 32.
    Noel A, Gloviczki P, Cherry KJ Jr, Safi H, Goldstone J, Morasch MD, et al. Abdominal qaortic reconstruction in infected fields: early results of the United States cryopreserved aortic allograft registry. J Vasc Surg. 2002;35(5):847–52.CrossRefPubMedGoogle Scholar
  33. 33.
    Heo S, Kim YW, Woo SY, Park YJ, Kim DK, Chung DR. Recent results of in situ abdominal aortic reonstruction with cryopreserved arterial allograft. Eur J Vasc Endovasc Surg. 2017;53(2):158–67.CrossRefPubMedGoogle Scholar
  34. 34.
    Della Schiava N, Mathevet JL, Boudjelit T, Arsicot M, Feugier P, Lermusiaux P, et al. Cryopreserved arterial allografts and ABO and rhesus compatibility. Ann Vasc Surg. 2016;33:173–80.CrossRefPubMedGoogle Scholar
  35. 35.
    Solanes N, Rigol M, Khabiri E, Castella M, Ramirez J, Roque M, et al. Effects of cryopreservation on the immunogenicity of porcine arterial allografts in early stages of transplant vasculopathy. Cryobiology. 2005;51(2):130–41.CrossRefPubMedGoogle Scholar
  36. 36.
    Zehr B, Niblick CJ, Downey H, Ladowski JS. Limb salvage with CryoVein cadaver saphenous vein allografts used for peripheral arterial bypass: role of blood compatibility. Ann Vasc Surg. 2011;25(2):177–81.CrossRefPubMedGoogle Scholar
  37. 37.
    Lew W, Moore W. Antibiotic-impregnated grafts for aortic reconstruction. Semin Vasc Surg. 2011;24(4):211–9.CrossRefPubMedGoogle Scholar
  38. 38.
    Lutz B, Reeps C, Biro G, Knappich C, Zimmermann A, Eckstein HH. Bovine pericardium as new technical option for in situ reconstruction of aortic graft infection. Ann Vasc Surg. 2017;41:118–26.CrossRefPubMedGoogle Scholar
  39. 39.
    van Zitteren M, van der Steenhoven TJ, Burger DHC, van Berge Henegouwen DP, Heyligers JMM, Vriens PWHE. Spiral vein reconstruciton of the infected abdominal aorta using the greater saphenous vein: preliminary results of the Tilburg experience. Eur J Vasc Endovasc Surg. 2011;41(5):637–46.CrossRefPubMedGoogle Scholar
  40. 40.
    Berard X, Stecken L, Pinaquy J-B, Cazanave C, Puges M, Pereyre S, et al. Comparison of the antimicrobial properties of silver impregnated vascular grafts with and without triclosan. Eur J Vasc Endovasc Surg. 2016;51(2):285–93.CrossRefPubMedGoogle Scholar
  41. 41.
    Aboshady I, Raad I, Vela D, Hassan M, Aboshady Y, Safi HJ, et al. Prevention of perioperative vascular prosthetic infection with a novel triple antimicrobial-bonded arterial graft. J Vasc Surg. 2015;64(6):1805–14.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Rebecca Sorber
    • 1
  • Michael J. Osgood
    • 1
  • Christopher J. Abularrage
    • 1
  • James H. BlackIII
    • 1
  • Ying Wei Lum
    • 1
    Email author
  1. 1.Division of Vascular Surgery and Endovascular TherapyThe Johns Hopkins HospitalBaltimoreUSA

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