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Management of Aortic Infections: Role of Open Surgery and the Value of Multidisciplinary Team Approach

  • Morad SallamEmail author
  • Oliver Lyons
  • Tommaso Donati
Chapter

Abstract

Aortic graft infection is known to be a very complex and challenging pathology, whether it is a surgical graft or an endograft, and despite of all the recent surgical and medical advances, it still carries a significant risk of morbidity and mortality. Since the first aortic endograft was inserted by Volodos and colleagues in Ukraine, the use of endografts in aortic disease has increased dramatically [1–3]. The majority of early endograft explantations were performed for complications in device insertion and deployment and persistent endoleak causing sac expansion. Stent infection was first reported in 1993 and is now thought to occur in 1–4% of endografts, resulting in major morbidity, mortality and economic cost [4–10]. It is unclear whether or not the incidence of endograft infection is increasing, but the use of endografts in infected fields such as mycotic aneurysms or aorto-enteric fistulae will result in an ongoing case load [6, 11–13]. There are few data available to guide management and clinical approaches to this complex condition which differ widely with variable outcomes, but consensus diagnostic criteria have been defined [14]. Large multicentre retrospective analyses have been performed using the Swedish vascular dataset and in France and the USA [9, 11, 12, 15]. Multicentre prospective data collection is underway by the Management of Aortic Graft Infection Collaboration (www.gsttbrc.com/MAGIC) [14, 16].

Notes

Acknowledgement

Vascular Infection Multidisciplinary team at Guy’s and St Thomas’ NHS Foundation Trust

Rachel Bell Consultant Vascular Surgeon

Nicholas Price Consultant in Infectious Diseases

Dan Taylor Consultant Anaesthetist

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Vascular SurgeonGuy’s and St Thomas’ NHS Foundation Trust LondonLondonUK
  2. 2.King’s College LondonLondonUK
  3. 3.Vascular Surgery, Academic Department of Vascular SurgerySchool of Cardiovascular Medicine & Sciences, BHF Centre of Research Excellence, St Thomas’ Campus, King’s College London and King’s Health PartnersLondonUK

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