title: Use of fascia-peritoneum patch as a pledget for an infected aortic stump.
abstract: Treatment of aortic prosthetic graft infections remains a challenge. One frequently encountered technical difficulty when removing an infected prosthetic aortic graft is how to close a short, friable remnant aortic stump. We present three case reports in which we used a layer of posterior rectus fascia-peritoneum to bolster oversewing a short infected aortic stump after removal of an infected aortic graft. All three patients underwent staged extra-anatomic axillary-to-femoral artery bypass procedures, with subsequent removal of the infected aortic graft as a second operation. Two of the three procedures were semi-elective, and one was done urgently because of a recurrent aortoenteric fistula. All three patients had less than 1 cm of remaining aortic neck below the renal arteries for closure. In each instance a segment of autogenous posterior rectus fascia-peritoneum was harvested and used as a circumferential pledget to bolster the anastomosis. No patient had stump blowout, and in no case was there computed tomography evidence of aneurysmal enlargement of the stump with follow-up of 12 and 24 months in two of the three survivors. Use of autogenous fascia-peritoneum is a durable and effective method to assist stump closure and prevent stump blowout after removal of infected aortic grafts.
authors.affiliation: Division of Vascular Surgery, The Cleveland Clinic Foundation, Desk S40, 9500 Euclid Avenue, Cleveland, OH 44195, USA. SaracT@ccf.org
authors.forename: Timur P
authors.initials: TP
authors.lastname: Sarac
authors.forename: Peter
authors.initials: P
authors.lastname: Augustinos
authors.forename: Sean
authors.initials: S
authors.lastname: Lyden
authors.forename: Kenneth
authors.initials: K
authors.lastname: Ouriel
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D001012:Aorta, Abdominal / Q000601:surgery*; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D005205:Fascia / Q000637:transplantation*; D005260:Female; D006801:Humans; D008297:Male; D010537:Peritoneum / Q000637:transplantation*; D016459:Prosthesis-Related Infections / Q000601:surgery*