Management of an infected aortic graft with endovascular stent grafting.
Aortic graft infection, one of the most common fatal complications of aortovascular surgery, is managed mainly by the removal of infected graft material and re-establishment of vascular continuity using an extra-anatomical bypass or in situ graft replacement. Despite significant progress in perioperative, surgical, and medical treatments, the mortality and morbidity for this condition remain high. Here, we report the use of endograft implantation and prolonged intravenous antibiotics to successfully treat a life-threatening Dacron aortic tube graft infection and anastomotic leak. Although the gold standard is surgical removal of infected material and repair with a homograft, in certain extremely high-risk patients such as ours, an alternate strategy may be warranted when the risks associated with surgery are prohibitive. Endovascular repair of a surgical Dacron graft leak may provide a novel temporizing measure in the acute setting, allowing for delayed semi-urgent surgical intervention, or it may provide a definitive treatment, as in our case. At the four-year follow-up, our patient was well with a good quality of life and with no clinical, radiological, or biochemical evidence of infection.
Department of Cardiothoracic Surgery, Guy's and St Thomas' Hospital NHS Foundation Trust, London, United Kingdom.
Sara
S
Jamel
Rizwan
R
Attia
Christopher
C
Young
D000368:Aged; D000658:Amoxicillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D002444:Cefuroxime / Q000627:therapeutic use; D019818:Clavulanic Acid / Q000627:therapeutic use; D004322:Drainage / Q000379:methods; D005500:Follow-Up Studies; D005839:Gentamicins / Q000627:therapeutic use; D006801:Humans; D007262:Infusions, Intravenous; D000077731:Meropenem; D008795:Metronidazole / Q000627:therapeutic use; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000382:microbiology* / Q000628:therapy*; D018805:Sepsis / Q000382:microbiology / Q000628:therapy*; D015607:Stents / Q000382:microbiology*; D013845:Thienamycins / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed / Q000379:methods
D000900:Anti-Bacterial Agents; D005839:Gentamicins; D013845:Thienamycins; D008795:Metronidazole; D019818:Clavulanic Acid; D000658:Amoxicillin; D000077731:Meropenem; D002444:Cefuroxime