title: Rifampin soaking dacron-based endografts for implantation in infected aortic aneurysms--new application of a time-tested principle.
abstract: Infections involving the aorta are associated with high rates of morbidity and mortality, and their management is complex. Saturating Dacron grafts in rifampin (60 mg/mL) inhibits the growth of organisms commonly found to be involved in both primary aortic infections and aortoenteric fistulas. Open repair and replacement of the aorta with rifampin-soaked Dacron grafts is frequently used in clinical practice and is considered a viable option for open repair with a low recurrence of infection; however, the morbidity and mortality of the procedure is significant. More recently, patients who are high risk for open surgery have been managed with endografts to treat infected aortas and aortoenteric fistulas with limited success, a high recurrence rate, and elevated mortality. We describe a technique to expose Dacron endografts with rifampin delivered via injection port or into the sheath before deployment in selected patients with aortic infections. We used this novel technique in 2 patients who were high risk for open repair: 1 with a bleeding aortoenteric fistula and 1 with mycotic abdominal aortic aneurysm. The first patient tolerated 1.5 years without surgical correction of the duodenal defect after placement of a rifampin-treated endograft. This allowed her to recover and ultimately undergo definitive repair under elective circumstances. Our second patient remains without evidence of recurrence 1 year after implantation for a mycotic abdominal aortic aneurysm. Following the principles of rifampin use in open vascular repairs, treating Dacron endografts with rifampin may add similar antimicrobial resistance when used to treat selected aortic infections.
authors: Department of Surgery/Division of Vascular Surgery, University of Arkansas for Medical Sciences, Little Rock, AR. Electronic address: GEscobar@uams.edu.
authors: Guillermo A
authors: GA
authors: Escobar
authors: Department of Surgery/Division of Vascular Surgery, University of Michigan Medical Center, Ann Arbor, MI.
authors: Jonathan L
authors: JL
authors: Eliason
authors: Department of Surgery/Division of Vascular Surgery, Wake Forest Baptist Health, Winston-Salem, NC.
authors: Justin
authors: J
authors: Hurie
authors: Department of Surgery/Division of Vascular Surgery, Emory University, Atlanta, GA.
authors: Shipra
authors: S
authors: Arya
authors: Department of Surgery/Division of Vascular Surgery, University of Michigan Medical Center, Ann Arbor, MI.
authors: John E
authors: JE
authors: Rectenwald
authors: Department of Surgery/Division of Vascular Surgery, University of Michigan Medical Center, Ann Arbor, MI.
authors: Dawn M
authors: DM
authors: Coleman
mesh_terms: D000328:Adult; D000368:Aged; D000785:Aneurysm, Infected / Q000175:diagnosis / Q000382:microbiology / Q000601:surgery*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000382:microbiology / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation*; D057510:Endovascular Procedures / Q000295:instrumentation*; D005260:Female; D006801:Humans; D011093:Polyethylene Terephthalates; D011474:Prosthesis Design; D012293:Rifampin / Q000008:administration & dosage*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D011093:Polyethylene Terephthalates; D012293:Rifampin