title: Long-Term Survival After Coverage With Prevertebral Fascia for Abdominal Aortic Stump Closure.
abstract: Abdominal aortic graft-enteric fistula is an uncommon but grave complication. Acceptable early results of its management have been reported in recent years, but aortic stump disruption remains a dreaded problem in the remote period. This report describes a case of a 71-year-old male with graft-enteric fistula following after a distant abdominal aortic aneurysm repair. The patient underwent 1-stage operation with extra-anatomic bypass preceding the complete removal of the infected aortic graft and intestinal repair. For coverage of the aortic stump closure, the prevertebral fascia was harvested as a flap and was successfully used to buttress the closure. Additionally, omental wrap was secured around the stump and around the area after complete graft removal. Postoperative intravenous antibiotic with meropenem was administered for 8 weeks, followed by suppression with ongoing oral antibiotic with trimethoprim-sulfamethoxazole for 6 months. Although sigmoidectomy and the left ureteral reconstruction were required, the patient is doing well without recurrent infection and without stump disruption after 8 years of follow-up.
authors.affiliation: 1 Department of Cardiovascular Surgery, Mimihara General Hospital, Osaka, Japan.
authors.forename: Takehiro
authors.initials: T
authors.lastname: Inoue
authors.affiliation: 2 Department of Cardiovascular Surgery, Kinki University School of Medicine, Osaka, Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Imura
authors.affiliation: 2 Department of Cardiovascular Surgery, Kinki University School of Medicine, Osaka, Japan.
authors.forename: Toshio
authors.initials: T
authors.lastname: Kaneda
authors.affiliation: 2 Department of Cardiovascular Surgery, Kinki University School of Medicine, Osaka, Japan.
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Saga
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001012:Aorta, Abdominal / Q000000981:diagnostic imaging / Q000382:microbiology / Q000601:surgery*; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D001027:Aortography / Q000379:methods; D064131:Back Muscles / Q000601:surgery*; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation*; D000072226:Computed Tomography Angiography; D020878:Device Removal; D006801:Humans; D007412:Intestinal Fistula / Q000000981:diagnostic imaging / Q000382:microbiology / Q000601:surgery*; D008297:Male; D009852:Omentum / Q000601:surgery; D016459:Prosthesis-Related Infections / Q000000981:diagnostic imaging / Q000382:microbiology / Q000601:surgery*; D012086:Reoperation; D013524:Surgical Flaps; D013536:Suture Techniques; D013997:Time Factors; D016896:Treatment Outcome; D058106:Wound Closure Techniques
chemical_list: D000900:Anti-Bacterial Agents
keywords: aortic stump; graft-enteric fistula; omental wrap; prevertebral fascia