title: The Role of Endovascular In Situ Revascularization in the Treatment of Arterial and Graft Infections.
abstract: Mycotic aneurysms and prosthetic graft infections are traditionally treated with excision of the infected tissue or graft, often requiring anatomical or extraanatomical bypass, carrying significant morbidity and mortality. Currently, the role of endovascular repair without excision in this setting has yet to be defined. We present 2 case scenarios, whereby mycotic pseudoaneurysms were successfully treated with endovascular stent-graft coverage and to present an in-depth review of endovascular in situ revascularization in the treatment of arterial and graft infections. There are data to support the use of stent grafting in mycotic aortic and iliac aneurysms, lower and upper extremity native arterial infections, lower extremity prosthetic bypass infections, and infections of carotid artery aneurysms. It is our belief that this technique may be utilized as primary therapy if there is no significant contamination and certainly serves an essential role in acute rupture or hemorrhage. In situations where there is significant tissue infection, stent grafting should be considered as a bridge if traditional excision is warranted.
authors.affiliation: Division of Vascular Diseases and Surgery, The Ohio State University Wexner Medical Center, Columbus, OH.
authors.forename: David S
authors.initials: DS
authors.lastname: Strosberg
authors.affiliation: Division of Vascular Diseases and Surgery, The Ohio State University Wexner Medical Center, Columbus, OH. Electronic address: babatunde.oriowo@osumc.edu.
authors.forename: Babatunde A
authors.initials: BA
authors.lastname: Oriowo
authors.affiliation: Division of Vascular Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX.
authors.forename: Mark G
authors.initials: MG
authors.lastname: Davies
authors.affiliation: Division of Vascular Diseases and Surgery, The Ohio State University Wexner Medical Center, Columbus, OH.
authors.forename: Hosam F
authors.initials: HF
authors.lastname: El Sayed
mesh_terms: D017541:Aneurysm, False / Q000000981:diagnostic imaging / Q000382:microbiology / Q000601:surgery*; D000785:Aneurysm, Infected / Q000000981:diagnostic imaging / Q000382:microbiology / Q000601:surgery*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000382:microbiology / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation; D000072226:Computed Tomography Angiography; D057510:Endovascular Procedures / Q000295:instrumentation; D006801:Humans; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000000981:diagnostic imaging / Q000382:microbiology / Q000601:surgery*; D015607:Stents; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents