AA11. Laparoscopic Retroperitoneal Washout of an Infected Aortobifemoral Graft: A Novel Technique

Abstract

Aortic prosthesis infection is a challenging complication of aortic bypass surgery with high morbidity and mortality. We report a successful image-guided, minimally invasive retroperitoneal washout of an infected aortobifemoral graft with 11 × 13-cm collection in a 71-year-old patient. Using a radiologically placed drainage catheter, laparoscopic washout of the infected perigraft collection was performed with image intensifier guidance. The tract was serially dilated, and the cavity was irrigated with copious saline and aqueous iodine solution under direct vision with a rigid nephroscope (Figs 1 and 2). A drain was left in situ for another week, and the patient completed 6 weeks of targeted antibiotic therapy. Surveillance computed tomography scan showed no new collection, thrombosis, aneurysm, leak, or fistula from the bypass graft. Bilateral lower limbs remained well perfused. Whereas video-assisted retroperitoneal débridement has recently been established as a viable surgical treatment of infected pancreatic necrosis, this is the first described case of minimally invasive video-assisted retroperitoneal washout of an infected aortic graft collection. Minimally invasive retroperitoneal washout may be a viable alternative to graft explantation and extra-anatomic bypass in aortic graft infection.Fig 2Intraoperative fluoroscopy showing position of guidewire after removal of previous percutaneous drain, dilation of the tract over guidewire with Enduro (Bard, Tempe, AZ) balloon, and insertion of the 24F sheath and nephroscope within the retroperitoneal space.View Large Image Figure ViewerDownload Hi-res image Download (PPT)