Infected Aortic Stent Graft Research Articles

1004 Urgent Explant of Infected Aortic Stent Graft in a Patient with Kidney Transplant Using Biological Aortoiliac Reconstruction and a Temporary Axillo-Femoral Perfusion Shunt: 6-Year Follow-Up and Literature Review

Abstract Background Written consent obtained for case report. A 59-year-old male who was 3-months post-EVAR repair under immunosuppression for kidney transplantation and anti-retroviral HIV treatment presented to ED in 2017 with abdominal pain and fever. CTAP revealed pyelonephritis in renal allograft. Blood cultures were positive for staphylococcus epidermidis. PETCT showed high-intensity uptake around endograft. Urgent explant of endograft and insitu biological aorto-biiliac graft reconstruction with bench prepared bilateral long saphenous veins were performed. Results The predicted challenges were locating source of infection, immunosuppressed state, and allograft preservation. Dacron graft was used as temporary perfusion shunt (left axillary artery to right superficial femoral artery) for renal allograft on right external iliac vessels. Endograft was removed via rooftop incision with visceral rotation. Supra-celiac and supra-superior mesenteric artery clamping times were 15 and 35 minutes. The source of infection was from infected appendix proximal to graft with erosion of right external iliac artery resulting in appendectomy in the same operation. Following 12-weeks of OPAT antibiotic-therapy, repeat PETCT revealed low-grade uptake around aortic graft and inflammatory markers were back to baseline. At 6 years in 2023, patient remains clinically well with ∼20% allograft function. Maintaining kidney allograft perfusion in the setting of elective non-infected aortic graft explant was previously reported, but with ENROUTE system (Rasheed et al., 2018). Conclusions The satisfactory long-term outcomes discussed here demonstrated with MDT planning involving vascular surgery, infectious diseases, renal medicine and patient, explant of infected graft with insitu biological graft reconstruction in renal transplant patients presenting with complex aortic-graft infection is feasible.

Clinical analysis of surgical treatment of infection after interventional operation for major iliac artery disease in 6 cases

Objective: To explore the surgical treatment strategy of stent graft infection after interventional treatment of major iliac artery related diseases. Methods: Retrospective analysis was performed on the clinical data of 6 patients with secondary stent graft infection after interventional treatment for major iliac artery related diseases admitted to the Department of Vascular Surgery,Affiliated Drum Tower Hospital,Medical School of Nanjing University from November 2021 to August 2022.There were 5 males and 1 female,with a mean age of 64 years (range:49 to 79 years).The infection time was 53 to 3 165 days.All the 6 patients received surgical treatment,including 3 patients who underwent anatomic bypass grafting (axillary arterial-femoral artery bypass,femoral arterial-femoral artery bypass) using artificial vessels,and 3 patients who underwent in situ abdominal aorta reconstruction using bovine pericardium.The perioperative situation,postoperative infection and the occurrence of serious adverse events were recorded,and the safety of different treatment methods and materials was evaluated. Results: All patients successfully completed the operation and no death occurred during hospitalization.Intraoperative blood loss was 2 000~5 000 ml,and intraoperative blood transfusion was 1 600 to 5 350 ml.All the patients were followed up for 81 to 395 days after surgery,and the incision healed well,and no reinfection occurred.Postoperative gastrointestinal bleeding occurred in 1 patient,secondary surgery (retroperitoneal hematoma removal) was performed in 1 patient due to postoperative bleeding at the vascular anastomosis,both lower limb amputations were performed in 1 patient due to postoperative lower limb ischemia,and intermittent claudication occurred in 2 patients.All patients were alive at the last follow-up. Conclusion: For patients with aortic stent graft infection,when the infection is not serious and there is enough space to block the proximal and distal aorta,in situ aortic reconstruction is an effective treatment,and different materials can achieve satisfactory results in a short period of time.

Who needs their descending thoracic aorta anyway? Extra-anatomic bypass for aorto-bronchial fistula after TEVAR

BackgroundAortobronchial fistula after TEVAR remains a vexing clinical problem associated with high mortality. Although a combination of endovascular and open surgical strategies have been reported in managing this pathology, there is as yet no definitive treatment algorithm that can be used for all patients. We discuss our approach to an aortobronchial fistula associated with an overtly infected aortic endograft.Case presentationA 49-year-old female sustained a traumatic aortic transection 14 years prior, managed by an endovascular stent-graft. Due to persistent endoleak, she underwent open replacement of her descending thoracic aorta 4 years later. Ten years after her open aortic surgery, the patient presented with hemoptysis, and a pseudoaneurysm at her distal aortic suture line was identified on computed tomography, whereupon she underwent placement of an endograft. Eight weeks later, she presented with dyspnea, recurrent hemoptysis, malaise and fever, with clinical and radiographic evidence of an aortobronchial communication and an infected aortic stent-graft. The patient underwent management via a two-stage open surgical approach, constituting an extra-anatomic bypass from her ascending aorta to distal descending aorta and subsequent radical excision of her descending aorta with all associated infected prosthetic material and repair of the airway.ConclusionAortobronchial fistula after TEVAR represents a challenging complex clinical scenario. Extra-anatomic aortic bypass followed by radical debridement of all contaminated tissue may provide the best option for durable longer-term outcomes.

Strategies and outcomes of different methods for treating abdominal aortic stent graft infection.

To report the strategies and short-term results of different treatment methods for abdominal aortic stent graft infection. Six consecutive patients (5 males and 1 female; mean age: 64 years; age range: 49-79 years) received surgical treatment for stent graft infection from November 2021 to December 2022. All patients underwent endovascular aortic repair (EVAR) for abdominal aortic and iliac artery disease, subsequently developed graft infection and then received corresponding surgical treatment with different materials (artificial blood vessel, bovine pericardium, autologous great saphenous vein) in our department. The outcomes were analysed. Immediate technical success was achieved intraoperatively in all six patients. The 30-day mortality rate was 0%. During a mean follow-up of 4 months (range, 3-13 months), one patient underwent a second operation due to vascular anastomotic haemorrhage and underwent bilateral limb amputations due to ischaemia. All patients survived. In the short term, the different materils and methods used to treat aortic stent graft infection achieved satisfactory results.

Clinical outcomes of in situ graft reconstruction in treating infected abdominal aortic stent grafts following endovascular aortic aneurysm repair: a single-center experience.

This study aimed to review our experience with the explantation of infected endovascular aneurysm repair (EVAR) grafts. This single-center, retrospective, observational study analyzed the data of 12 consecutive patients who underwent infected aortic stent graft explantation following EVAR between January 1, 2010 and December 31, 2019, of which 11 underwent in situ graft reconstruction following graft removal. The presentation symptoms, infection route, original pathology of abdominal aortic aneurysms (AAA), graft materials, and clinical outcomes were analyzed. Six patients underwent total explantation, whereas 5 underwent removal of only the fabric portions. For in situ reconstructions, prosthetic grafts and banked allografts were used in 8 and 3 patients, respectively. Four mechanisms of graft infection were noted in 11 patients: 4 had bacteremia from systemic infections, 3 had persistent infections following EVAR of primary infected AAA, 3 had ascending infections from adjacent abscesses, and 1 had an aneurysm sac erosion resulting in an aortoenteric fistula. No infection-related postoperative complications or reinfections occurred during the mean 65.27-month (standard deviation, ±52.51) follow-up period. One patient died postoperatively because of the rupture of the proximal aortic wall pseudoaneurysm that had occurred during forceful bare stent removal. Regardless of graft material, in situ graft reconstruction is safe for interposition in treating an infected aortic stent graft following EVAR. In our experience, the residual bare stent is no longer a risk factor for reinfection. Therefore, it is important not to injure the proximal aortic wall when removing the bare stent by force.

True infection or contamination in patients with positive Cutibacterium blood cultures—a retrospective cohort study

Cutibacterium is a genus often considered a contaminant when present in blood cultures, but it can also cause severe infections, especially related to implanted foreign materials. We investigated the incidence and features of patients with true Cutibacterium infection. Patients with positive Cutibacterium blood cultures between the years 2015–2020 in southern Sweden were identified through microbiology records and medical records were studied retrospectively. Cutibacterium isolates were species determined using MALDI-TOF MS. Patients were classified as having true infection or contamination according to a definition considering both clinical and microbiological features and these groups were compared. A total of 313 episodes of positive Cutibacterium blood cultures were identified in 312 patients. Of these, 49 (16%, corresponding to an incidence of 6 cases per million inhabitants per year) were classified as true infections. The most common species was Cutibacterium acnes (87%), and the majority were elderly men with comorbidities. Patients with true Cutibacterium infection often had an unknown focus of infection (n = 21) or a focus in the respiratory tract (n = 18). We identified one episode of ventriculo-peritoneal shunt infection, three episodes of aortic stent-graft infection, and one episode of infective endocarditis. Two patients, where Cutibacterium was isolated at the site of infection, had only one positive blood culture. The finding of positive Cutibacterium blood cultures should not always be considered contamination. Definitions of true Cutibacterium bacteremia with a demand that more than one blood culture must be positive may miss true infections.

Percutaneous embolization of a ruptured mycotic visceral aortic aneurysm stump hemorrhage

Introduction and Objective Managing infected endovascular aortic stent grafts is difficult and often has morbid consequences. We report a complicated case of endovascular aortic stent graft infection treated through complex surgical and endovascular management. A standard attempt at open surgical correction was made, however, due to the complex nature of the patient's condition; much of the treatment accomplishedvia endovascular techniques for ultimate resolution. Case Report Graphical AbstractA) CTA maximum intensity projection after initial surgical repair demonstrating an axillary-femoral and femoral-femoral bypass creation (star), distal aortic and bilateral artery ligation (asterisks). B) Sagittal abdominal CTA 2 weeks after initial surgery demonstrating contrast extravasation from the aortic stump (arrow). View Large Image Figure Viewer Download Hi-res image Graphical AbstractA) Posterior projection of a volume rendered CTA after the second surgical repair demonstrating distal thoracic aorta ligation (open arrow), previous ligations (asterisks), bypass grafts from the distal thoracic aorta to the SMA (white arrow), splenic artery (open arrowhead), and left renal artery (white arrowhead). B) Sagittal abdominal CTA demonstrating recurrent hemorrhage in the visceral aorta (arrow), with themultiple ligations (asterisks) of the aorta and SMA, as well as the celiac bypass (arrowhead). View Large Image Figure Viewer Download Hi-res image Graphical AbstractA) Oblique image of the aortic stump access using an 18-gauge Hawkins needle (Cook, Bloomington, IN) (white arrowheads) shows inflow at the celiac ostium as a contrast void (white circle), opacification of the replaced right hepatic (black arrow), right renal artery (black arrowhead), and visceral aorta with extravasation of contrast (white arrow). B) SOS 2 catheter (Cook, Bloomington, IN) selection of the celiac artery (white arrow head) with retrograde flow in to the aortic lumen (white circle), inflow from the splenic artery stump bypass (black arrowhead), and antegrade flow into the common hepatic artery (black arrow). View Large Image Figure Viewer Download Hi-res image Graphical AbstractThe ostia of the celiac artery, right renal artery, and direct aortic origin right hepatic celiacartery origin were embolized using multiple techniques. A) A 0.24 microcatheter (white arrowhead) was advanced into the splenic artery and used to place an Amplatz IV (6 × 11mm) (St. Jude Medical, St. Paul, MN) (black arrowhead) into the ostium of the celiac artery to exclude the aortic stump but preserve hepatic arterial supply. Direction of blood flow from the splenic bypass towards the celiac ostium and into the common hepatic artery is demarcated with open arrows. B) The replaced right hepatic artery was embolized with multiple 0.018 6mm and 4mm detachable coils (Boston Scientific S Interlock, Marlboro, MA) (arrow). C) The visceral aortic lumen and right renal artery were embolized with 0.035 and 0.018 detachable coils (Boston Scientific S Interlock, Marlboro, MA), a 0.035 Benson wire with removed mandrel (Cook,Bloomington, IN) and n-BCA glue (TruFill Johnson and Johnson, Miami, FL). The aortic access track was then closed with an 8mm Amplatz plug and n-BCA glue (arrowhead). View Large Image Figure Viewer Download Hi-res image Graphical AbstractA) 3-year post-operative follow up 3D rendered image showing patents bypasses to the SMA (white arrow), splenic artery (open arrowhead), and left renal artery (white arrowhead), stable ligation of the distal thoracic aorta and embolized visceral abdominal aorta. B) 3-year post-operative sagittal CT showing absence of perfusion to the visceral aortic (arrow). View Large Image Figure Viewer Download Hi-res image Discussion Complex aortic surgery is challenging especially in the presence of recurrent infection. This case was a unique situation in which a less invasive endovascular correction was successful for a patient with multiple recent aortic surgeries in which perioperative mortality for any additional surgeries was likely. Managing infected endovascular aortic stent grafts is difficult and often has morbid consequences. We report a complicated case of endovascular aortic stent graft infection treated through complex surgical and endovascular management. A standard attempt at open surgical correction was made, however, due to the complex nature of the patient's condition; much of the treatment accomplishedvia endovascular techniques for ultimate resolution. Complex aortic surgery is challenging especially in the presence of recurrent infection. This case was a unique situation in which a less invasive endovascular correction was successful for a patient with multiple recent aortic surgeries in which perioperative mortality for any additional surgeries was likely.

A simple method for removal of an infected aortic stent graft: A case report

A simple method for removal of an infected aortic stent graft: A case report

Mid-Term Outcome of Infected Abdominal Aortic Stent Graft Dismantlement with Reconstruction of Bilateral Axillofemoral Bypass.

Background: Abdominal aortic stent graft infection (AAGI) is a severe complication. The optimal management of AAGI remains unclear. This study provides updated results of bilateral axillofemoral bypasses (AFBs) for patients with AAGI. Patients and Methods: In total, 31 patients (25 men; mean age, 67.1 years) with AAGI treated using AFB between January 2006 and April 2020 were included. Overall, the mean follow-up duration was 24 months (range, 1-72). In the 23 patients who survived the post-operative period, the mean follow-up duration was 32 months (range, 12-72). Results: Thirty-day and in-hospital mortality rates was 16% and 26%, respectively. The 12-month primary and secondary patency rates for the AFB graft were both 91%. In total, seven (30%) patients received re-interventions such as thrombectomy and balloon angioplasty. No amputation was required during follow-up. Culture results were positive in 87% of pre-operative cultures and 84% of intra-operative cultures. Staphylococcus aureus was the most prevalent pathogen, with four cases of methicillin-resistant Staphylococcus aureus and one each of vancomycin-resistant enterococci, carbapenem-resistant Klebsiella pneumoniae, and carbapenem-resistant Enterobacteriaceae. In-hospital mortality rate was 57% in patients with drug-resistant pathogens. Conclusions: Reconstruction with bilateral AFB and stent graft removal in patients with AAGI is a feasible treatment modality and provided an acceptable patency rate and low amputation rate. Additional studies investigating long-term results and the optimal treatment of AAGI are required.

IP143. A Complicated Course for an Infected Aortic Stent Graft

IP143. A Complicated Course for an Infected Aortic Stent Graft

Infected Aortic Stentgraft Treated with Fresh Cold Stored Arterial Allograft

Infected Aortic Stentgraft Treated with Fresh Cold Stored Arterial Allograft

An endoluminal aortic prosthesis infection presenting as pneumoaorta and aortoduodenal fistula.

Herein, we present a case of pneumoaorta and aortoduodenal fistula (ADF) caused by an endoluminal aortic prosthesis infection. An 82-year-old man underwent endovascular aneurysm repair with a stent graft to exclude a 5.1-cm abdominal aortic aneurysm. Three months after the index procedure, the patient was taken to the emergency department at a medical university hospital. He presented with a 2-d history of bloody diarrhea. An endoluminal aortic stent graft infection was diagnosed, and an ADF was identified. The patient died of septic shock despite emergency surgery and intensive care. When encountered, stent graft infections require appropriate antibiotics and graft explantation. The diagnosis of an ADF is important, and surgery remains the most effective management if septic shock presents despite conservative treatment.

Unusual Perigraft Abscess Formation Associated with Stent Graft Infection after Endovascular Aortic Repair of Abdominal Aortic Aneurysm: A Case Report

The incidence of aortic stent graft infection is with 0.2% to 0.7% low (1). However, there is an increasing need to be vigilant for the risk of stent graft infections as there are more patients treated using the endovascular technique. An early detection of graft infections and an adequate treatment during follow-up are also important to prevent serious complications. There have been several reports on stent graft infection with its characteristic clinical presentations and computed tomography (CT) findings (2-6). However, even with these characteristic CT findings, there have been few cases reported of abscess formation due to graft infection without characteristic CT findings, which could lead to either misdiagnosis or delayed diagnosis. We report a case of perigraft abscess formation that showed an increased size of aneurysmal sac without any apparent evidence of causative risk factors and was developed as a late complication 2 years after endovascular aortic repair (EVAR) for an abdominal aortic aneurysm (AAA).

Purulent Cutaneous Fistula: As the First Symptom of the Late Aortic Stent-Graft Infection—A Case Report and Review of the Literature

Purpose. Aortic stent-graft infection with fistula formation is a rare complication with high mortality rate when treated surgically by stent-graft removal. We report a case of a patient with aortic stent-graft infection, prosthetic-duodenal, and prosthetic-cutaneous fistulas operated without the removal of an infected prosthesis and ineffectively tailored antibiotic therapy. Case Report. A 66-year-old patient with high cardiovascular risk and endovascular stent-graft implantation developed a symptomatic infection of the aortic stent graft 42 months after procedure. It was manifested by iliolumbar muscle abscess and two fistulas: prosthetic cutaneous and prosthetic duodenal. The prosthetic-duodenal fistula was excised and separated from the prosthesis. The perforation within the duodenum was closed in layers. Iliolumbar abscess was removed and drainage was effected .The stent graft was left. The patient received tailored antibiotic therapy. He was readmitted to hospital after 4 weeks with symptoms of infection and leakage of pus discharge in the lumbar area. Despite the antibiotic therapy, the total parenteral nutrition of the patient's clinical status and malnutrition deteriorated and he died of cardiac arrest. Conclusion. The presented case confirms that leaving off of the infected stent graft in the patient with severe comorbidity and treated with a tailored antibiotic therapy may not be effective.

Psoas abscess complicating endovascular aortic aneurysm repair.

Aortic stent graft infection is a rare but serious complication associated with high mortality. This report emphasizes the need for continued awareness of potential graft-related septic complications in patients undergoing Endovascular Aortic Repair (EVAR). We report a case in which a post-EVAR patient became unwell about 30 days post operatively and was shown on CT scanning to have a psoas abscess. The abscess was managed with percutaneous drainage and antibiotics. The patient remains well with no evidence of psoas collection or perigraft infection one year on. We review the available literature and discuss the merits of different management strategies.

Infection of endovascular abdominal aortic aneurysm stent graft after urosepsis: case report and review of the literature

Infection of endovascular abdominal aneurysm stent grafts is an uncommon but known complication. Inoculation with bacteria of the endovascular abdominal aneurysm stent graft during the actual implantation, in the periprocedural hospitalization or later due to an aortoenteric fistula, has been described in the literature. We report a case of endovascular abdominal aortic aneurysm stent graft infection occurring 40 months after implantation in a patient doing well up to an episode of urosepsis. In conclusion, we postulate that poor intraluminal healing of stent grafts, as observed in several explant studies, may result in a higher susceptibility to episodes of bacteremia than prosthetic vascular grafts inserted during open repair. We therefore consider the administration of prophylactic antibiotics in patients with endovascular stent grafts during periods with a likelihood of bacteremia.

Primary aortoenteric fistula following endovascular aortic repair due to type II endoleak

An 84-year-old female was lost to follow-up after endovascular aneurysm repair at another hospital with known type II endoleak. She later presented with presyncope and hematemesis. A referral center esophagogastroduodenoscopy showed possible duodenal diverticulum. She had recurrent symptoms and repeat computed tomography scan showed air within the aortic sac. At our center, she underwent stent graft explantation and axillofemoral reconstruction for a primary aortoenteric fistula. She was discharged and is doing well 5 months postoperatively. A high degree of suspicion for aortoenteric fistula is imperative in any patient with upper gastrointestinal hemorrhage after open or endovascular abdominal aortic aneurysm repair.

Clostridium septicum post-endovascular aneurysm repair stent-graft infection

Endovascular aortic aneurysm repair (EVAR) is establishing its role as a valid alternative for the treatment of abdominal aortic aneurysm. Post-EVAR graft infection is a rare and devastating complication. The incidence of post-EVAR graft infection is yet to be defined, and available data at this stage consist of case reports and small series. Possible etiologies for aortic stent-graft infection include perioperative contamination and hematogenous seeding. To the best of our knowledge, this is the first report of post-EVAR stent graft infection with Clostridium septicum. The possible mechanisms of this unusual hematogenous seeding have been discussed.

Abdominal Aortic Aneurysm Repair Complicated by Infection With Clostridium septicum

Aortic stent-graft infection after endovascular abdominal aortic aneurysm (AAA) repair is an uncommon, but very serious complication with potentially devastating consequences.(1) Traditional open techniques of repair of AAA demonstrate an infection rate of 0.5-3%. The exact rate of infection with endovascular repair is unknown, but literature review demonstrates an overall incidence of 0.43-1.17% retrospectively.(2,3) Etiology of endovascular graft infections typically results from flora derived from the skin or gastrointestinal tract.(4)Clostridium septicum is a naturally occurring anaerobic bacterium native to the gastrointestinal tract. It is typically associated with spontaneous nontraumatic gas gangrene owing to bacteremia from the gastrointestinal tract with an incidence rate of 0.07%.(5) To our knowledge, this is the first reported case of endovascular AAA graft infection owing to Clostridium septicum species.

Aortic stent graft infection in a patient with Marfan syndrome

Aortic stent graft infection in a patient with Marfan syndrome