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Infected aortic bifurcation grafts: experience with fourteen patients
Abstract:
The experience with 14 patients with infected aortic bifurcation grafts has been reviewed. Factors which appeared to predispose to infection in 11 patients included "re-do" operations, concomitant cholecystectomy or gastrostomy, and ruptured abdominal aneurysm. A mixture of gastrointestinal organisms was responsible for the infections. The pathogenesis, presentation, and treatment varied according to whether the proximal or distal anastomosis was involved or not. Aortoduodenal communications were present in five patients; they presented with gastrointestinal bleeding or septicemia. One patient survived as a result of early, aggressive surgical therapy. Infection presented at the distal anastomosis in nine patients, either as groin abscess or false aneurysm. Conservative therapy failed in the majority of patients but apparently was successful in three of five patients in whom infection did not involve the intra-abdominal portion of the graft. When infection does involve the intra-abdominal portion of the graft, then the graft must be excised also. Revascularization often can be accomplished with extra-anatomic bypasses of prosthesis or autogenous material, depending on the characteristics of the individual patient. Regardless of the mode of presentation or the site of infection, the early institution of judicious surgical management offers the best chance of success in these patients, and temporization usually leads to failure.
Insights
Infected aortic grafts require prompt surgical intervention. Early, aggressive treatment of aortic graft infections, especially when involving the intra-abdominal portion, improves patient survival and outcomes.
Area of Science:
- Vascular Surgery
- Infectious Diseases
Background:
- Infected aortic grafts pose significant challenges in vascular surgery.
- Risk factors for graft infection include re-do operations, abdominal aortic aneurysm rupture, and concomitant procedures.
Purpose of the Study:
- To review the experience with infected aortic bifurcation grafts.
- To identify predisposing factors, common pathogens, and treatment outcomes.
- To elucidate the varied presentations and optimal management strategies.
Main Methods:
- Retrospective review of 14 patients with infected aortic bifurcation grafts.
- Analysis of predisposing factors, causative organisms, clinical presentation, and treatment modalities.
- Evaluation of outcomes based on the site of infection (proximal vs. distal anastomosis) and treatment approach.
Main Results:
- Gastrointestinal organisms were the primary cause of infection.
- Aortoduodenal communications occurred in five patients, presenting with bleeding or septicemia.
- Distal anastomosis infections (groin abscess, false aneurysm) were more common (nine patients).
- Conservative therapy was largely unsuccessful, particularly for intra-abdominal graft infections.
- Early, aggressive surgical management, including graft excision and extra-anatomic bypass, was associated with survival.
Conclusions:
- Infected aortic grafts necessitate early and decisive surgical management.
- Graft excision is crucial when the intra-abdominal portion is involved.
- Extra-anatomic bypass can facilitate revascularization.
- Timely surgical intervention offers the best prognosis; delayed treatment often leads to failure.