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Prosthetic graft infection involving the thoracic aorta: graft excision and extra-anatomic revascularization
1Department of Surgery, New York Hospital, New York 10021.
Abstract:
Late-appearing infection of prosthetic grafts continues to plague the vascular surgeon. Although generally caused by biofilm-producing coagulase-negative staphylococci, other Gram-positive, as well as Gram-negative, organisms may also be etiologic. Extra-anatomic revascularization with either simultaneous or staged removal of the entire contaminated prosthesis has emerged as the preferred method of management of the infected aortic prosthesis. In addition to the usual technical problems accompanying surgery for aortic graft infection, operation for prosthetic graft infection involving the ascending aorta and aortic arch introduces the potential problem of temporary cerebral ischemia. The successful management of a 64-year-old woman with late Staphylococcus aureus infection of an aortoinnominate-left subclavian bifurcation graft by graft excision and extra-anatomic revascularization, in whom intraoperative cerebral ischemia was circumvented by initial placement of a right femoroaxillary bypass graft is described here.
Insights
Managing late prosthetic graft infections, often caused by Staphylococcus aureus, requires graft excision and extra-anatomic revascularization. A novel approach successfully circumvented cerebral ischemia during aortic graft surgery.
Area of Science:
- Vascular Surgery
- Infectious Diseases
- Medical Device Infections
Background:
- Late prosthetic graft infections pose significant challenges for vascular surgeons.
- Coagulase-negative staphylococci are common culprits, but other bacteria can also cause infection.
- Management often involves extra-anatomic revascularization and prosthesis removal.
Observation:
- A 64-year-old woman presented with late Staphylococcus aureus infection of an aortoinnominate-left subclavian bifurcation graft.
- Surgical management included graft excision and extra-anatomic revascularization.
- Intraoperative cerebral ischemia was a significant concern due to the graft's location.
Findings:
- The patient underwent successful graft excision and extra-anatomic revascularization.
- Cerebral ischemia was prevented by the initial placement of a right femoroaxillary bypass graft.
- This approach allowed for safe management of the infected aortic graft.
Implications:
- This case highlights a successful strategy for managing complex aortic graft infections.
- The femoroaxillary bypass technique offers a solution to prevent cerebral ischemia during ascending aorta and aortic arch graft surgery.
- This approach may improve outcomes for patients with prosthetic graft infections in critical locations.