Graft for Mycotic Thoracic Aortic Aneurysm: Omental Wrapping to Prevent Infection

Nine cases of mycotic thoracic aortic aneurysm were treated surgically between July 1995 and March 2003. The aneurysms were located in the ascending aorta in 1 patient, the descending thoracic aorta in 5, and the thoracoabdominal aorta in 3. Preoperatively, 3 patients were in shock due to rupture of the aneurysm. All patients underwent aneurysmectomy and in-situ graft placement. In 5 patients, the graft was covered with a pedicled omental flap to prevent postoperative graft infection. There were 2 hospital deaths: one patient died of multi-organ failure, and the other died from intrathoracic bleeding. After discharge, one patient died from intrathoracic bleeding 3 months after surgery. These 3 patients had not received omental wrapping. Postoperative graft infection did not occur in the 6 surviving patients during a mean follow-up period of 4.0 ± 3.1 years. It was concluded that covering the prosthetic graft with a pedicled omental flap may help prevent postoperative graft infection and improve the surgical results.

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Successful treatment of myocotic thoracic aortic aneurysm by in situ graft replacement with omental wrapping

The Japanese Journal of Thoracic and Cardiovascular Surgery ◽

10.1007/bf02744606 ◽

2006 ◽

Vol 54 (2) ◽

pp. 78-80 ◽

Cited By ~ 2

Author(s):

Yoshiharu Nishimura ◽

Yoshitaka Okamura ◽

Takeshi Hiramatsu ◽

Masahiro Iwahashi ◽

Shigeru Komori

Keyword(s):

Aortic Aneurysm ◽

Successful Treatment ◽

Thoracic Aortic Aneurysm ◽

Graft Replacement ◽

Omental Wrapping

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A case of a highly tortuous descending thoracic aortic aneurysm treated by surgical exclusion

SAGE Open Medical Case Reports ◽

10.1177/2050313x20926440 ◽

2020 ◽

Vol 8 ◽

pp. 2050313X2092644

Author(s):

Koji Tsutsumi ◽

Hideyuki Shimizu

Keyword(s):

Aortic Aneurysm ◽

Thoracic Aortic Aneurysm ◽

Prosthetic Graft ◽

Late Complications ◽

Main Body ◽

Descending Aorta ◽

Descending Thoracic Aortic Aneurysm ◽

Aorta Replacement ◽

The Right

The patient was a 76-year-old woman with an atypical descending thoracic aortic aneurysm due to a highly tortuous descending aorta. The surgical approach in this case required special consideration because of the aneurysm’s location. The main body of the aneurysm was in the right thoracic cavity. Descending thoracic aorta replacement with a prosthetic graft and aneurysmal total exclusion were performed through a left curvilinear thoracoabdominal incision. The patient’s postoperative course was uneventful. Surgical exclusion of a thoracic aortic aneurysm may be a useful technique in this special situation. Postoperative follow-up is needed to prevent early and late complications.

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Midterm outcome of biosynthetic collagen prosthesis for treating aortic and peripheral prosthetic graft infections

Vascular ◽

10.1177/17085381211025380 ◽

2021 ◽

pp. 170853812110253

Author(s):

Thomas Betz ◽

Markus Steinbauer ◽

Ingolf Toepel ◽

Christian Uhl

Keyword(s):

Femoral Artery ◽

Graft Infection ◽

Prosthetic Graft ◽

Graft Occlusion ◽

Infrarenal Aorta ◽

Aortic Graft ◽

Reinfection Rate ◽

Autologous Vein

Objectives To report the midterm outcomes of treating prosthetic peripheral and aortic graft infections using a biosynthetic collagen prosthesis in a tertiary vascular center. Methods A retrospective analysis of all patients with prosthetic peripheral and aortic graft infections who underwent in situ reconstruction using a biosynthetic collagen prosthesis between March 2015 and November 2020 was conducted. Perioperative and midterm outcomes were analyzed. Results A biosynthetic collagen prosthesis was used in 19 patients (14 males, median age 66 years) to reconstruct the femoral artery ( n = 6), iliac artery ( n = 1), and infrarenal aorta ( n = 12). All patients were treated for a prosthetic vascular graft infection. The median follow-up period was 26.6 months (range 1–66 months). The 30-day graft failure rate was 15.7% ( n = 3), leading to a major amputation in one patient (5.3%). All grafts were occluded aortofemoral reconstructions in patients with occluded superficial femoral artery and were treated by immediate thrombectomy. The 30-day mortality rate was 5.3% ( n = 1), and survival after 3 years was 63.2%. The reinfection rate was 5.3% ( n = 1). At 13.6 months, the occlusion of a femoral graft was detected in 5.3% ( n = 1) and was treated with a new interposition graft. We observed no graft rupture or degeneration during follow-up. Conclusions Although results of in situ repair with autologous vein seem to be superior with little or none reinfection and low number of occlusions, biosynthetic collagen prostheses show acceptable midterm outcomes in terms of graft occlusion and mortality after prosthetic peripheral and aortic graft infections. Similar to other xenogenous materials, the reinfection rate is low with this prosthesis. With regard to immediate availability and easy handling, the use of a biosynthetic collagen prosthesis might be favorable compared to other replacement materials while treating prosthetic graft infections.

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Ovine Biosynthetic Grafts for Aortoiliac Reconstructions in Nonsterile Operative Fields

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0041-1723000 ◽

2021 ◽

Author(s):

Hazem El Beyrouti ◽

Mohammad Bashar Izzat ◽

Angela Kornberger ◽

Nancy Halloum ◽

Kathrin Dohle ◽

...

Keyword(s):

Treatment Group ◽

Vascular Grafts ◽

Graft Infection ◽

Prosthetic Graft ◽

Vascular Graft Infection ◽

Vascular Prostheses ◽

Graft Thrombosis ◽

Life Threatening ◽

Omniflow Ii

Abstract Background Prosthetic vascular grafts placed surgically or via endovascular techniques can be subject to the risk of life-threatening graft infections. The Omniflow II vascular prosthesis is a biosynthetic graft that was reported to have favorable properties in resisting infections. Materials and Methods We retrospectively reviewed our 3 years' experience of using the Omniflow II prostheses for aortoiliac reconstructions in patients considered to carry a substantial risk of subsequent prosthetic graft infections (prevention group) as well as in patients with actively infected prosthetic vascular grafts (treatment group). Results Aorto-bi-iliac (n = 4) and aortobifemoral (n = 12) vascular reconstructions were performed using bifurcated Omniflow II prostheses in nine patients in the prevention group and seven patients in the treatment group. During mean follow-up of 28.6 ± 17.2 months, there was one case of graft infection (6.3%) and graft thrombosis (6.3%) with subsequent successful thrombectomy. Early and late surgical revisions were required in eight (50%) and two (12.6%) patients, respectively. All graft prostheses were patent at last follow-up. Conclusion Using bifurcated Omniflow II vascular prostheses in patients with or at a high risk of vascular graft infection is advisable, and is associated with acceptable reinfection and patency rates.

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Cryopreserved arterial homografts for in situ reconstruction of mycotic aneurysms and prosthetic graft infection

European Journal of Cardio-Thoracic Surgery ◽

10.1016/s1010-7940(95)80050-6 ◽

1995 ◽

Vol 9 (9) ◽

pp. 502-506 ◽

Cited By ~ 54

Author(s):

P VOGT ◽

L VONSEGESSER ◽

Y GOFFIN ◽

M PASIC ◽

M TURINA

Keyword(s):

Graft Infection ◽

Prosthetic Graft ◽

Prosthetic Graft Infection ◽

In Situ Reconstruction ◽

Mycotic Aneurysms

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Socioeconomic disparities in surveillance and follow‐up of patients with thoracic aortic aneurysm

Journal of Cardiac Surgery ◽

10.1111/jocs.16173 ◽

2021 ◽

Author(s):

Michael Shang ◽

Gabe Weininger ◽

Makoto Mori ◽

Arianna Kahler‐Quesada ◽

Ellelan Degife ◽

...

Keyword(s):

Aortic Aneurysm ◽

Thoracic Aortic Aneurysm ◽

Socioeconomic Disparities

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Ruptured Thoracic Aortic Aneurysm Infected with Listeria Monocytogenes: A Case Report and a Review of Literature

Open Journal of Cardiovascular Surgery ◽

10.4137/ojcs.s11446 ◽

2013 ◽

Vol 6 ◽

pp. OJCS.S11446 ◽

Cited By ~ 5

Author(s):

Shigeki Masuda ◽

Nobuhiro Takeuchi ◽

Masanori Takada ◽

Koichi Fujita ◽

Yoshiharu Nishibori ◽

...

Keyword(s):

Listeria Monocytogenes ◽

Aortic Aneurysm ◽

Thoracic Aortic Aneurysm ◽

Aortic Rupture ◽

Prosthetic Graft ◽

Sigmoid Colon Cancer ◽

Causative Organism ◽

Protein Levels ◽

Reactive Protein ◽

History Of

A 75-year-old male with a history of alcoholic liver cirrhosis, sigmoid colon cancer, and metastatic liver cancer was admitted to our institution with a complaint of a prickly feeling in his chest. On admission, a chest radiograph revealed a normal cardio-thoracic ratio of 47%. Echocardiography revealed pericardial effusion and blood chemical analyses revealed elevated C-reactive protein levels (14.7 mg/dL). On day 3, chest radiography revealed cardiomegaly with a cardio-thoracic ratio of 58% and protrusion of the left first arch. Contrast-enhanced chest computed tomography revealed a saccular aneurysm in the aortic arch with surrounding hematoma; thus, a ruptured thoracic aortic aneurysm was suspected. Emergency surgery was performed, which revealed a ruptured aortic aneurysm with extensive local inflammation. The diagnosis of an infected aortic rupture was therefore confirmed. The aneurysm and abscess were resected, followed by prosthetic graft replacement and omental packing. Histopathology of the resected aneurysm revealed gram-positive bacilli; and Listeria monocytogenes was confirmed as the causative organism by culture. Postoperative course was uneventful; on postoperative day 60, the patient was ambulatory and was discharged. Here we report the case of a male with a ruptured thoracic aortic aneurysm infected with L. monocytogenes.

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