Unclear Reason of Recurrent Graft Infections after Aortobifemoral Reconstruction

BACKGROUND: Aortic graft infection is one of the most serious complications of vascular reconstruction with the incidence of 1%. The clinical presentation can vary, which delays the diagnosis. CASE REPORTS: Infections in our patients affected iliac, inguinal region, and retroperitoneum, which are not relatively common sites of graft infection. We present clinical presentation, imaging procedures, and surgical treatment of three patients with unknown cause of late graft infection after 6, 7, and 9 years. CONCLUSION: In our presentations, the etiological factors of the infection are not known, but they suggest that events in the gastrointestinal tract may be related to them. Aggressive surgery should be taken into consideration as a first choice in the similar cases.

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Surgical Treatment of the Infected Aortic Graft

10.2310/vasc.3057 ◽

2017 ◽

Author(s):

Jayer Chung

Keyword(s):

Preoperative Evaluation ◽

Graft Infection ◽

Prosthetic Graft ◽

Vascular Reconstruction ◽

Graft Material ◽

Aortic Graft ◽

Operative Planning ◽

Femoral Vessels ◽

Aortic Graft Infection ◽

Autogenous Reconstruction

The primary goal of treatment in dealing with an infected aortic graft is to save life and limb. This goal is best accomplished by eradicating all infected graft material and maintaining adequate circulation with appropriate vascular reconstruction. This review describes the choice of procedures, including an extra-anatomic bypass, an aortic allograft, an antibiotic-treated prosthetic graft, and an in situ autogenous reconstruction. Once a procedure has been decided on, preoperative evaluation and operative planning must take place. The review describes operative technique from the thigh incision and exposure of the femoral vessels to closure. Postoperative care is described. Outcomes and complications are discussed. Special consideration is given to aortoenteric fistulas. This review contains 8 figures, 2 tables, and 83 references. Key words: antibiotic-impregnated Dacron, aortic graft infection, aortoenteric erosion, aortoenteric fistula, axillobifemoral bypass, cryopreserved allograft, neoaortoiliac surgery

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Branched Endovascular Aortic Plug in Patients With Infrarenal Aortic Graft Infection and Hostile Anatomy

Journal of Endovascular Therapy ◽

10.1177/1526602819900988 ◽

2020 ◽

Vol 27 (2) ◽

pp. 328-333

Author(s):

Hamid Gavali ◽

Kevin Mani ◽

Mia Furebring ◽

John Mogensen ◽

Anders Wanhainen

Keyword(s):

Abdominal Aorta ◽

Case Reports ◽

Graft Infection ◽

Aortic Graft ◽

Compassionate Use ◽

Custom Made ◽

Aortic Graft Infection ◽

Male Patients ◽

Axillobifemoral Bypass

Purpose: To present a novel 4-branched endovascular aortic plug (BEVAP) for treatment of patients with infrarenal aortic graft infection. Case Reports: Two polymorbid male patients with aortic graft infections and an unsuturable diseased paravisceral aorta were treated under compassionate use with a custom-made stent-graft. The BEVAP is a factory-modified Zenith t-Branch thoracoabdominal endovascular graft with the distal tubular main graft portion removed, creating an aortic plug that excludes the abdominal aorta while maintaining perfusion to the visceral organs. The BEVAP device is deployed using a femoral approach, and the branches are accessed through an axillary approach. A standard axillobifemoral bypass is created to perfuse the lower body. One to 2 days later, the infected infrarenal graft is resected without the need of aortic clamping or closure of the aortic stump. The BEVAP device in these 2 cases resulted in thrombosis of the abdominal aorta and the infected graft prior to explantation. Conclusion: Using the BEVAP enables radical treatment of selected patients with hostile anatomy and infrarenal aortic graft infections who have an aneurysmal paravisceral aortic segment that prevents traditional radical surgical treatment with in situ reconstruction or extra-anatomical bypass.

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