PERICARDIAL NEO-AORTA FOR RESOLUTION OF A VASCULAR CATASTROPHY. INNOVATIVE SOLUTION FOR AORTIC PROSTHETIC INFECTION.
DOI:
https://doi.org/10.48750/acv.161Keywords:
Aortic prosthetic infection, In-situ reconstruction, Bovine pericardiumAbstract
Introduction and Purpose: Aortic prosthetic graft infection is a rare but potentially fatal complication. Treatment require the complete excision of the prosthetic material, debridement of the surrounding tissues, broad-spectrum antibiotics, and limb revascularization which can be done through in situ reconstruction or by extra-anatomic solutions. The authors present a case of an in situ reconstruction with bovine pericardium graft.
Methods and Results: We report a case of a patient, previously submitted to a aortic-bifemoral bypass with Dacron prosthesis complicated of infection six years after and treated with complete excision and in-situ reconstruction with bifurcated Dacron silvergrat and antibiotics for life. One year after the patient develop bilateral pulsatile groin mass with inflammatory signs and fever. The computed tomography showed signs of prosthetic infection, aposition of D3 duodenal portion with the underlying prosthesis. The patient is submitted a total graft excision, fistulectomy with duodenojejunostomy and an in situ aortic reconstruction with a Y graft tailored from a self-made tube graft from bovine pericardium and endarterectomized superficial femoral arteries. The patient underwent a 45 days antibiotic regimen and it was discharged with an overall good condition.
Discussion and Conclusion: Patients with infectious aortic disease present in a frail state and with high risk of mortality and morbidity. Because of their off-the-shelf availability, handling properties, and freedom from reinfection and durability, self-made bovine pericardial grafts are an useful option in urgent reconstruction of vascular infections.
Downloads
References
treatment of prosthetic vascular graft infections: review of the literature
and proposals of a Working Group. Int J Antimicrob Agents 2015; 46:254-65.
2. O’Connor S, Andrew P, Batt M, Becquemin JP. A systematic review
and meta-analysis of treatments for aortic graft infection. J Vasc
Surg 2006; 44:38-45
3. Charlton-Ouw, K.M., Sandhu, H.K., Huang, G., Leake, S.S., Miller, C.C. 3rd,
Estrera, A.L. et al. Re-infection after resection and revascularization of
infected infrarenal abdominal aortic grafts. J Vasc Surg. 2014; 59: 684–692
4. Swain, T.W. 3rd, Calligaro, K.D., and Dougherty, M.D. Management of
infected aortic prosthetic grafts. Vasc Endovasc Surg. 2004; 38: 75–82
5. Dulbecco E, Camporrotondo M, Blanco G, Haberman D. In situ reconstruction
with bovine pericardial tubular graft for aortic graft infection.
Rev Bras Cir Cardiovasc 2010;25(2):249-52.
6. Aavik A, Lieberg J, Kals J, Pulges A, Kals M, Lepner U. Ten Years
Experience of Treating Aorto-Femoral Bypass Graft Infection
with Venous Allografts. Eur J Vasc Endovasc Surg 2008;36(4):432-7.
7. Dinis da Gama, A.; Rosa, A.; Soares, M. & Moura, C. (2004). Use of autologous
superficial femoral artery in surgery for aortic prosthesis infection. Annals
of Vascular Surgery, Vol.18, No.5, (Sep), pp. 593–596, ISSN 0890-5096
8. Leontyev S, Borger MA, Modi P, Lehmann S, Seeburger J, Doenst T, et al.
Surgical management of aortic root abscess: A 13-year experience in 172
patients with 100% follow up. J Thorac Cardiovasc Surg 2012;143(2):332-7.
9. McMillan W, Hile C, Leville C. Bovine Pericardial Patch Repair in
Infected Fields. J Vasc Surg 2011;54(5):1542.
10. Li X, Guo Y, Ziegler KR, Model LS, Eghbalieh SDD, Brenes RA, et al.
Current Usage and Future Directions for the Bovine Pericardial
Patch. Ann Surg 2011;25(4):561-8.
11. Li X, Guo Y, Ziegler KR, Model LS, Eghbalieh SD, Brenes RA, et al.
Current usage and future directions for the bovine pericardial patch.
Ann Vasc Surg 2011;25:561-8.
12. Czerny M, von Allmen R, Opfermann P, Sodeck G, Dick F, Stellmes A,
et al. Self-made pericardial tube graft: a new surgical concept for
treatment of graft infections after thoracic and abdominal aortic
procedures. Ann Thorac Surg 2011;92(5):1657-62.
