AORTIC GRAFT INFECTION: A HYBRID AND STAGED SOLUTION
Introduction: Aortic graft infection (AGI) is a life-threatening condition and a therapeutic challenge for vascular surgeons. We report a case of a complex AGI managed by a hybrid and staged strategy. Methods: Data related to the present case report were collected from hospital medical records. R...
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| Format: | Article |
| Language: | Portuguese |
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Sociedade Portuguesa de Angiologia e Cirurgia Vascular
2019-10-01
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| Series: | Angiologia e Cirurgia Vascular |
| Subjects: | |
| Online Access: | https://acvjournal.com/index.php/acv/article/view/249 |
| _version_ | 1797951933901701120 |
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| author | Tony R. Soares Pedro Amorim Viviana Manuel Carlos Martins Pedro Martins Luís Mendes Pedro |
| author_facet | Tony R. Soares Pedro Amorim Viviana Manuel Carlos Martins Pedro Martins Luís Mendes Pedro |
| author_sort | Tony R. Soares |
| collection | DOAJ |
| description |
Introduction: Aortic graft infection (AGI) is a life-threatening condition and a therapeutic challenge for vascular surgeons. We report a case of a complex AGI managed by a hybrid and staged strategy.
Methods: Data related to the present case report were collected from hospital medical records.
Results: A 51-year-old male patient, submitted 5 years ago to prosthetic aorto-bifemoral and superior mesenteric artery (SMA) bypass to treat aorto-iliac and visceral occlusive disease and a recent history of a right femoral anastomotic pseudoaneurysm managed by open surgery, was admitted to our emergency room with a left femoral anastomotic pseudoaneurysm and inflammatory signs on the right groin. The diagnostic workup (angio-CT and PET-Scan) strongly suggested infection of the aorto-bifemoral graft.
A three-stage hybrid approach was then planned. In the first step, a left axillofemoral PTFE bypass was performed avoiding the infected area with ligation of the infected limb graft of the aorto-bifemoral bypass. Two weeks later, the patient was submitted to a successful endovascular recanalization of the SMA with implantation of a self-expandable bare metal stent, followed by a right axillofemoral PTFE bypass and ligation of the infected limb graft. One week later, the final stage included the exclusion of the proximal anastomosis of the visceral bypass with a covered stent in the SMA and a laparotomy for complete excision of the intrabdominal infected grafts with subsequent aortic ligation. The patient was discharged on the next three weeks on oral antimicrobial therapy. The post-op CT scan confirmed the patency of the SMA recanalization, both renal arteries, as well as the extra-anatomic bypasses to the lower limbs, with apparent resolution of the abdominal infection.
Conclusion: The reported case is very unusual and represents a challenge due to the presence of a SMA bypass associated to the AGI. Endovascular recanalization of the SMA occlusion made possible the total excision of the infected abdominal grafts.
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| first_indexed | 2024-04-10T22:38:25Z |
| format | Article |
| id | doaj.art-709f51df486c4387b526e8f869a6f113 |
| institution | Directory Open Access Journal |
| issn | 1646-706X 2183-0096 |
| language | Portuguese |
| last_indexed | 2024-04-10T22:38:25Z |
| publishDate | 2019-10-01 |
| publisher | Sociedade Portuguesa de Angiologia e Cirurgia Vascular |
| record_format | Article |
| series | Angiologia e Cirurgia Vascular |
| spelling | doaj.art-709f51df486c4387b526e8f869a6f1132023-01-16T09:12:07ZporSociedade Portuguesa de Angiologia e Cirurgia VascularAngiologia e Cirurgia Vascular1646-706X2183-00962019-10-0115210.48750/acv.249AORTIC GRAFT INFECTION: A HYBRID AND STAGED SOLUTIONTony R. Soares0Pedro Amorim1Viviana Manuel2Carlos Martins3Pedro Martins4Luís Mendes Pedro5Department of Vascular Surgery, Hospital Santa Maria, Lisbon, Portugal; Lisbon Academic Medical Centre, Lisbon, PortugalDepartment of Vascular Surgery, Hospital Santa Maria, Lisbon, Portugal; Lisbon Academic Medical Centre, Lisbon, PortugalDepartment of Vascular Surgery, Hospital Santa Maria, Lisbon, Portugal; Lisbon Academic Medical Centre, Lisbon, PortugalDepartment of Vascular Surgery, Hospital Santa Maria, Lisbon, Portugal; Lisbon Academic Medical Centre, Lisbon, PortugalDepartment of Vascular Surgery, Hospital Santa Maria, Lisbon, Portugal; Lisbon Academic Medical Centre, Lisbon, PortugalDepartment of Vascular Surgery, Hospital Santa Maria, Lisbon, Portugal; Lisbon Academic Medical Centre, Lisbon, Portugal; University of Lisbon, Lisbon, Portugal Introduction: Aortic graft infection (AGI) is a life-threatening condition and a therapeutic challenge for vascular surgeons. We report a case of a complex AGI managed by a hybrid and staged strategy. Methods: Data related to the present case report were collected from hospital medical records. Results: A 51-year-old male patient, submitted 5 years ago to prosthetic aorto-bifemoral and superior mesenteric artery (SMA) bypass to treat aorto-iliac and visceral occlusive disease and a recent history of a right femoral anastomotic pseudoaneurysm managed by open surgery, was admitted to our emergency room with a left femoral anastomotic pseudoaneurysm and inflammatory signs on the right groin. The diagnostic workup (angio-CT and PET-Scan) strongly suggested infection of the aorto-bifemoral graft. A three-stage hybrid approach was then planned. In the first step, a left axillofemoral PTFE bypass was performed avoiding the infected area with ligation of the infected limb graft of the aorto-bifemoral bypass. Two weeks later, the patient was submitted to a successful endovascular recanalization of the SMA with implantation of a self-expandable bare metal stent, followed by a right axillofemoral PTFE bypass and ligation of the infected limb graft. One week later, the final stage included the exclusion of the proximal anastomosis of the visceral bypass with a covered stent in the SMA and a laparotomy for complete excision of the intrabdominal infected grafts with subsequent aortic ligation. The patient was discharged on the next three weeks on oral antimicrobial therapy. The post-op CT scan confirmed the patency of the SMA recanalization, both renal arteries, as well as the extra-anatomic bypasses to the lower limbs, with apparent resolution of the abdominal infection. Conclusion: The reported case is very unusual and represents a challenge due to the presence of a SMA bypass associated to the AGI. Endovascular recanalization of the SMA occlusion made possible the total excision of the infected abdominal grafts. https://acvjournal.com/index.php/acv/article/view/249aortic graft infectionaorto-bifemoral bypassperipheral arterial diseasevisceral bypasshybrid surgery |
| spellingShingle | Tony R. Soares Pedro Amorim Viviana Manuel Carlos Martins Pedro Martins Luís Mendes Pedro AORTIC GRAFT INFECTION: A HYBRID AND STAGED SOLUTION Angiologia e Cirurgia Vascular aortic graft infection aorto-bifemoral bypass peripheral arterial disease visceral bypass hybrid surgery |
| title | AORTIC GRAFT INFECTION: A HYBRID AND STAGED SOLUTION |
| title_full | AORTIC GRAFT INFECTION: A HYBRID AND STAGED SOLUTION |
| title_fullStr | AORTIC GRAFT INFECTION: A HYBRID AND STAGED SOLUTION |
| title_full_unstemmed | AORTIC GRAFT INFECTION: A HYBRID AND STAGED SOLUTION |
| title_short | AORTIC GRAFT INFECTION: A HYBRID AND STAGED SOLUTION |
| title_sort | aortic graft infection a hybrid and staged solution |
| topic | aortic graft infection aorto-bifemoral bypass peripheral arterial disease visceral bypass hybrid surgery |
| url | https://acvjournal.com/index.php/acv/article/view/249 |
| work_keys_str_mv | AT tonyrsoares aorticgraftinfectionahybridandstagedsolution AT pedroamorim aorticgraftinfectionahybridandstagedsolution AT vivianamanuel aorticgraftinfectionahybridandstagedsolution AT carlosmartins aorticgraftinfectionahybridandstagedsolution AT pedromartins aorticgraftinfectionahybridandstagedsolution AT luismendespedro aorticgraftinfectionahybridandstagedsolution |