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. 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.
Main Authors: | Soares,Tony R., Amorim,Pedro, Manuel,Viviana, Martins,Carlos, Martins,Pedro, Pedro,Luís Mendes |
---|---|
Format: | Digital revista |
Language: | English |
Published: |
Sociedade Portuguesa de Angiologia e Cirurgia Vascular
2019
|
Online Access: | http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-706X2019000200009 |
Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
Similar Items
-
A hybrid solution to manage a thoracoabdominal aortic aneurysm: the simplified technique associated to endografting of the proximal aortic anastomosis
by: Soares,Tony R., et al.
Published: (2019) -
Two-stage Omental Flap Approach for Ascending Aortic Graft Infection
by: Andrade,Darío, et al.
Published: (2020) -
Vascular graft infections in open aortic surgery: who is at risk and how to treat? - a narrative review
by: Duarte,António, et al.
Published: (2022) -
Aortic reconstruction with bovine pericardial grafts
by: Silveira,Lindemberg Mota, et al.
Published: (2003) -
Autopsy image following aortic arch parallel grafting of a ruptured aortic aneurysm
by: Melo,Ryan Gouveia e, et al.
Published: (2022)