Self-Made Pericardial Tube Graft: A New Surgical Concept for Treatment of Graft Infections After Thoracic and Abdominal Aortic Procedures

摘要

PatientsDiagnostic AlgorithmTreatment AlgorithmPreparation of Neoaortic SegmentsAntibiotic Treatment AlgorithmData Collection and Follow-Up ProtocolStatistical MethodsResultsIn-Hospital MortalityPrevious Aortic Operations and Estimated Infection Entry SitesTime Point of Infection and Microbiological FindingsReconstructive Surgical ProceduresAdditional ProceduresFollow-UpCommentLimitations and Strengths of the StudyReferencesThe aim of this study was to evaluate a new surgical concept for the treatment of graft infections after operation or endovascular treatment of thoracic, thoracoabdominal, and abdominal aortic diseases.MethodsBetween 2004 and 2011, 15 patients (mean age 72 ± 10 years, 87% men) with prosthetic graft or endovascular graft infection were treated with complete removal of the infected prosthetic material, extensive debridement of the surrounding tissues, and orthotopic vascular reconstruction with self-made xenopericardial tube grafts constructed from a patch. Perioperative and long-term outcomes were evaluated.ResultsPerioperative mortality was 27% (n = 4). All deaths were due to multiorgan failure resulting from uncontrolled septicemia from the local infectious process. Mean observational follow-up was 24 months (5 to 83 months). Control computed tomographic scans showed normal findings at the operative site in all patients. Antibiotic treatment was continued for a mean of 6 months. Freedom from reinfection was 100%. Freedom from reoperation was also 100%.ConclusionsTreatment of graft infections after operation or endovascular treatment of thoracic, thoracoabdominal, and abdominal aortic diseases by complete removal of the infected prosthetic material and extensive debridement as well as orthotopic vascular reconstruction using self-made xenopericardial tube grafts as neoaortic segments provides excellent results with regard to durability and freedom from reinfection and reoperation. This new concept is an additional alternative to cryopreserved homografts that extends the armamentarium for treating patients with these highly complex conditions.CTSNet classification:26Treatment of graft infections after operation or endovascular treatment of thoracic, thoracoabdominal, and abdominal aortic diseases remains an insufficiently explored topic. Therapeutic options are limited, surgical procedures are most frequently complex, and outcome is variable [