A Case of Placement of the Reversed Gore Exclucder Contralateral Leg for Isolated Left Iliac Mycotic Artery Aneurysm / 日本心臓血管外科学会雑誌

A 49-year-old female with ruptured left common iliac mycotic arterial aneurysm (Lt. CIAA) was brought to our hospital as an emergency case. In Japan, endovascular treatment is unsuitable for the treatment of mycotic aneurysms, but findings from a Swedish national database showed that there was no difference in the long-term prognosis lasting over 10 years. Therefore, we performed endovascular aortic repair (EVAR) and saved the patient's life. The diameter of the proxymal sealing zone was larger than that of the distal zone. We used the Gore Excluder leg, which was inverted and implanted to match the caliber. Percutaneous abscess drainage was also performed on postoperative day 7 when hemostasis was confirmed for early infection control. The patient was discharged at 8 weeks postoperatively. After discharge from the hospital, oral antibiotics were continued until 6 months after the surgery. Six months postoperatively, contrast-enhanced computed tomography showed that the abscesses have disappeared. Blood samples that were taken at one month after the completion of antibiotics showed no evidence of the recurrence of infection and a curative course was achieved.

Manejo exitoso de infección de injerto vascular: rol del 18 fluorodeoxyglucose positron emission tomography/computed tomography / Successful management of vascular graft infection: The role of 18fluorodeoxyglucose positron emission tomography/computed tomography

La opción de un injerto vascular es una medida correctiva para pacientes con enfermedad arterial periférica o aneurismas y para acceso arteriovenoso en pacientes con hemodiálisis crónica. A partir de la colocación de una prótesis de injerto vascular se puede desarrollar infección asociada en el 1-6% de los pacientes, con una alta incidencia de mortalidad del 13 al 58%. El diagnóstico de una infección asociada a injerto vascular se realiza a partir de hallazgos clínicos, microbiológicos e imagenológicos, para así definir, además de su presencia, su compromiso y extensión. El manejo ideal requiere de tratamiento quirúrgico y antibioticoterapia; sin embargo, el tratamiento quirúrgico no siempre es posible. Reportamos este caso de manejo médico exitoso de una infección de injerto vascular de aorta en la cual el 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) presentó utilidad como método diagnóstico y de seguimiento.

The option of a vascular graft is a corrective intervention for patients with peripheral artery disease, aneurisms, and to achieve arterio-venous access in patients on chronic hemodialysis. Infections from a prosthetic vascular graft occurs in 1 to 6% of patients, and this development is related to the incidence of mortality of 13 to 58%. The diagnosis of a vascular graft infection is made via the combination of clinical, microbiologic and imaging findings that allow a definition of not only the presence of infection but also its severity and spread. The ideal approach requires both surgical and antimicrobial therapy; however, the former is not always possible. We report a case of successful medical management of an aortic vascular graft infection and the usefulness of a 18F-fluorodeoxyglucose positron emission tomography/computedtomography (18F-FDG-PET/CT) scan as a tool for diagnosis and follow-up.

Clinical Evaluations of Prosthetic Vascular Graft Infection

Infection of a prosthetic vascular graft is a perilous complication, difficult to eradicate, and if not recognized or adequately treated eventually caused the prosthesis to malfunction, often with life- threatening hemorrhage. Authors retrospectively evaluated the 17 cases of prosthetic vascular graft infection to determine treatment modalities of graft infection from May 1983 to April 1997 at department of surgery, Yeungnam University Hospital. Aortic and peripheral vascular graft infection were 2 and 15 cases, and mortality rate were 50% and 13.3%, respectively. Amputation rate was 13.3% in peripheral vascular graft infection. Most of the patients had experienced symptoms and signs of infection, such as fever, leukocytosis, pus discharge, wound disruption and/or bleeding due to anastomotic disruption. The Most common pathogen was Staphylococcus aureus(12 cases) and others were Staphylococcus epidermidis(4 cases), Escherichia coli(1 cases). The most common site of infection was inguinal area(7 cases) that associated with repeated operation for thromboembolectomy. The diagnosis was made with Duplex ultrasonography, computed tomography and sinography. In one case of aorto-iliac bypass, graft-cutaneous fistula was found by sinography. Treament modalities were local antibiotic soaking dressing only (4 cases), rotational muscle flap(1 case), graft excision with revascularization(4 cases), and graft excision without revascularization(6 cases) in peripheral graft infection and aortic graft excision with extra-anatomic bypass graft(2 cases) in aortic graft infection with systemic antibiotic administration. In conclusion, prevention of vascular graft infection and early diagnosis of infection are very important. The time to infection after operation, infection sites, bacteological pathogens and general condition of patients are also important to select treatment modalities, such as local care only, muscle flap application, interposition graft, and removal of graft with or without revascularization.