Original Article
Surgical treatment strategy for endograft infection after thoracic endovascular aortic repair
Tang Yangfeng, Han Lin, Fan Xingli, Zhang Boyao, Zhang Jiajun, Xue Qing, Xu Zhiyun
Published 2019-11-01
Cite as Chin J Surg, 2019,57(11): 848-852. DOI: 10.3760/cma.j.issn.0529-5815.2019.11.010
Abstract
ObjectiveTo examine the results of surgical treatment for endograft infection after thoracic endovascular aortic repair (TEAVR).
MethodsClinical data of 7 patients underwent surgical treatment for endograft infection after TEAVR at Department of Cardiothoracic Surgery, Changhai Hospital, the Navy Medical University between January 2016 and December 2018 were analyzed retrospectively. There were 6 males and 1 female, aging (51.5±16.7) years (range: 25 to 68 years). The origin of the aortic disease was descending aortic aneurysm in 5 cases, and Stanford B aortic dissection in 2 cases. Abdominal aorta below the level of the diaphragm was not involved in all patients. Two patients received "chimney technology" for left subclavian artery procedures. Time to infection was 5(3) months (M(QR)) (range: 1 to 24 months). Aortic endograft infection was diagnosed with a combination of microbiology (positive blood cultures, except one with mycotic), radiological evidence and clinical evidence of sepsis. Two patients suffered from aorto-esophageal fistula received emergency surgery, others were treated with elective surgery. Extra-anatomic prosthetic graft bypass was used for reconstruction of aorta, infected endogarft and aorta was removed, sac drainage was performed. Aorto-esophageal fistula was procedured according to the degree of lesions. All patients received antibiotics with specialist advice for 6 to 8 weeks.
ResultsOne patient died due to septic shock. In the follow-time (range: 6 to 24 months), 1 patient suffered from thoracic infection in 3 months after surgery, an other patient got iliac abscess after a month.
ConclusionsEndograft infection after TEAVR is high risk but may be curative. Appropriate selection of patients for infected endograft explantation could get a satisfied results.
Key words:
Aneurysm, dissecting; Infection; Prostheses and implants
Contributor Information
Tang Yangfeng
Department of Cardiothoracic Surgery, Changhai Hospital, the Navy Medical University, Shanghai 200433, China
Han Lin
Department of Cardiothoracic Surgery, Changhai Hospital, the Navy Medical University, Shanghai 200433, China
Fan Xingli
Department of Cardiothoracic Surgery, Changhai Hospital, the Navy Medical University, Shanghai 200433, China
Zhang Boyao
Department of Cardiothoracic Surgery, Changhai Hospital, the Navy Medical University, Shanghai 200433, China
Zhang Jiajun
Department of Cardiothoracic Surgery, Changhai Hospital, the Navy Medical University, Shanghai 200433, China
Xue Qing
Department of Cardiothoracic Surgery, Changhai Hospital, the Navy Medical University, Shanghai 200433, China
Xu Zhiyun
Department of Cardiothoracic Surgery, Changhai Hospital, the Navy Medical University, Shanghai 200433, China