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The Journal of Cardiovascular Surgery 2020 Dec 10

DOI: 10.23736/S0021-9509.20.11702-6


lingua: Inglese

Update on graft infections in thoracoabdominal aortic aneurysm surgery

Wahaj MUNIR 1, Tillana N. TARKAS 1, Mohamad BASHIR 2 , Benjamin ADAMS 3

1 Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK; 2 Vascular Surgery Department, Royal Blackburn Teaching Hospital, Blackburn, UK; 3 Aortovascular Surgery, Barts Heart Centre, St.
Bartholomew’s Hospital, London, UK


The incidence of an aortic graft infection following the repair of thoracoabdominal aortic aneurysm, is a rare yet insidious complication which requires prompt recognition and management. The decision-making framework for management encompasses the choice or anti-microbial therapy alone versus pursuing surgical intervention, which can then also lead to considering the potential for allografts. The current literature on the matter is heavily burdened by limitations of the reported retrospective experiences consisting of small patient cohorts. Studies have reported the favored approach of surgical intervention, although statistical significance is not reached. There is a clear recognized impact that the event surrounding the initial repair has on the occurrence of graft infection itself; with emergency repairs, and incidence of nosocomial infection being associated with higher rates of graft infection. We must consider the influencers of this ominous complications, which go back to the perioperative events itself; whether the initial intervention was elective or an emergency, the impact of nosocomial infections, the choice of open versus endovascular for initial repair. Only with the appropriate management strategy that encompasses all these factors, will allow the best treatment to be provided for patients. A sound understanding and appreciation for the aforementioned can allow the stratification of the risk associated with the occurrence of an aortic graft infection, leading to surveillance opportunities to provide the crucial ability to rapidly recognize this complication.

KEY WORDS: Aorta; Outcomes; Aneurysm; Infections

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