0820_Vouyouka.pdf

1、INFECTED ENDOGRAFTS:MANAGEMENT KEYS AND PITFALLS Ageliki G.Vouyouka MD FACS RPVI Professor of Surgery and Radiology Mount Sinai Medical Center/Icahn School Of Medicine New York City NYIncidence 0.2%-8%(EVAR)Mortality 18%-88%47%gram positive cocci13%polymicrobialPathogenesis Multifactorial Early vs L

2、ateManagement demands multidisciplinary approach and logical planningDiagnosis might be challenging and thus delayedNo large multi-institutional studies AORTIC ENDOGRAFT INFECTION(AEI)A RARE BUT LIFE-THREATENING COMPLICATION OF ENDOVASCULAR AORTIC REPAIR 206 EVAR/REVARs 2004-2014RISK FACTORS A frequ

3、ent cause is an untreated preexisting infections Urinary Tract Infections Adjunctive procedures (embolization)Re-interventions Cardiac catheterizationDental procedures without antibiotic coverageOther surgeries postop without antibiotic coverageNo evidence that any endograft fabric is more prone to

4、infectionGraft infections more often with endografts than prosthetic grafts?DIAGNOSIS OF AORTIC GRAFT INFECTIONMAGIC CRITERIA 2016Lyons et al.(Eur J Vasc Endovasc Surg 2016;52:758-763 TREATMENT ALGORITHM FOR AORTIC ENDOGRAFT INFECTIONFOR GRAFT INFECTION WITH LARGE ABSCESS OR MULTI-RESISTANT MICRO-OR

5、GANISMS,EXTRA-ANATOMIC RECONSTRUCTION MAY BE CONSIDERED.REMOVAL OF THE ENDOGRAFT Initial supra-celiac control Do not pull suprarenal stents Do not leave behind fabric May incorporate the stents within the stump closure or anastomosis Reinforcement of the suture line:bovine patch omentum,muscle/fasci

6、a flap Ureteral stents Aggressive tissue debridement Control of enteric spillage LONG TERM SURVIVAL AFTER SURGICAL TREATMENT30 d mortality 11%30 d morbidity 35%Long term Survival worse:Prosthetic graftsTEVAR infectionGram negativesPolymicrobial infectionsAorto