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Infected aortic grafts

Infected aortic grafts. Daniel f. neuzil. Infected aortic grafts . 1-6% incidence of prosthetic graft infection Groin is origin most often MRSA, S. epi , major bugs Risk factors – women, obesity, copd , operation longer than 4hrs. Infected aortic grafts .

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Infected aortic grafts

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  1. Infected aortic grafts Daniel f. neuzil

  2. Infected aortic grafts • 1-6% incidence of prosthetic graft infection • Groin is origin most often • MRSA, S. epi, major bugs • Risk factors – women, obesity, copd, operation longer than 4hrs

  3. Infected aortic grafts • MRSA infection associated with 50% amputation rate • Pseudomonas very aggressive(including autogenous tissue) • Antimicrobial therapy alone associated with increased mortality

  4. Infected aortic grafts • Diagnosis early graft infection: • Computarized tomography, clinical assessment, crp, esr

  5. Infected aortic grafts

  6. Infected aortic grafts

  7. Infected aortic grafts

  8. Infected aortic grafts

  9. Infected aortic grafts • Late graft infection diagnosis: • CTA, Tc, WBC, ESR, CRP, and clinical suspicion • Chronic cutaneous fistula • Pseudoaneurysm at anastamotic site • Gastrointestinal hemorrhage

  10. Infected aortic grafts

  11. Infected aortic grafts

  12. Infected aortic grafts • Treatment • Antibiotics 36-46 % mortality • Excise graft • Revascularize

  13. Infected aortic grafts • Extra-anatomic • Omental flap • Ax-fem 18% early and 32% late mortality • Thoraco-fem

  14. Infected aortic grafts • Anatomic • Homografts 25-30 % aneurysmal degeneration • Antibiotic impregnated grafts 4-22% reinfection, 50% 5yr mortality • Femoral vein - Claggett

  15. Infected aortic grafts • Femoral vein reconstruction (NAIS) neoaortoiliac system • 1997 • 30 day mortality less than 10% • 5 yr. patency 75-91% • Reinfection less than 2% • 5yr mortality 30-50%

  16. Infected aortic grafts • NAIS • 15 % chronic venous insufficiency • 2-7 % amputation rate • Minimal late aneurysmal change

  17. Infected aortic grafts • VMMC Experience • 11 infected aortic grafts • 2 infected native aortas • 3/11 infected aortic grafts were endoluminal grafts

  18. Infected aortic grafts

  19. Infected aortic grafts

  20. Infected aortic grafts

  21. Infected aortic grafts

  22. Infected aortic grafts NAIS for 11/12 1/12 had chronically occluded bilateral FV 11/12 replaced with FV 1/11 post-operative death various combinations of reconstruction depending on FV size and length

  23. Infected aortic grafts Dan Neuzil, M.D. Daniel.Neuzil@vmmc.org 206-290-8160

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