초록접수 현황
| 14F-184 | 포럼 발표 |
The Management of Endograft Infections Following Endovascular Thoracic and Abdominal Aneurysm Repair
Do Jung Kim, Nam Young Youn, Hyun Chel Joo
Department of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Korea
Background : Recently endovascular aortic aneurysm repair has evolved into a widely accepted treatment modality. Graft infection following endovascular aortic aneurysm repair has scarcely been reported and so far appears to be confined to single cases. The objective of this study was to describe the incidence of endograft infection after endovascular repair of abdominal (EVAR) and thoracic aortic aneurysm (TEVAR) and to report treatment options and their outcome.
Methods : A retrospective cohort study was performed of patients endovascularly operated for abdominal and thoracic aortic aneurysm between March 2010 and June 2014. Diagnosis of infected endograft was made based on clinical findings, blood tests and cultures, imaging studies, and intraoperative findings at reoperation.
Results : Seven patients with an infected endograft were identified in endovascular procedure (TEVAR- 3, EVAR- 4). The median time from initial TEVAR/EVAR to diagnosis of infection was 6 months (range 3-13 months). All patients were initially treated with antibiotic therapy and surgical open conversions were done in five patients. In two patients, conservative management was done. Isolated microorganisms included coagulase-negative Staphylococcus (n=1), Enterobacter aerogenes (n= 1), Escherichia coli (n= 1), Candida (n= 1) and unknown (n=3). Surgical mortality was 0 %. One who was waiting for surgery was died of cerebral hemorrhage. The remaining six patients survived to discharge. Median time of follow-up was 25 months (range 3-48 months). At their last follow-up visit, three of patients still used antimicrobial therapy.
Conclusion : This report emphasizes the need for continued awareness of potential graft-related septic complications in patients undergoing endovascular aortic repair. Several surgical treatment options are available and can be performed successfully with encouraging results.
Methods : A retrospective cohort study was performed of patients endovascularly operated for abdominal and thoracic aortic aneurysm between March 2010 and June 2014. Diagnosis of infected endograft was made based on clinical findings, blood tests and cultures, imaging studies, and intraoperative findings at reoperation.
Results : Seven patients with an infected endograft were identified in endovascular procedure (TEVAR- 3, EVAR- 4). The median time from initial TEVAR/EVAR to diagnosis of infection was 6 months (range 3-13 months). All patients were initially treated with antibiotic therapy and surgical open conversions were done in five patients. In two patients, conservative management was done. Isolated microorganisms included coagulase-negative Staphylococcus (n=1), Enterobacter aerogenes (n= 1), Escherichia coli (n= 1), Candida (n= 1) and unknown (n=3). Surgical mortality was 0 %. One who was waiting for surgery was died of cerebral hemorrhage. The remaining six patients survived to discharge. Median time of follow-up was 25 months (range 3-48 months). At their last follow-up visit, three of patients still used antimicrobial therapy.
Conclusion : This report emphasizes the need for continued awareness of potential graft-related septic complications in patients undergoing endovascular aortic repair. Several surgical treatment options are available and can be performed successfully with encouraging results.
책임저자: 주현철
연세대학교 의과대학 심장혈관병원 흉부외과학교실
연락처 : 김도정, Tel: 02-2227-2821 , E-mail : phalcorpse@yuhs.ac
