Vascular graft infections in open aortic surgery: who is at risk and how to treat? - a narrative review

Detalhes bibliográficos
Autor(a) principal: Duarte,António
Data de Publicação: 2022
Outros Autores: Pedro,Diogo Mendes, Melo,Ryan Gouveia e, Martins,Beatriz, Santos,Carla Mimoso, Sobrinho,Gonçalo, Fernandes,Ruy Fernandes e, Pedro,Luís Mendes
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
Texto Completo: http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-706X2022000400230
Resumo: Abstract Introduction: Vascular graft infections are a rare and severe complication of open aortic surgery. As such, strategies to improve diagnosis and management are paramount. Nevertheless, there is little evidence regarding the factors associated with a higher susceptibility of infection. Moreover, there is little consensus on the best diagnostic workup and most adequate approaches to control and mitigate this surgical complication. We aim to summarize the latest evidence on aortic graft infection through a narrative review. Methods: We conducted a literature search in a medical database (PubMed) and included studies on vascular graft infection and aortic repair. Results: So far, patient-related comorbidities (such as diabetes, smoking, advanced age and chronic kidney disease), as well as procedure-related factors (location and type of graft, postoperative hyperglycemia, bacteremia, emergency setting), have been reported. Unlike extracavitary infections, aortic graft infections may present with subtle or no clinical manifestations. Aortoenteric fistulas are the exception to the rule, carrying a significantly higher mortality rate. All patients should be thoroughly tested with full blood counts, blood cultures and extensive imaging studies. Adequate antibiotic therapy is one of the pillars of treatment and should not be delayed. The selection of the antimicrobial regimen should be personalized and made in a multidisciplinary team. Surgical strategies are of paramount importance in controlling infection. These can be divided into graft-sparing techniques and graft explantation. The choice of the appropriate approach depends on the surgeon’s experience, the extent of disease and the patient’s general status and comorbidities. Conclusion: Aortic graft infections are a rare and severe complication of vascular surgery. A swift diagnosis and management are paramount. Despite significant efforts on how to treat the infection with more adequate antibiotic and surgical therapies, effective preventive measures and a clear definition of predisposing factors remain the main areas for future studies.
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spelling Vascular graft infections in open aortic surgery: who is at risk and how to treat? - a narrative reviewAortic surgeryvascular graftgraft infectionaortoenteric fistulAbstract Introduction: Vascular graft infections are a rare and severe complication of open aortic surgery. As such, strategies to improve diagnosis and management are paramount. Nevertheless, there is little evidence regarding the factors associated with a higher susceptibility of infection. Moreover, there is little consensus on the best diagnostic workup and most adequate approaches to control and mitigate this surgical complication. We aim to summarize the latest evidence on aortic graft infection through a narrative review. Methods: We conducted a literature search in a medical database (PubMed) and included studies on vascular graft infection and aortic repair. Results: So far, patient-related comorbidities (such as diabetes, smoking, advanced age and chronic kidney disease), as well as procedure-related factors (location and type of graft, postoperative hyperglycemia, bacteremia, emergency setting), have been reported. Unlike extracavitary infections, aortic graft infections may present with subtle or no clinical manifestations. Aortoenteric fistulas are the exception to the rule, carrying a significantly higher mortality rate. All patients should be thoroughly tested with full blood counts, blood cultures and extensive imaging studies. Adequate antibiotic therapy is one of the pillars of treatment and should not be delayed. The selection of the antimicrobial regimen should be personalized and made in a multidisciplinary team. Surgical strategies are of paramount importance in controlling infection. These can be divided into graft-sparing techniques and graft explantation. The choice of the appropriate approach depends on the surgeon’s experience, the extent of disease and the patient’s general status and comorbidities. Conclusion: Aortic graft infections are a rare and severe complication of vascular surgery. A swift diagnosis and management are paramount. Despite significant efforts on how to treat the infection with more adequate antibiotic and surgical therapies, effective preventive measures and a clear definition of predisposing factors remain the main areas for future studies.Sociedade Portuguesa de Angiologia e Cirurgia Vascular2022-12-01info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articletext/htmlhttp://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-706X2022000400230Angiologia e Cirurgia Vascular v.18 n.4 2022reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAPenghttp://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-706X2022000400230Duarte,AntónioPedro,Diogo MendesMelo,Ryan Gouveia eMartins,BeatrizSantos,Carla MimosoSobrinho,GonçaloFernandes,Ruy Fernandes ePedro,Luís Mendesinfo:eu-repo/semantics/openAccess2024-02-06T17:23:07Zoai:scielo:S1646-706X2022000400230Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-20T02:29:32.209200Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse
dc.title.none.fl_str_mv Vascular graft infections in open aortic surgery: who is at risk and how to treat? - a narrative review
title Vascular graft infections in open aortic surgery: who is at risk and how to treat? - a narrative review
spellingShingle Vascular graft infections in open aortic surgery: who is at risk and how to treat? - a narrative review
Duarte,António
Aortic surgery
vascular graft
graft infection
aortoenteric fistul
title_short Vascular graft infections in open aortic surgery: who is at risk and how to treat? - a narrative review
title_full Vascular graft infections in open aortic surgery: who is at risk and how to treat? - a narrative review
title_fullStr Vascular graft infections in open aortic surgery: who is at risk and how to treat? - a narrative review
title_full_unstemmed Vascular graft infections in open aortic surgery: who is at risk and how to treat? - a narrative review
title_sort Vascular graft infections in open aortic surgery: who is at risk and how to treat? - a narrative review
author Duarte,António
author_facet Duarte,António
Pedro,Diogo Mendes
Melo,Ryan Gouveia e
Martins,Beatriz
Santos,Carla Mimoso
Sobrinho,Gonçalo
Fernandes,Ruy Fernandes e
Pedro,Luís Mendes
author_role author
author2 Pedro,Diogo Mendes
Melo,Ryan Gouveia e
Martins,Beatriz
Santos,Carla Mimoso
Sobrinho,Gonçalo
Fernandes,Ruy Fernandes e
Pedro,Luís Mendes
author2_role author
author
author
author
author
author
author
dc.contributor.author.fl_str_mv Duarte,António
Pedro,Diogo Mendes
Melo,Ryan Gouveia e
Martins,Beatriz
Santos,Carla Mimoso
Sobrinho,Gonçalo
Fernandes,Ruy Fernandes e
Pedro,Luís Mendes
dc.subject.por.fl_str_mv Aortic surgery
vascular graft
graft infection
aortoenteric fistul
topic Aortic surgery
vascular graft
graft infection
aortoenteric fistul
description Abstract Introduction: Vascular graft infections are a rare and severe complication of open aortic surgery. As such, strategies to improve diagnosis and management are paramount. Nevertheless, there is little evidence regarding the factors associated with a higher susceptibility of infection. Moreover, there is little consensus on the best diagnostic workup and most adequate approaches to control and mitigate this surgical complication. We aim to summarize the latest evidence on aortic graft infection through a narrative review. Methods: We conducted a literature search in a medical database (PubMed) and included studies on vascular graft infection and aortic repair. Results: So far, patient-related comorbidities (such as diabetes, smoking, advanced age and chronic kidney disease), as well as procedure-related factors (location and type of graft, postoperative hyperglycemia, bacteremia, emergency setting), have been reported. Unlike extracavitary infections, aortic graft infections may present with subtle or no clinical manifestations. Aortoenteric fistulas are the exception to the rule, carrying a significantly higher mortality rate. All patients should be thoroughly tested with full blood counts, blood cultures and extensive imaging studies. Adequate antibiotic therapy is one of the pillars of treatment and should not be delayed. The selection of the antimicrobial regimen should be personalized and made in a multidisciplinary team. Surgical strategies are of paramount importance in controlling infection. These can be divided into graft-sparing techniques and graft explantation. The choice of the appropriate approach depends on the surgeon’s experience, the extent of disease and the patient’s general status and comorbidities. Conclusion: Aortic graft infections are a rare and severe complication of vascular surgery. A swift diagnosis and management are paramount. Despite significant efforts on how to treat the infection with more adequate antibiotic and surgical therapies, effective preventive measures and a clear definition of predisposing factors remain the main areas for future studies.
publishDate 2022
dc.date.none.fl_str_mv 2022-12-01
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dc.publisher.none.fl_str_mv Sociedade Portuguesa de Angiologia e Cirurgia Vascular
publisher.none.fl_str_mv Sociedade Portuguesa de Angiologia e Cirurgia Vascular
dc.source.none.fl_str_mv Angiologia e Cirurgia Vascular v.18 n.4 2022
reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação
instacron:RCAAP
instname_str Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação
instacron_str RCAAP
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reponame_str Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
collection Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
repository.name.fl_str_mv Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação
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