Vascular graft infections in open aortic surgery: who is at risk and how to treat? - a narrative review
Autor(a) principal: | |
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Data de Publicação: | 2022 |
Outros Autores: | , , , , , , |
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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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 |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-706X2022000400230 |
url |
http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-706X2022000400230 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-706X2022000400230 |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
text/html |
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 |
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Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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RCAAP |
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RCAAP |
reponame_str |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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