PERICARDIUM BOVINE PATCH INFECTION AFTER AORTIC LIGATION — CLINICAL CASE
Autor(a) principal: | |
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Data de Publicação: | 2021 |
Outros Autores: | , , , , , , |
Tipo de documento: | Artigo |
Idioma: | por |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | https://doi.org/10.48750/acv.350 |
Resumo: | Introduction: Prosthetic graft infection is one of the most feared complications after aortic surgery (0,19% after conventional surgery and 0,16% after EVAR). Clinical case: Male patient, 53 years-old, with a prior history of hypertension, dyslipidemia, stroke, smoking habits, was submitted in 2015 to an aorto-bifemoral bypass for aortic occlusive disease. In October 2019 the angio CT showed signs of prosthetic graft infection and an aorto-enteric fistula. The patient was initiated on vancomycin and was submitted to an axillofemoral bypass and after 5 days, submitted to aortic ligation and correction of the enteric defect. The aortic stump was reinforced with a bovine pericardium patch. The graft microbiology identified Candida glabrata, Enterobacter cloacae e Klebsiella pneumoniae. Few months after, the follow-up angio CT showed an aortic stump collection suggesting infection and abscess formation and the authors proposed an aortic stump revision in order to remove the infected tissue. Via thoraco-phreno-laparotomy, the abdominal aorta was exposed by retroperioneal access, and all infected tissue including the pericardium patch was excised. The microbiology of the pericardium bovine patch resected revealed Candida glabrata and Enterococcus faecium. The patient was discharged with antibiotics and cautious follow-up. Conclusion: In patients with low profile surgical risk, an aggressive strategy may offer the best effective treatment chance for patients presenting with aortic prosthetic graft infection and pericardium bovine patch infection. Nevertheless, these patients require long term follow-up due to the risk of recurrence. Pericardium patches may infect if implanted in contaminated tissue, so autologous grafts should be the preference whenever possible. |
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PERICARDIUM BOVINE PATCH INFECTION AFTER AORTIC LIGATION — CLINICAL CASEINFEÇÃO DE PATCH DE PERICÁRDIO BOVINO DE LAQUEAÇÃO DE COTO AÓRTICO — UM CASO CLÍNICOAorto enteric fistulaPericardium bovine patchInfectionFístula aorto entéricaPatch pericárdio bovinoInfecçãoIntroduction: Prosthetic graft infection is one of the most feared complications after aortic surgery (0,19% after conventional surgery and 0,16% after EVAR). Clinical case: Male patient, 53 years-old, with a prior history of hypertension, dyslipidemia, stroke, smoking habits, was submitted in 2015 to an aorto-bifemoral bypass for aortic occlusive disease. In October 2019 the angio CT showed signs of prosthetic graft infection and an aorto-enteric fistula. The patient was initiated on vancomycin and was submitted to an axillofemoral bypass and after 5 days, submitted to aortic ligation and correction of the enteric defect. The aortic stump was reinforced with a bovine pericardium patch. The graft microbiology identified Candida glabrata, Enterobacter cloacae e Klebsiella pneumoniae. Few months after, the follow-up angio CT showed an aortic stump collection suggesting infection and abscess formation and the authors proposed an aortic stump revision in order to remove the infected tissue. Via thoraco-phreno-laparotomy, the abdominal aorta was exposed by retroperioneal access, and all infected tissue including the pericardium patch was excised. The microbiology of the pericardium bovine patch resected revealed Candida glabrata and Enterococcus faecium. The patient was discharged with antibiotics and cautious follow-up. Conclusion: In patients with low profile surgical risk, an aggressive strategy may offer the best effective treatment chance for patients presenting with aortic prosthetic graft infection and pericardium bovine patch infection. Nevertheless, these patients require long term follow-up due to the risk of recurrence. Pericardium patches may infect if implanted in contaminated tissue, so autologous grafts should be the preference whenever possible.Introdução: A infeção protésica é uma das complicações mais temidas da cirurgia aórtica (0,19% após cirurgia convencional e 0,16% após EVAR). Os autores relatam um caso raro de infeção secundária de patch de pericárdio bovino utilizado no reforço da laqueação de coto aórtico por explante de prótese aorto-bifemoral infectada. Caso clínico: Doente de 53 anos, com antecedentes de HTA, cardiopatia hipertensiva, hipercolesterolémia, ex fumador e status pós AVC, foi submetido em 2015 a bypass aorto-bifemoral com prótese de Dacron® por doença aorto-ilíaca oclusiva. Em outubro 2019 apresenta em angio TC sinais de infeção protésica e fistula aorto paraprotésica ABF — duodenal (D3). Iniciou AB dirigida com vancomicina e foi submetido a bypass axilo-bifemoral e, após 5 dias, a remoção de prótese de bypass aorto-bifemoral, laqueação de coto aórtico e secção do jejuno proximal. A microbiologia da prótese identificou Candida glabrata, Enterobacter cloacae e Klebsiella pneumoniae. Após alguns meses, em angio TC de seguimento foi detetada coleção com cerca de 38 x 34mm de dimensão, justa coto aórtico, cujas características sugeriam tratar-se de coleção infetada pelo que o doente foi submetido a drenagem e desbridamento cirúrgico por abordagem retroperitoneal através de tóraco-freno-laparotomia. Procedeu-se à excisão do tecido infectado, incluindo o pericárdio bovino usado como reforço da laqueação aórtica. A biópsia do patch identificou Candida glabrata e no líquido pericoto aórtico foi identificado, para além do acima referido, Enterococcus faecium. Conclusão: Em doentes com baixo perfil de risco, uma estratégia cirúrgica agressiva oferece as melhores hipóteses de tratamento eficaz em contexto de infeção de prótese aórtica e posteriormente de infeção de patch de coto aórtico. No entanto estes doentes carecem de vigilância a longo prazo dado o risco de reinfeção local. A utilização de pericárdio bovino em zona contaminada pode resultar na sua infeção secundária, pelo que devem ser privilegiados enxertos autólogos sempre que possível.Sociedade Portuguesa de Angiologia e Cirurgia Vascular2021-06-03T00:00:00Zinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttps://doi.org/10.48750/acv.350oai:ojs.acvjournal.com:article/350Angiologia e Cirurgia Vascular; Vol. 17 No. 1 (2021): March; 66-69Angiologia e Cirurgia Vascular; Vol. 17 N.º 1 (2021): Março; 66-692183-00961646-706Xreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAPporhttp://acvjournal.com/index.php/acv/article/view/350https://doi.org/10.48750/acv.350http://acvjournal.com/index.php/acv/article/view/350/238Copyright (c) 2021 Angiologia e Cirurgia Vascularinfo:eu-repo/semantics/openAccessCatarino, JoanaAlves, GonçaloGonçalves, FredericoQuintas, AnitaFerreira, RitaCorreia, RicardoBento, RitaFerreira, Maria Emília2022-05-23T15:10:11Zoai:ojs.acvjournal.com:article/350Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T14:57:42.364935Repositório 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 |
PERICARDIUM BOVINE PATCH INFECTION AFTER AORTIC LIGATION — CLINICAL CASE INFEÇÃO DE PATCH DE PERICÁRDIO BOVINO DE LAQUEAÇÃO DE COTO AÓRTICO — UM CASO CLÍNICO |
title |
PERICARDIUM BOVINE PATCH INFECTION AFTER AORTIC LIGATION — CLINICAL CASE |
spellingShingle |
PERICARDIUM BOVINE PATCH INFECTION AFTER AORTIC LIGATION — CLINICAL CASE Catarino, Joana Aorto enteric fistula Pericardium bovine patch Infection Fístula aorto entérica Patch pericárdio bovino Infecção |
title_short |
PERICARDIUM BOVINE PATCH INFECTION AFTER AORTIC LIGATION — CLINICAL CASE |
title_full |
PERICARDIUM BOVINE PATCH INFECTION AFTER AORTIC LIGATION — CLINICAL CASE |
title_fullStr |
PERICARDIUM BOVINE PATCH INFECTION AFTER AORTIC LIGATION — CLINICAL CASE |
title_full_unstemmed |
PERICARDIUM BOVINE PATCH INFECTION AFTER AORTIC LIGATION — CLINICAL CASE |
title_sort |
PERICARDIUM BOVINE PATCH INFECTION AFTER AORTIC LIGATION — CLINICAL CASE |
author |
Catarino, Joana |
author_facet |
Catarino, Joana Alves, Gonçalo Gonçalves, Frederico Quintas, Anita Ferreira, Rita Correia, Ricardo Bento, Rita Ferreira, Maria Emília |
author_role |
author |
author2 |
Alves, Gonçalo Gonçalves, Frederico Quintas, Anita Ferreira, Rita Correia, Ricardo Bento, Rita Ferreira, Maria Emília |
author2_role |
author author author author author author author |
dc.contributor.author.fl_str_mv |
Catarino, Joana Alves, Gonçalo Gonçalves, Frederico Quintas, Anita Ferreira, Rita Correia, Ricardo Bento, Rita Ferreira, Maria Emília |
dc.subject.por.fl_str_mv |
Aorto enteric fistula Pericardium bovine patch Infection Fístula aorto entérica Patch pericárdio bovino Infecção |
topic |
Aorto enteric fistula Pericardium bovine patch Infection Fístula aorto entérica Patch pericárdio bovino Infecção |
description |
Introduction: Prosthetic graft infection is one of the most feared complications after aortic surgery (0,19% after conventional surgery and 0,16% after EVAR). Clinical case: Male patient, 53 years-old, with a prior history of hypertension, dyslipidemia, stroke, smoking habits, was submitted in 2015 to an aorto-bifemoral bypass for aortic occlusive disease. In October 2019 the angio CT showed signs of prosthetic graft infection and an aorto-enteric fistula. The patient was initiated on vancomycin and was submitted to an axillofemoral bypass and after 5 days, submitted to aortic ligation and correction of the enteric defect. The aortic stump was reinforced with a bovine pericardium patch. The graft microbiology identified Candida glabrata, Enterobacter cloacae e Klebsiella pneumoniae. Few months after, the follow-up angio CT showed an aortic stump collection suggesting infection and abscess formation and the authors proposed an aortic stump revision in order to remove the infected tissue. Via thoraco-phreno-laparotomy, the abdominal aorta was exposed by retroperioneal access, and all infected tissue including the pericardium patch was excised. The microbiology of the pericardium bovine patch resected revealed Candida glabrata and Enterococcus faecium. The patient was discharged with antibiotics and cautious follow-up. Conclusion: In patients with low profile surgical risk, an aggressive strategy may offer the best effective treatment chance for patients presenting with aortic prosthetic graft infection and pericardium bovine patch infection. Nevertheless, these patients require long term follow-up due to the risk of recurrence. Pericardium patches may infect if implanted in contaminated tissue, so autologous grafts should be the preference whenever possible. |
publishDate |
2021 |
dc.date.none.fl_str_mv |
2021-06-03T00:00:00Z |
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 |
https://doi.org/10.48750/acv.350 oai:ojs.acvjournal.com:article/350 |
url |
https://doi.org/10.48750/acv.350 |
identifier_str_mv |
oai:ojs.acvjournal.com:article/350 |
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por |
language |
por |
dc.relation.none.fl_str_mv |
http://acvjournal.com/index.php/acv/article/view/350 https://doi.org/10.48750/acv.350 http://acvjournal.com/index.php/acv/article/view/350/238 |
dc.rights.driver.fl_str_mv |
Copyright (c) 2021 Angiologia e Cirurgia Vascular info:eu-repo/semantics/openAccess |
rights_invalid_str_mv |
Copyright (c) 2021 Angiologia e Cirurgia Vascular |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
application/pdf |
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; Vol. 17 No. 1 (2021): March; 66-69 Angiologia e Cirurgia Vascular; Vol. 17 N.º 1 (2021): Março; 66-69 2183-0096 1646-706X 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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RCAAP |
reponame_str |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
collection |
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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