Document Detail


Retroperitoneal in-line aortic bypass for treatment of infected infrarenal aortic grafts.
MedLine Citation:
PMID:  1448729     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Since 1970, we have treated 43 patients with infected aortic grafts. Early in the series, four patients were treated with resection of the fistula or erosion and systemic and topical antibiotics without removal of the graft. All four patients died. Thirty-two patients were treated by conventional therapy; there were 13 deaths (40 percent). More recently, seven patients were managed by the left retroperitoneal placement of a new in-line polytetrafluoroethylene (PTFE) aortic graft through clean tissue planes, followed by the immediate transperitoneal removal of the infected graft without cross-contamination. Patients were maintained postoperatively on antibiotics for a minimum of two weeks. All seven patients survived without septic complications, with a mean follow-up time of 36 months (six months to four years). The surgical technique consists of initial suprarenal control of the aorta, followed by infrarenal division and oversewing of the distal aorta. A PTFE bifurcation graft is placed connecting the proximal aorta and the appropriate femoral vessels, the right limb tunneled through the space of Retzius. After closure of the incisions, through the space of Retzius. After closure of the incisions, the patient is placed in the supine position and the infected graft is removed transperitoneally. We believe that retroperitoneal in-line aortic bypass for treatment of an infected aortic graft offers a favorable alternative to conventional therapy by avoiding the use of an extra-anatomic bypass and associated risk of stump blowout.
Authors:
R P Leather; R C Darling; B B Chang; D M Shah
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Surgery, gynecology & obstetrics     Volume:  175     ISSN:  0039-6087     ISO Abbreviation:  Surg Gynecol Obstet     Publication Date:  1992 Dec 
Date Detail:
Created Date:  1992-12-24     Completed Date:  1992-12-24     Revised Date:  2009-11-11    
Medline Journal Info:
Nlm Unique ID:  0101370     Medline TA:  Surg Gynecol Obstet     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  491-4     Citation Subset:  AIM; IM    
Affiliation:
Vascular Surgery Section, Albany Medical College, New York 12208.
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MeSH Terms
Descriptor/Qualifier:
Anti-Bacterial Agents / administration & dosage,  therapeutic use
Aortic Diseases / surgery*
Blood Vessel Prosthesis / adverse effects*,  standards
Combined Modality Therapy
Follow-Up Studies
Hospital Mortality
Hospitals, University
Humans
New York / epidemiology
Polytetrafluoroethylene / therapeutic use*
Prosthesis-Related Infections / etiology,  mortality,  surgery*
Reoperation / methods*,  standards
Survival Rate
Chemical
Reg. No./Substance:
0/Anti-Bacterial Agents; 9002-84-0/Polytetrafluoroethylene

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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