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Background: Fungal prosthetic graft infections are associated with high mortality, typically requiring aggressive surgical debridement. We present an alternative, minimally invasive approach to address these challenging clinical cases.Case Presentation: A 76-year-old Caucasian male with prior aortic root and arch replacement presented with localized chest wall tenderness after being hit by a car door. Computed tomography angiogram incidentally identified fluid in the anterior mediastinum, surrounding his ascending aortic graft. Rather than undertaking a high-risk reoperative sternotomy and redo complex aortic reconstruction, we elected to proceed with a robotic-assisted, minimally invasive debridement of the aortic graft, coupled with an omental wrap, entirely within the closed chest. Microbiology was positive for Aspergillus species. The patient made an uncomplicated recovery and was discharged home on antifungal therapy, likely to continue indefinitely.Conclusions: Infected prosthetic aortic grafts can be successfully managed with debridement and pedicled omental flap coverage via a minimally invasive approach within the closed chest, obviating the morbidity of a complex reoperative open procedure. [ABSTRACT FROM AUTHOR]

Aortic diseases located in the ascending aorta, aortic arch or proximal descending aorta often require more than one surgical intervention depending on the type of pathology and its extent as well as future anticipated aortic problems. These obstacles were tackled in 1983 by Hans Borst with the introduction of the classic elephant trunk (cET). This was an outstanding and straightforward procedure. Since then, the cET was very often the first surgical approach for patients with extensive aortic pathology of the ascending aorta and arch extending into the downstream aorta. Thirteen years later, Suto and Kato introduced the frozen elephant trunk (fET) which was later on perfectionized by industry and applied in various ways by many surgical groups worldwide. Comparing the cET with the fET raises a lot of difficulties. The lack of randomization and the presence of procedural and complication-related limitations for each technique do not allow for definitive conclusions about the ideal procedure to treat complex aortic pathology. It would be very short-sighted to close all future discussions about the subject with this statement of the Hannover group made in 2011. Since both techniques and its results cannot be compared statistically due to the heterogeneity of patient groups, the lack of randomization, the difference in type and extent of pathology, the differences in surgical techniques, the learning curve in gaining experience in both techniques, and the lack of reporting standards, no scientific conclusion can be drawn as to which technique is most successful. Comparisons may even be considered futile. It is the purpose of this paper merely to make a descriptive observation of both techniques, to discuss some important elements of interest and to give some constructive and useful criticism. [ABSTRACT FROM AUTHOR]

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Purpose: To review the different outcomes of the endovascular repair of major abdominal arteriovenous fistulas (AVFs). Methods: An online systematic review of the literature was undertaken to identify all reported cases of endovascular repair of major AVFs, covering 9 major databases as well as relevant journals up to September 2013. Our own case was included. The primary outcome was technical success and mortality, the secondary outcome was the rate of complications and the operators’ recommendations. Results: Forty-eight articles were reviewed totaling a number of 54 patients including our own. The most common fistula site was the aortocaval segment. Aortic stent grafts were used in 78% of patients. Technical success was 94%. Intraoperative mortality was 0% with a 90-day mortality of 10%, half of which were not related to the primary pathology. Of the successful procedures, 12% of patients had major complications. One died before reintervention. All others had uneventful recoveries; 21% had minor complications treated conservatively. The majority of authors were in favor of this treatment modality. [ABSTRACT FROM AUTHOR]

Background Mortality associated with aortic graft infection is considerable. The gold standard for surgical treatment remains explantation of the graft. However, prognostic factors associated with early mortality due to this surgical procedure are not well-known. Methods Retrospective analysis of patients admitted in our center between January 2006 and October 2011 for aortic graft infection. The primary endpoint was in-hospital mortality. A bivariate analysis of characteristics of patients associated with in-hospital outcome was performed. Results Twenty five evaluable patients were studied. All patients were male. Their mean age was 67 ± 8.4 years. Most of them (92%) had severe underlying diseases. An in situ prosthetic graft replacement, mainly using cryopreserved arterial allografts, was performed in all patients, excepted one who underwent extra-anatomic bypass. Causative organisms were identified in 23 patients (92%). The in-hospital mortality rate was 48%. Among pre-operative characteristics, age ⩾ 70 years, creatinine ⩾ 12 mg/L and C reactive protein ⩾ 50 mg/L were significantly associated with in-hospital mortality. Hospital mortality rates increased with the number of risk factor present on ICU admission, and were 0%, 14.3%, 85.7% and 100% for 0, 1, 2 and 3 factors, respectively. The only intra-operative factor associated with prognosis was an associated intestinal procedure due to aorto-enteric fistula. SAPS II, SOFA score and occurrence of medical or surgical complications were postoperative characteristics associated with in-hospital mortality. Conclusion Morbidity and mortality associated with surgical approach of aortic graft infections are considerable. Age and values of creatinine and C Reactive protein on hospital admission appear as the most important determinant of in hospital mortality. They could be taken into account for guiding the surgical strategy. [ABSTRACT FROM AUTHOR]

Infections with are rare and are associated with contact with animals or animal products. Streptococcus equi zooepidemicus There are very few reports about infected vascular grafts or aneurysms with this etiology. We present two patients. The first is a 77-year-old man with an infected bifurcated graft four years after an open operation for an abdominal aortic aneurysm (AAA). The second is a 72-year-old man with a symptomatic mycotic AAA, treated with endovascular aneurysm repair. Both received prolonged treatment with bactericidal antibiotics and responded well. Follow-up time at present is 5.5 years for the first, and 4.5 years for the second, patient. [ABSTRACT FROM AUTHOR]

There remains no treatment for chronic allograft rejection mainly manifested by progressive arteriosclerosis. We investigated the effect of Allotrap peptide RDP58 therapy on arteriosclerosis in an aortic allotransplant model. RDP58 was administered intraperitoneally at 0.1, 0.5, or 2.5 mg/kg, every other day after transplantation. RDP58 therapy markedly inhibited vascular intimal thickening, media necrosis, and adventitial cellular inflammation. The attenuation of arteriosclerosis was associated with the induction of heme oxygenase (HO)-1 expression, inhibition of TNF-α production in aortic allografts, as well as decreased specific complement-dependent cytotoxic antibodies in serum. RDP58 inhibited both smooth muscle cell (SMC) proliferation with an 80% inhibition at 100 μM without evidence of cytotoxicity and TNF-induced apoptosis of SMCs in a dose-dependent fashion. These data suggest that the suppressive effect of RDP58 on allograft arteriosclerosis is due to multiple actions of the peptide, including induction of HO-1, inhibition of TNF-α, and a direct effect on SMC proliferation. [ABSTRACT FROM AUTHOR]

Reconstruction alternatives following removal of an infected aortic graft bear a high morbidity and mortality rate. Recent reports suggest that cryopreserved tissue may be implanted in infected fields and, therefore, may be suitable for replacement of infected aortic grafts. We report two cases of aortic replacement with cryopreserved allografts. Case 1: A 60-year-old woman presented with 6 months of right groin pain and a 30-1b. weight loss. She underwent aortobifemoral bypass in 1981 for occlusive disease, with revisions in 1983 and 1985. Computed tomography (CT) and indium-111 WBC scan suggested aortobifemoral graft infection. The aortobifemoral graft was removed and replaced with a cryopreserved aortoiliac allograft. Postoperatively, she had a left hemispheric stroke with right arm weakness. She recovered well, and 7 months later was doing well, with palpable distal pulses and no evidence of recurrent infection on CT scan. Case 2: Two years after placement of an aortobiiliac graft for aneurysmal disease, a 77-year-old man presented with sequelae of septic emboli. There was no fat plane between the proximal graft and small bowel on CT scan. Indium-111 WBC scan suggested aortic graft infection. Abdominal exploration confirmed aortic graft-enteric erosion, with a defect in the proximal jejunum, which was repaired. The infected graft was removed and the aorta replaced with a cryopreserved aortic allograft. He had no postoperative complications. Thirteen months after surgery, he is asymptomatic, without complications or evidence of infection on CT or WBC scans. Aortic cryopreserved allografts may be a feasible alternative for replacement of infected aortic grafts. Our early experience has been promising, but long-term follow-up is necessary to assess secondary aneurysmal or thrombotic changes in these grafts. [ABSTRACT FROM PUBLISHER]

Diagnosis and treatment of mycotic aneurysms in renal transplant recipients are extremely challenging. Choice of vascular prostheses, surgical techniques, diagnostic procedures, and medical treatment are still disputable. In this case report we present a recipient who developed an abdominal aortic aneurysm, infected with Aspergillus fumigatus, involving the major visceral arteries. In order to replace the aneurysmatic aorta and reconstruct the visceral arteries, the aneurysm was replaced surgically with a fresh AB0 compatible donor aortic graft together with donor iliac arteries. In addition to surgical treatment, this case highlights the diagnostic difficulties, modern anti-mycotic treatment, and underlying causes of this condition. [ABSTRACT FROM AUTHOR]

An unusual case of cholecystographic contrast material outlining a fistulous tract from the duodenum to an aortic graft is presented. [ABSTRACT FROM AUTHOR]