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Background Although the true prevalence and incidence are not clearly known, mycotic pulmonary artery aneurysm is a potentially devastating condition that leads to high mortality, over 60% if untreated. Among them, mycotic pulmonary artery pseudoaneurysm, which occurs in relatively central areas, has rarely been reported. We report an extremely rare case of a late complication with a mycotic pulmonary artery pseudoaneurysm, presumably due to infective endocarditis, in a 68-year-old woman 4 months after total arch replacement. Case presentation A 68-year-old woman was referred to our department for 2 weeks with fever of unknown origin. She had a history of emergency total arch replacement for an acute type A aortic dissection 4 months earlier and chronic rheumatoid arthritis on monthly subcutaneous tocilizumab treatment for several years. Blood culture was positive for Enterococcus faecalis. Transthoracic and transesophageal echocardiography revealed a left ventricular ejection fraction of 58%, severe mitral regurgitation with a 15-mm diameter vegetation on the anterior mitral leafet, and severe aortic insufciency with string-like structures. Contrast computed tomography showed a focal saccular outpouching from the right pulmonary artery. On 18F-fuorodeoxyglucose (FDG) positron emission tomography, focal uptake of FDGs was observed along the same lesion of the pulmonary artery and ascending-arch graft. The patient eventually recovered after the surgical intervention of mitral and aortic valve replacement, re-total arch replacement, pulmonary artery repair, application of omental fap, and antibiotics without any evidence of re-infection after 1 year. Conclusions We report a successful surgical repair of mycotic pulmonary artery pseudoaneurysm 4 months after total arch replacement for acute type A aortic dissection. This report describes an efective treatment for an extremely rare postoperative condition. [ABSTRACT FROM AUTHOR]

Prosthetic vascular graft infection is one of the most severe vascular surgery complications. Fibrin gel (FG) has many useful characteristics as biocompatibility, biodegradation, adhesion, and haemostasis to develop the local antibiotic delivery system. In this study, human plasma was collected from peripheral blood that was used to create fibrin gel by supplement ion Ca2+. Antibiotic-containing fibrin gel was then evaluated in some characteristics such as surface structure, biodegradation, antibiotic delivery, cytotoxicity, and bacterial biofilm prevention in vitro and in vivo. The results showed that fibrin gel was excellent material for the extended delivery of antibiotics. Most importantly, antibiotic-containing fibrin gel was not toxic for human fibroblast cells in vitro and inhibited bacterial biofilm growth in vitro and in vivo. This research is the first step in developing an antibiotic delivery system for effective graft infection treatments. [ABSTRACT FROM AUTHOR]

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A 70-year-old man with a chronic type B aortic dissection was treated with two stent grafts deployed in the descending thoracic aorta. The patient was re-admitted to the hospital at 16 months after thoracic endovascular stent grafting because of a high fever. A blood culture showed sepsis due to a Staphylococcus species. A CT scan showed an increase in the size of the thrombosed false lumen. Complete excision of the infected descending aortic wall and infected stent graft were performed. The descending thoracic aorta was reconstructed using a rifampicin-bonded Dacron graft and omental wrapping. The combination of in situ graft replacement using a rifampicin-bonded graft and omental wrapping is considered an effective treatment for thoracic stent graft infection. [ABSTRACT FROM AUTHOR]

Aorto-esophageal fistula (AEF) is a rare but devastating complication of thoracic aorta endovascular repair (TEVAR). We report a case of a 64-year-old male who presented with chest pain and high CRP levels 10 months after TEVAR for a 9 cm diameter descending thoracic aortic aneurysm. The diagnosis of an AEF was confirmed and the patient was treated conservatively with broad spectrum antibiotics and total parental alimentation. After control of sepsis was achieved, esophagectomy with gastric tube reconstruction was performed and an omental pedicle was used to cover the aortic wall. No intervention to the aorta was made at that time due to the potentially infected mediastinum. The patient's recovery was uneventful and 2 years postoperatively he is in good condition and lives a normal life. Esophagectomy seems to be a mandatory stage of treatment in the setting of AEF. In cases where signs of graft infection are persistent, aortic surgery might be also necessary. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to determine whether polytetrafluoroethylene grafts or Omniflow II biosynthetic grafts are more resistant to infection caused by Staphylococcus aureus. Methods: Sixty rats were divided into six groups. In Groups 1A, 1B and 1C, a polytetrafluoroethylene graft was implanted in each rat, and, in Groups 2A, 2B and 2C, a biosynthetic graft was implanted in each rat. Staphylococcus aureus was inoculated into Groups 1B, 1C, 2B and 2C, and the rats in Groups 1C and 2C were treated with teicoplanin. One week later, the rats were euthanized, the grafts were removed and a microbiological count was performed. A histopathological examination was subsequently carried out, and the C-reactive protein, prealbumin and leukocyte levels were investigated. Results: There were no significant differences in the C-reactive protein, prealbumin and leukocyte levels. The differences in the results of the microbiological evaluations between the groups were significant. The quantitative culture results showed no bacterial growth in Groups 1A, 1C and 2A. The number of bacteria in Group 1B was statistically lower than that in Group 2B. When the groups receiving treatment were compared, Group 2C had bacterial growth, whereas Group 1C did not. The histopathological examinations showed similar results. Conclusions: Omniflow II grafts are more susceptible to infection than polytetrafluoroethylene grafts. [ABSTRACT FROM AUTHOR]

Objective: Once a replaced prosthetic graft is infected, it is usually necessary to re-replace the thoracic aorta to achieve complete resolution of the infection. It is, however, an exceedingly invasive approach to perform such a repeat surgery on patients in a poor condition. We have managed both re-replacement of an infected prosthetic graft and conservative therapy with vacuum-assisted wound closure (VAC) without re-replacement. These two treatment modalities were retrospectively assessed. Methods: Retrospective clinical chart review was undertaken on 21 patients with prosthetic graft infection after thoracic aortic replacement between December 1999 and December 2012. Surgical outcomes were evaluated between the two groups: re-replacement group (group R, n = 14) and no-replacement group (group NR, n = 7). Results: In-hospital survival rates were 64.3 % in group R and 85.7 % in group NR. Mortality in group R included five patients, sepsis in two patients, and intraoperative aortic rupture, heart failure, and cerebral infarction in one. Mortality in group NR included one patient (sepsis). In terms of long-term outcome, one patient in group R and one patient in group NR died of rupture of a residual aortic aneurysm, and one patient in group NR died of renal disease during follow-up (52.8 ± 41.5 months for R and 43.2 ± 28.5 months for NR; mean ± standard deviation). Conclusions: Re-replacement of an infected prosthetic graft after a thoracic aortic operation still carries a significant risk for mortality. VAC therapy may provide an acceptable option for such a subgroup of patients with this serious condition. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the process of bacterial invasion from the surface to inside prosthetic vascular grafts. Methods: Elastomer-sealed Dacron vascular grafts (ESDVGs) and gelatin-coated Dacron vascular grafts (GCDVGs) were cut into 6-cm segments and placed in a U-shaped configuration on culture plates. Physiological saline was poured inside the grafts and a suspension of Pseudomonas aeruginosa was added to the outside. Samples taken from inside the grafts at nine time points for up to 60 h were spread on agar. Bacterial colonies were then analyzed. The grafts were also examined using scanning electron microscopy (SEM). Results: Contaminated vascular graft models were produced in 18 ESDVGs (group T) and 12 GCDVGs (group G). The bacterial counts inside the vascular grafts in both groups increased over time. Bacterial colonies were confirmed in all samples from group G by 30 h, whereas bacteria appeared inside the grafts from group T at various times between 0 and 60 h. Bacteria were undetectable in one model from group T throughout the study. SEM revealed that the elastomeric membrane in the ESDVG was uneven. Conclusion: Bacterial invasion of vascular grafts does not always occur immediately after contamination. ESDVGs may be more resistant to bacterial invasion as they have a thicker and evenly enriched elastomeric membrane. [ABSTRACT FROM AUTHOR]

Infection of prosthetic grafts, especially with methicillin-resistant Staphylococcus aureus (MRSA), often becomes critical. Although topical administration of antibiotics has been applied empirically, no comprehensive data are available showing long-lasting effects and safety of local antibiotic usage. By means of animal experiments we assessed fibrin glue (FG) as a slow-release vehicle for vancomycin (VCM) against local MRSA infection. Preliminary in-vitro experiments were performed to confirm that the FG-VCM mixture maintained viscosity as a sealant and led to slow-release of VCM. We next created a subcutaneous pocket in a rodent back and implanted a 1 cm woven graft with 1 ml FG alone, or with serial concentrations of VCM (0-120 mg/ml. n = 3 for each group). MRSA of 1 × 10 colony-forming units (CFU) was injected into the pocket after wound closure. The graft was explanted 7 days later and was submitted for culture ('Culture-graft'). Blood samples were obtained for regular blood work, serum VCM concentration measurements, and blood culture ('Culture-blood'). The pocket tissue was also submitted for measurement of local VCM concentration. There was a remarkable infectious response in the group without vancomycin; however, no other groups developed any sign of infection. 'Culture-graft' resulted in MRSA growth for V0 only. 'Culture-blood' was negative in all groups, and only minimal serum concentrations of vancomycin were detected. One-dose topical administration of VCM via FG was effective against localized MRSA graft infection without systemic VCM administration. Topical administration of antibiotics may help treat difficult graft infections and reduce systemic use of potent antibiotics. [ABSTRACT FROM AUTHOR]

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Copyright of Gefaesschirurgie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Gefaesschirurgie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Gefaesschirurgie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Infection is the most challenging and life-threatening complication of vascular access and causes significant morbidity, loss of access, and mortality. The aims of this review are to determine the magnitude of the infection problem, identify possible factors, and provide an update on the management of vascular access infections . Infections account for approximately 15% to 36% of all deaths in dialysis patients (the second leading cause after cardiovascular events) and for about 20% of admissions. Several studies demonstrate a hierarchy of infection risk from temporary catheter, tunnelled cuffed catheter, arteriovenous grafts, to arteriovenous fistula in decreasing order. Suspicion of infection must be followed by appropriate blood cultures, including possible simultaneous sampling from a peripheral vein and the access. The best way to treat vascular access infection is prevention, bearing in mind the idea 'fistula first' and 'lines last', with the appropriate use of arteriovenous grafts and newer devices sandwiched in between. [ABSTRACT FROM AUTHOR]

A 30-year-old man with Marfan syndrome who underwent Crawford type II extension aneurysm repair about 9 years ago was referred to our hospital with persistent fever. Computed tomography (CT) showed air around the mid-descending aortic prosthetic graft. Because the air did not disappear in spite of intravenous antibiotics, F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) was performed. FDG-PET/CT revealed four high-uptake lesions. After dissecting the aortic graft particularly focusing on the high-uptake lesions, this patient underwent in situ graft re-replacement of descending aortic graft with a rifampicin-bonded gelatin-impregnated Dacron graft and omentopexy. The patient remains well without recurrent infection at 3 months after surgery. [ABSTRACT FROM AUTHOR]

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Purpose. The study was conducted to compare the results of two different techniques of vascular reconstruction in patients after the removal of infected vascular prostheses. Methods. Sixty-three patients with vascular prostheses infections underwent treatment. Either the infected fragments or the entire prosthesis was removed in all of the patients. Extra-anatomical grafts were implanted in 19 cases. Cryopreserved allogenic arterial grafts were applied for reconstruction in 44 patients. Results. In a 19-patient group with extra-anatomical grafts, two patients died (10.5%). In seven patients (36.8%) relapse symptoms of infection appeared. Primary and secondary patencies of the grafts after 3 years were 31.6% and 52.6% respectively. In a group of 44 patients with allogenic grafts no recurrence of infection was observed. Six patients died (13.6%). Primary and secondary patencies after 3 years were 63.6% and 81.8% respectively. Conclusions. The results reveal the benefits of the allogenic arterial grafts in revascularization in patients with major vascular prostheses infections. The differences in secondary patencies of the implanted allogenic grafts indicate the necessity of an early selection of patients for the complete removal of the infected prosthesis, during a time when patients are in general good health. [ABSTRACT FROM AUTHOR]

A successfully-treated case of graft infection after thoracoabdominal aortic repair is reported. A 61-year-old male underwent graft replacement of a Crawford type IV thoracoabdominal aortic aneurysm and developed graft infection due to methicillin-resistant Staphylococcus aureus. After 35 days' open retroperitoneal irrigation, the culture around the graft turned negative, and omental transposition and skin flap transfer were successfully conducted. The long-term open retroperitoneal irrigation could be conducted without significant complications, and it was very effective in controlling the severe infection. [ABSTRACT FROM AUTHOR]

Mediastinitis due to graft infection is a serious and potentially lethal complication associated with replacement of the ascending aorta. We present the case of a 67-year-old man with this condition for the aneurysm and chronic dissection. Mediastinitis and sepsis were diagnosed and debridement, irrigation with povidone solution and omental transposition were performed successfully. Continuous closed irrigation prior to omental transposition without replacement of the infected graft is useful for treating mediastinitis after ascending aortic or arch replacement. [ABSTRACT FROM AUTHOR]

A 63-year-old man was referred to our department for treatment of intermittent claudication in the right lower limb. The preoperative angiogram showed severe stenosis extending from the terminal aorta to the bilateral common femoral arteries, with occlusion of the right superficial femoral artery and the left popliteal artery. He underwent aortobifemoral bypass with thromboendarterectomy of the left common femoral artery, and right graft-popliteal artery bypass. The patient had an uneventful postoperative course; however, 14 days after the operation, a pulsatile mass suddenly appeared in the left groin. Emergency surgery revealed disruption of the left distal anastomosis of the aortobifemoral bypass and therefore, revision, in the form of graft-profunda femoris artery interposition with graft-superficial femoral artery bypass, was performed. Microscopic examination showed colonies of bacteria in the host artery adventitia adjacent to the anastomosis. Culture of the discharge from the right groin operative scar revealed methicillin-resistant Staphylococcus aureus (MRSA). The discharge resolved following the intravenous administration of vancomycin and the local application of vancomycin ointment. There were no operative complications other than the MRSA infection, and the patient was discharged 20 days after revision surgery. In the 14 months since the revision, all grafts have remained patent and there have been no further symptoms of graft infection. [ABSTRACT FROM AUTHOR]

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Thirty-one Dacron double velour prostheses removed from 16 patients were studied microscopically in order to elucidate the changes they underwent following implantation. The process of incorporation was divided into three phases. In the initial phase, immediately following the implantation, the prostheses became surrounded by a fibrin meshwork. In the organizing phase, which sets in 10 weeks after the implantation, there was an external fibrous capsular formation around the initially fibrin-infiltrated grafts. There was also fibroblastic ingrowth and granulation formation among the interstices and the prostheses showed firm adhesion to the surrounding tissues. One year following the implantation, after most of the luminal surfaces had been covered with collagen tissues, the cellular infiltration subsided and the graft passed into the stable phase. Foreign body giant cells and lymphocytes were seen throughout the study period. These prostheses were then compared with other prostheses which do not have velour structures. The nonvelour grafts showed less adhesion to the surrounding tissues. Microscopically, cellular reaction and collagenous ingrowth were also less. The velour surface thus seems to stimulate granulation ingrowth and to contribute to the firm adhesion of the graft to the surrounding tissues. This firm adhesion enhances resistance to infection and is considered safer in case of suture aneurysm formation. [ABSTRACT FROM AUTHOR]

A clinical review of 400 prosthetic arterial reconstructions, carried out in the Second Department of Surgery of Kyushu University Hospital during a period from 1965 to 1981, revealed 10 graft infections (2.5 per cent). There were two out of 120 abdominal aneurysms (1.7 per cent) and 8 out of 260 aorto-femoral occlusive diseases (3.1 per cent). The contributing factors included intraoperative contamination with duodenal juice during surgery for abdominal aneurysms ruptured into the duodenum (2 cases), minor hematoma and/or lymphorrhoea at the groin or lower abdominal wall (5 cases), wound infection (1 case), compression necrosis of the sigmoid colon by the implanted graft (1 case) or perityphlitic abscess due to a perforating appendicitis (1 case). Bacteriologic examination revealed a predominance of a variety of staphylococcus at the groin or lower abdominal wall and E. coli in the abdominal cavity. Four patients expired. Limb amputation had to be done in 2, and 4 were cured. In the management of infected graft at the groin or lower abdominal wall, we used with success a skin sliding closure technique after continuous wound lavage in 3 patients. [ABSTRACT FROM AUTHOR]

Two patients having the abdominal aneurysm with aortoduodenal fistula were treated surgically, but graft infection occurred. One patient died about 6 months after and the other about one year after the operation due to massive hemorrhage from the postoperative aortointestinal fistula. The difficulties in the treatment of the aortoduodenal fistula were discussed. [ABSTRACT FROM AUTHOR]

Nine patients with suspected prosthetic vascular graft infection were studied with axial spin echo (SE) and short TI inversion recovery (STIR) magnetic resonance imaging. Images were assessed for presence and extent of abnormality. All patients had either surgical (8/9) or bacteriologic (6/9) confirmation of infection. STIR images better defined the extent of infection and had greater fat-fluid contrast than SE images in 6/9 studies. In 3 cases with peri-graft fluid alone, T2-weighted images had slightly greater contrast, although the STIR images were still diagnostic. STIR imaging can offer improved accuracy in evaluation of suspected prosthetic graft infection when used in conjunction with SE techniques. [ABSTRACT FROM AUTHOR]

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A 65-year-old man developed graft infection 3 years after total aortic arch replacement for a chronic dissecting aneurysm. Redo total aortic arch replacement was performed using an extended homograft following 2 days of open drainage of the mediastinum. The patient has been free from a recurrent mediastinitis over the last 3 years. [ABSTRACT FROM AUTHOR]

Human infections caused by Lactobacillus spp. are rarely reported in the literature. Underlying conditions are frequently reported, and identification of lactobacilli to the species level remains rare. A case of Lactobacillus casei septicaemia secondary to a vascular graft infection is reported. The 16S rRNA sequencing technique was used to definitively identify Lactobacillus casei. [ABSTRACT FROM AUTHOR]