Post-operative Infection of Prosthetic Materials or Stents Involving the Supra-aortic Trunks: A Comprehensive Review.

Abstract

OBJECTIVE:

The aim of this paper was to provide recommendations for diagnosis and management in the setting of infection following open or endovascular reconstructions of the supra-aortic trunks.

METHODS:

A review of the Medline database was performed from 1997 to 2017 by a combined strategy of MeSh terms.

RESULTS:

The literature search identified 49 publications: 36 studies addressing prosthetic material infections and 13 studies addressing stent infections. A total of 140 cases of prosthetic material infections were reported, mostly involving carotid patches. Surgical treatment was mostly based on complete removal of the infected material followed by in situ arterial reconstruction (86 cases, 62.3%). Peri-operative complications included cranial nerve injury in 17 cases (12.5%), stroke in eight (6.7%), bleeding in four (2.9%), re-infection in five (3.6%), and cardiac failure in three cases (2.2%). Stent infections were reported in 12 patients: eight carotid stents, three subclavian stents and one tandem brachiocephalic subclavian stent. Treatment was not described for one case, was conservative in one case, consisted of stent removal with venous reconstruction in six cases, stent removal without reconstruction because of carotid thrombosis in two cases, and carotid embolisation in two cases. Complications included intra-operative death in one case (9.1%), stroke in two (18.2%), reinfection in one (9.1%), bleeding in one (9.1%), and cardiac failure in one case (9.1%).

CONCLUSION:

Appropriate pre-operative imaging is mandatory and treatment modality should be determined by patient condition. Complete removal of the infected material, followed by in situ arterial reconstruction with venous material seems advisable, despite high morbidity. However, alternative strategies may be considered for fragile and high risk patients. A multidisciplinary approach is mandatory to ensure optimum results.

• Authors: Anne Lejay, Igor Koncar, Holger Diener, Melina Vega de Ceniga, Nabil Chakfé
• Journal: European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery (Eur J Vasc Endovasc Surg) Vol. 56 Issue 6 Pg. 885-900 (Dec 2018) ISSN: 1532-2165 [Electronic] England
• PMID: 30121172 (Publication Type: Journal Article, Review)
• Copyright: Copyright © 2018 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.

Chemical References

• Anti-Bacterial Agents

Topics

• Anti-Bacterial Agents (therapeutic use)
• Aorta (surgery)
• Blood Vessel Prosthesis (adverse effects)
• Blood Vessel Prosthesis Implantation (adverse effects, instrumentation)
• Endovascular Procedures (adverse effects, instrumentation)
• Humans
• Postoperative Complications
• Prosthesis-Related Infections (diagnosis, drug therapy, surgery)
• Stents (adverse effects)
• Vascular Surgical Procedures (adverse effects, instrumentation)