ABSTRACT
BACKGROUND: There is no international consensus regarding the optimum management of infected aortae (mycotic aneurysms, infected aortic grafts). Neoaortoiliac reconstruction has advantages over extra-anatomical bypass grafting; however, the use of autologous vein is associated with venous hypertension and compartment syndrome, alternatively cadaveric homografts are associated with high rates of perianastomotic hemorrhage, limb occlusion, and pseudoaneurysm. Arterial repair using xenoprosthetic patches is associated with lower infection rates compared to the use of prosthetic material. The aim of this case series and literature review is to report the use of xenoprosthetic bovine biomaterial for neoaortic repair of mycotic aneurysmal disease and infected aortic grafts. METHODS: Patients with evidence of infected aortic grafts or mycotic aneurysms who were suitable for open aortic surgery were included. Following removal of the graft/excision of the aneurysmal sac, a 10 × 16 cm XenoSure Biologic Surgical Patch (LeMaitre, Germany) was rolled into a tube, or bifurcated tube graft, and secured with prolene sutures. Proximal and distal anastomoses were conducted as per standard aortic anastomoses. Patients were continued on long-term antibiotics and surveyed with computerized tomography at 1, 3, 6, and 12 months. RESULTS: Six patients underwent bovine aortic repair between 2013 and 2015: an infected Dacron aortobi-iliac graft causing iliac pseudoaneurysm, an infected Dacron aortic graft from open repair later relined with endovascular stent graft, a mycotic iliac aneurysm, and 3 mycotic aortic aneurysms. All were treated with bovine reconstructed aortic grafts or patches. Patients had a median age of 69.5 years (range 67-75), with perioperative and 30-day mortality of 0%. Median follow-up was 13 months (range 2-23). Postoperative contrast-enhanced computed tomography revealed no evidence of infection at the operative site in all patients. Freedom from reinfection and reintervention was 100%. CONCLUSIONS: Xenoprosthetic (bovine) neoaortic grafts are an alternative method to treat infected aortae with excellent short-term freedom from infection and reintervention. Optimum duration of postoperative antibiotic therapy remains undetermined. Further cases and longer follow-up are required to determine the true efficacy of this technique.
Subject(s)
Aneurysm, Infected/surgery , Aortic Aneurysm/surgery , Blood Vessel Prosthesis Implantation/instrumentation , Blood Vessel Prosthesis , Prosthesis-Related Infections/surgery , Aged , Aneurysm, Infected/diagnostic imaging , Aneurysm, Infected/microbiology , Animals , Anti-Bacterial Agents/administration & dosage , Aortic Aneurysm/diagnostic imaging , Aortic Aneurysm/microbiology , Aortography/methods , Blood Vessel Prosthesis/adverse effects , Blood Vessel Prosthesis Implantation/adverse effects , Cattle , Computed Tomography Angiography , Device Removal , Heterografts , Humans , Polyethylene Terephthalates , Prosthesis Design , Prosthesis-Related Infections/diagnostic imaging , Prosthesis-Related Infections/microbiology , Suture Techniques , Treatment OutcomeABSTRACT
PURPOSE: This study tests an existing Vascular Biochemistry and Haematology Outcome Model (VBHOM) on independent data and presents further refinements to the model. METHODS: Data from 306 patients who underwent lower limb amputation over a 4-year period were collated. Urea, creatinine, sodium, potassium, hemoglobin, white cell count, albumin, age, gender, mode-of-admission, and short-term mortality events were extracted from the database. This study tests an existing model and trains a new model for predicting mortality using forward stepwise logistic regression. RESULTS: The existing model suggests a significant lack of fit (c-index = 0.665, P = .04). For the exception of gender and mode-of-admission, all predictor variables had significant univariate associations with short-term mortality (P < .05). The refined model included age, sodium, potassium, creatinine, and albumin and had good discriminatory power (c-index = 0.8, no evidence of lack of fit, P = .616). CONCLUSIONS: Our simplified model had good predictive ability and suggests redundancy in input variables used by the existing models.
Subject(s)
Amputation, Surgical/mortality , Lower Extremity/blood supply , Peripheral Vascular Diseases/surgery , Age Factors , Aged , Aged, 80 and over , Amputation, Surgical/adverse effects , Biomarkers/blood , Creatinine/blood , Discriminant Analysis , England , Female , Humans , Logistic Models , Male , Multivariate Analysis , Patient Selection , Peripheral Vascular Diseases/blood , Peripheral Vascular Diseases/mortality , Potassium/blood , Risk Assessment , Risk Factors , Serum Albumin/analysis , Sodium/blood , Time Factors , Treatment OutcomeABSTRACT
BACKGROUND: The systemic nature of atherosclerosis compromises medium-term survival following major vascular surgery. Neutrophil-lymphocyte ratio (NLR) is a simple index of systemic inflammatory burden which correlates with survival following percutaneous coronary intervention. METHODS: Patients undergoing elective major vascular surgery in 2 tertiary vascular units were identified from prospectively maintained databases. Factors associated with 2-year mortality were assessed by univariate and multivariate analyses. RESULTS: Over a 4-year period, 1021 patients underwent elective major vascular surgery (carotid endarterectomy, abdominal aortic aneurysm repair, lower limb revascularization). Two-year mortality was 11.2%. In multivariate analysis, preoperative NLR > 5 was independently associated with 2-year mortality (multivariate odds ratio [OR] 2.21; 95% confidence interval [CI] 1.22-4.01). CONCLUSION: Preoperative NLR identifies patients at increased risk of death within 2 years of major vascular surgery. This simple index may facilitate targeted preventive measures for high-risk patients.
Subject(s)
Lymphocytes/immunology , Neutrophils/immunology , Peripheral Vascular Diseases/surgery , Vascular Surgical Procedures/mortality , Aged , Aged, 80 and over , Cross-Sectional Studies , Elective Surgical Procedures/mortality , Endarterectomy, Carotid/mortality , Endovascular Procedures/mortality , England , Female , Humans , Kaplan-Meier Estimate , Logistic Models , Lymphocyte Count , Male , Middle Aged , Odds Ratio , Peripheral Vascular Diseases/immunology , Peripheral Vascular Diseases/mortality , Predictive Value of Tests , Prospective Studies , Risk Assessment , Risk Factors , Survival Rate , Time Factors , Treatment OutcomeABSTRACT
A persistent sciatic artery aneurysm is a rare congenital vascular anomaly. Surgical intervention is reserved for symptomatic cases. The authors report the case of a 72-year-old woman who presented with thromboembolic occlusion of an aneurysmal persistent sciatic artery. Although initially symptomatic, she was managed expectantly with the aid of serial duplex sonographic imaging. The persistent sciatic artery subsequently thrombosed as a result of hypotension secondary to a myocardial infarction. No surgical intervention was required. The current literature on this condition is reviewed.