Thoracic endovascular aortic repair as emergency therapy despite suspected aortic infection.

OBJECTIVES: To evaluate thoracic endovascular aortic repair (TEVAR) as emergency therapy despite suspected aortic infection. METHODS: Within a 5-year period, we treated 6 patients with a strategy of primary TEVAR despite suspected aortic infection in patients with symptomatic or already ruptured thoracic aortic pathology. RESULTS: In-hospital mortality was 16.7%. The reason for death was septic multiorgan failure. During follow-up, 2 patients were converted to secondary open surgery in a stable elective setting. The median follow-up was 42.5 months. All surviving patients are not receiving continuing antibiotic therapy. Freedom from infection is 100% to date. CONCLUSIONS: TEVAR as emergency therapy despite suspected aortic infection is feasible and may well serve as a definite treatment option in selected cases. As recurring infection cannot be entirely excluded, life-long clinical and morphological surveillance remains mandatory.

Self-made pericardial tube graft: a new surgical concept for treatment of graft infections after thoracic and abdominal aortic procedures.

BACKGROUND: The aim of this study was to evaluate a new surgical concept for the treatment of graft infections after operation or endovascular treatment of thoracic, thoracoabdominal, and abdominal aortic diseases. METHODS: Between 2004 and 2011, 15 patients (mean age 72 ± 10 years, 87% men) with prosthetic graft or endovascular graft infection were treated with complete removal of the infected prosthetic material, extensive debridement of the surrounding tissues, and orthotopic vascular reconstruction with self-made xenopericardial tube grafts constructed from a patch. Perioperative and long-term outcomes were evaluated. RESULTS: Perioperative mortality was 27% (n = 4). All deaths were due to multiorgan failure resulting from uncontrolled septicemia from the local infectious process. Mean observational follow-up was 24 months (5 to 83 months). Control computed tomographic scans showed normal findings at the operative site in all patients. Antibiotic treatment was continued for a mean of 6 months. Freedom from reinfection was 100%. Freedom from reoperation was also 100%. CONCLUSIONS: Treatment of graft infections after operation or endovascular treatment of thoracic, thoracoabdominal, and abdominal aortic diseases by complete removal of the infected prosthetic material and extensive debridement as well as orthotopic vascular reconstruction using self-made xenopericardial tube grafts as neoaortic segments provides excellent results with regard to durability and freedom from reinfection and reoperation. This new concept is an additional alternative to cryopreserved homografts that extends the armamentarium for treating patients with these highly complex conditions.

[Surgical options in the treatment of chronic venous ulcers]. / Chirurgische Therapieoptionen beim chronisch venösen Ulcus cruris.

Surgery offers several options in prevention of chronic venous insufficiency and its sequelae. Both the operation on veins with valve dysfunction to reduce reflux and the elimination of obstruction in thrombosed veins aim for the reduction of venous hypertension. Elevated venous pressure, impairment of cutaneous capillaries and a chronic inflammatory process result in sclerosis of skin and subcutaneous tissue and might proceed to the fascia resulting in a chronic compartment syndrome. Non- healing chronic venous ulcers under conservative therapy for more than three months may be treated by vein-surgery, local wound care therapy like shaving and negative pressure treatment and if necessary by lowering of elevated intracompartimental pressure by fasciotomy or even fasciectomy.