Javairiah Fatima, MD, Audra A

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Treatment strategies and outcomes in patients with infected aortic endografts Javairiah Fatima, MD, Audra A. Duncan, MD, Eileen de Grandis, MD, Gustavo S. Oderich, MD, Manju Kalra, MD, Peter Gloviczki, MD, Thomas C. Bower, MD Journal of Vascular Surgery Volume 58, Issue 2, Pages 371-379 (August 2013) DOI: 10.1016/j.jvs.2013.01.047 Copyright © 2013 Society for Vascular Surgery Terms and Conditions

Fig 1 Computed tomography (CT) scan reveals periaortic fluid with gas bubbles (white arrow) and psoas abscess (double arrow) suggestive of infected aortic aneurysm. Journal of Vascular Surgery 2013 58, 371-379DOI: (10.1016/j.jvs.2013.01.047) Copyright © 2013 Society for Vascular Surgery Terms and Conditions

Fig 2 A focus of intense radiotracer uptake is present immediately anterior to the bifurcated aortoiliac graft interposed between the prior aneurysm sac and the transverse duodenum. Journal of Vascular Surgery 2013 58, 371-379DOI: (10.1016/j.jvs.2013.01.047) Copyright © 2013 Society for Vascular Surgery Terms and Conditions

Fig 3 A, Intraoperative findings demonstrating aortoduodenal fistula (arrow). B, Explanted graft with bile staining (arrow). Journal of Vascular Surgery 2013 58, 371-379DOI: (10.1016/j.jvs.2013.01.047) Copyright © 2013 Society for Vascular Surgery Terms and Conditions

Fig 4 Intraoperative picture of frank perigraft purulence. Journal of Vascular Surgery 2013 58, 371-379DOI: (10.1016/j.jvs.2013.01.047) Copyright © 2013 Society for Vascular Surgery Terms and Conditions

Fig 5 After explantation of infected endograft, in situ reconstruction is the preferred repair using three different graft materials as indicated: rifampin-soaked Dacron, autogenous vein, or cryopreserved graft. Journal of Vascular Surgery 2013 58, 371-379DOI: (10.1016/j.jvs.2013.01.047) Copyright © 2013 Society for Vascular Surgery Terms and Conditions

Fig 6 Technique for explantation of infected aortic endograft and replacement with in situ rifampin-soaked Dacron grafts. A, In situ endograft preoperatively. B, Proximal and distal controls are established and the infected endograft is removed with debridement of all infected tissue. C, Rifampin-soaked Dacron graft is used to replace the endograft. D, A tongue of omentum is brought retrocolic, and a 360° omentum wrap is performed. Journal of Vascular Surgery 2013 58, 371-379DOI: (10.1016/j.jvs.2013.01.047) Copyright © 2013 Society for Vascular Surgery Terms and Conditions