Professor and Chief of Vascular and Cardiothoracic Surgery @ The University of New Mexico School of Medicine
Infected F/BEVAR Explant Dear friends, Thank you again for the academic discussion about this case. Our decision to explant and stay out of the very purulent sac was based on the sac aspirant being frankly purulent and the microbiology consisting of gram positives, gram negatives and yeast (likely foregut source). Patient was treated with broad spectrum IV antibiotics and antifungals for a week prior to explant. Intraoperatively we noticed unexpected progression of infection transmurally into the supraceliac aorta. Our initial plan was to create a stump with the celiac beveled into it however the aorta, that looked ok on preop imaging, would not even hold a clamp and sutures kept tearing till I went about 6 centimeter above the celiac after temporary clamping above the branching allograft. There was pus within the wall of supraceliac aorta, something I have not seen before. Plan is to continue outpatient antibiotic and antifungal treatment for minimum of 6 months and continue interval imaging. This is our second instance of infection in a F/BEVAR in over 150 implants. Unfortunately graft infection, although rare, is something that we need to be prepared for. Strategies discussed on this thread are all appropriate options in different settings. I would love to hear more thoughts. #aortaed #unmvascularsurgery Gustavo Oderich MD Jesse Manunga Peter Gloviczki, MD, PhD Rafael Demarchi Malgor, MD, MBA FACS Faisal Aziz MD, MBA, FACS, Distinguished-FSVS Naveed Saqib Muhammad Aftab MD, FACS, FACC Ross Clark, MD, MBA, RPVI Firas Mussa