Journal ReadingSurgical strategy for

aorta-related infection

China Medical University Int.吳易儒

Background

● Aorta related infection○ rare○ high mortality

● Standard treatment:○ open surgical repair with resection○ debridement○ in situ graft replacement○ extra anatomical bypass

● Endovascular repair○ useless

Meterials and Methods

● 71(3.3%) patients had aorta-related infections○ 70- open surgical repair+ resection/ endovascular

repair○ 1- medical therapy

● Aorta infection diagnosed by:○ clinical course○ CT○ blood culture(+)○ histopathological examination

Surgical treatment

● Debridement of infected tissue● Copious saline irrigation● In situ graft replacement● Endovascular repair

○ localized infected site○ immunocompromised host○ bridge to open surgical repair

Standard surgical strategy

● Complete resection of infected tissue● in situ graft replacement of the aorta● rifampicin-soaked, gelatin-impregnated

Dacron graft● followed by omentopexy● 70 patients:

○ 45: insitu replacdment○ 18: endovascular aortic repair○ 7: extra-anatomical bypass

Surgical strategy

● Before 2008: resect infected tissue and abscess

● Since 2008: also resect surrounding aneurysmal wall

● 29: Omental flap install● 3: Pedicled latissmus dorsi muscle flap

Result

Figure 1

Figure 2A

Figure 2B

Figure 2C

Figure 3

Figure 4

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