Post-operative Infection of Prosthetic Materials or Stents Involving the Supra-aortic Trunks: A Comprehensive Review

Anne Lejay, Igor Koncar, Holger Diener, Melina Vega de Ceniga, Nabil Chakfé

Research output: Contribution to journalReview article

8 Scopus citations

Abstract

Objective: The aim of this paper was to provide recommendations for diagnosis and management in the setting of infection following open or endovascular reconstructions of the supra-aortic trunks. Methods: A review of the Medline database was performed from 1997 to 2017 by a combined strategy of MeSh terms. Results: The literature search identified 49 publications: 36 studies addressing prosthetic material infections and 13 studies addressing stent infections. A total of 140 cases of prosthetic material infections were reported, mostly involving carotid patches. Surgical treatment was mostly based on complete removal of the infected material followed by in situ arterial reconstruction (86 cases, 62.3%). Peri-operative complications included cranial nerve injury in 17 cases (12.5%), stroke in eight (6.7%), bleeding in four (2.9%), re-infection in five (3.6%), and cardiac failure in three cases (2.2%). Stent infections were reported in 12 patients: eight carotid stents, three subclavian stents and one tandem brachiocephalic subclavian stent. Treatment was not described for one case, was conservative in one case, consisted of stent removal with venous reconstruction in six cases, stent removal without reconstruction because of carotid thrombosis in two cases, and carotid embolisation in two cases. Complications included intra-operative death in one case (9.1%), stroke in two (18.2%), reinfection in one (9.1%), bleeding in one (9.1%), and cardiac failure in one case (9.1%). Conclusion: Appropriate pre-operative imaging is mandatory and treatment modality should be determined by patient condition. Complete removal of the infected material, followed by in situ arterial reconstruction with venous material seems advisable, despite high morbidity. However, alternative strategies may be considered for fragile and high risk patients. A multidisciplinary approach is mandatory to ensure optimum results.

Original languageEnglish (US)
Pages (from-to)885-900
Number of pages16
JournalEuropean Journal of Vascular and Endovascular Surgery
Volume56
Issue number6
DOIs
StatePublished - Dec 2018

Keywords

  • Brachiocephalic trunk
  • Carotid arteries
  • Infection
  • Operative
  • Subclavian artery
  • Surgical procedures

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

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