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Treatment of an Infected TEVAR with Extra- and Endovascular Bacteriophage Application

INTRODUCTION: Graft infections are severe complications. Surgical resection of infected aortic stent grafts is associated with high mortality and morbidity. Therefore, alternatives or adjuncts to antibiotic treatment and extensive surgery are urgently needed. REPORT: A 67 year old woman was admitted...

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Autores principales: Grambow, Eberhard, Junghans, Simon, Kröger, Jens Christian, Reisinger, Emil Christian, Krause, Bernd Joachim, Groß, Justus
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9257328/
https://www.ncbi.nlm.nih.gov/pubmed/35812072
http://dx.doi.org/10.1016/j.ejvsvf.2022.02.004
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author Grambow, Eberhard
Junghans, Simon
Kröger, Jens Christian
Reisinger, Emil Christian
Krause, Bernd Joachim
Groß, Justus
author_facet Grambow, Eberhard
Junghans, Simon
Kröger, Jens Christian
Reisinger, Emil Christian
Krause, Bernd Joachim
Groß, Justus
author_sort Grambow, Eberhard
collection PubMed
description INTRODUCTION: Graft infections are severe complications. Surgical resection of infected aortic stent grafts is associated with high mortality and morbidity. Therefore, alternatives or adjuncts to antibiotic treatment and extensive surgery are urgently needed. REPORT: A 67 year old woman was admitted with a methicillin sensitive Staphylococcus aureus infected stent graft in the thoracic aorta. Local infection was confirmed by PET-CT imaging. Surgical resection of the stent graft was not feasible because of comorbidities. Therefore, a three step approach for local bacteriophage treatment was performed as a last resort treatment. Firstly, the para-aortic tissue was debrided via left thoracotomy, a bacteriophage suspension was applied on the outer surface of the aorta, and a vacuum irrigation system was installed. After repeated alternating instillation of the bacteriophage suspension for three days, as a second step, the vacuum sponges were removed and a bacteriophage containing gel was applied locally on the outer surface of the aorta. In the third step, the bacteriophage containing gel was applied to a thoracic stent graft, which in turn was placed endovascularly into the infected stent. DISCUSSION: After 28 days, the patient was discharged from hospital with normalised infection parameters. PET-CT imaging at three and 12 months post-intervention did not show signs of infection in or around the thoracic aorta. This Case demonstrates successful treatment of an infected endovascular stent graft by application of bacteriophages both to extravascular and, as a novel approach, endovascular sites using a bacteriophage coated stent graft.
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spelling pubmed-92573282022-07-07 Treatment of an Infected TEVAR with Extra- and Endovascular Bacteriophage Application Grambow, Eberhard Junghans, Simon Kröger, Jens Christian Reisinger, Emil Christian Krause, Bernd Joachim Groß, Justus EJVES Vasc Forum Case Report INTRODUCTION: Graft infections are severe complications. Surgical resection of infected aortic stent grafts is associated with high mortality and morbidity. Therefore, alternatives or adjuncts to antibiotic treatment and extensive surgery are urgently needed. REPORT: A 67 year old woman was admitted with a methicillin sensitive Staphylococcus aureus infected stent graft in the thoracic aorta. Local infection was confirmed by PET-CT imaging. Surgical resection of the stent graft was not feasible because of comorbidities. Therefore, a three step approach for local bacteriophage treatment was performed as a last resort treatment. Firstly, the para-aortic tissue was debrided via left thoracotomy, a bacteriophage suspension was applied on the outer surface of the aorta, and a vacuum irrigation system was installed. After repeated alternating instillation of the bacteriophage suspension for three days, as a second step, the vacuum sponges were removed and a bacteriophage containing gel was applied locally on the outer surface of the aorta. In the third step, the bacteriophage containing gel was applied to a thoracic stent graft, which in turn was placed endovascularly into the infected stent. DISCUSSION: After 28 days, the patient was discharged from hospital with normalised infection parameters. PET-CT imaging at three and 12 months post-intervention did not show signs of infection in or around the thoracic aorta. This Case demonstrates successful treatment of an infected endovascular stent graft by application of bacteriophages both to extravascular and, as a novel approach, endovascular sites using a bacteriophage coated stent graft. Elsevier 2022-02-16 /pmc/articles/PMC9257328/ /pubmed/35812072 http://dx.doi.org/10.1016/j.ejvsvf.2022.02.004 Text en © 2022 Published by Elsevier Ltd on behalf of European Society for Vascular Surgery. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Case Report
Grambow, Eberhard
Junghans, Simon
Kröger, Jens Christian
Reisinger, Emil Christian
Krause, Bernd Joachim
Groß, Justus
Treatment of an Infected TEVAR with Extra- and Endovascular Bacteriophage Application
title Treatment of an Infected TEVAR with Extra- and Endovascular Bacteriophage Application
title_full Treatment of an Infected TEVAR with Extra- and Endovascular Bacteriophage Application
title_fullStr Treatment of an Infected TEVAR with Extra- and Endovascular Bacteriophage Application
title_full_unstemmed Treatment of an Infected TEVAR with Extra- and Endovascular Bacteriophage Application
title_short Treatment of an Infected TEVAR with Extra- and Endovascular Bacteriophage Application
title_sort treatment of an infected tevar with extra- and endovascular bacteriophage application
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9257328/
https://www.ncbi.nlm.nih.gov/pubmed/35812072
http://dx.doi.org/10.1016/j.ejvsvf.2022.02.004
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