rifampin and Aortic-Aneurysm

Topics: Aged; Antitubercular Agents; Aortic Aneurysm; Blood Vessel Prosthesis; Drug-Eluting Stents; Endovascular Procedures; Female; Humans; Isoniazid; Male; Middle Aged; Postoperative Complications; Retrospective Studies; Rifampin; Survival Rate; Treatment Outcome; Tuberculosis

To evaluate the short and long-term results of in situ prosthetic graft treatment using rifampicin-soaked silver polyester graft in patients with aortic infection.. All the patients surgically managed in our center for an aortic infection were retrospectively analyzed. The primary endpoint was the intra-hospital mortality, secondary outcomes were limb salvage, persistent or recurrent infection, prosthetic graft patency, and long-term survival.. From January 2004 to December 2015, 18 consecutive patients (12 men and 6 women) were operated on for aortic infection. Six mycotic aneurysms and 12 prosthetic infections, including 8 para-entero-prosthetic fistulas, were treated. In 5 cases, surgery was performed in emergency. During the early postoperative period, we performed one major amputation and two aortic infections were persistent. Intra-hospital mortality was 27.7%. The median follow-up among the 13 surviving patients was 26 months. During follow-up, none of the 13 patients presented reinfection or bypass thrombosis.. This series shows that in situ revascularization with rifampicin-soaked silver polyester graft for aortic infection have results in agreement with the literature in terms of intra-hospital mortality with a low reinfection rate.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Aneurysm, Infected; Anti-Bacterial Agents; Aortic Aneurysm; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Female; France; Hospital Mortality; Humans; Male; Middle Aged; Polyesters; Prosthesis Design; Prosthesis-Related Infections; Retrospective Studies; Rifampin; Risk Factors; Silver; Time Factors; Treatment Outcome; Young Adult

Topics: Aneurysm, Infected; Aortic Aneurysm; Humans; Polyethylene Terephthalates; Rifampin; Stents

In the treatment of an infected aorta, open repair and replacement with a rifampin-impregnated Dacron vascular graft decrease the risk of prosthetic graft infections, with several protocols available in the literature. We hypothesize that the same holds true for endovascular aneurysm repair, and after studying and optimizing rifampin solution concentration and incubation period to maximize the coating process of rifampin on Dacron endovascular stent grafts (ESGs), we propose a rapid real-time perioperative protocol.. Several prepared rifampin solutions, including a negative control solution, were used to coat multiple triplicate sets of Dacron endovascular aortic stent grafts at different but set incubation periods. Rifampin elution from the grafts was studied by spectroscopic analysis. Once an optimized solution concentration and incubation time were determined, the elution of rifampin over time from the graft and the graft's surface characteristics were studied by ultraviolet-visible spectroscopy and atomic force microscopy.. All coated ESGs with any concentration of prepared rifampin solution, regardless of incubation time, immediately demonstrated a visible bright orange discoloration and subsequently after elution procedures returned to the original noncolored state. At the 25-minute incubation time (standard flush), there was no statistical difference in the amount of rifampin coated to the ESGs with 10-mg/mL, 30-mg/mL, and 60-mg/mL solutions (0.06 ± 0.01, 0.07 ± 0.05, and 0.044 ± 0.01, respectively; P > .05). This was also true for a 10-minute incubation time (express flush) of 10-mg/mL and 60-mg/mL rifampin solution concentrations (0.04 ± 0.007 and 0.066 ± 0.014, respectively; P = .22). The elution-over-time of coated rifampin ESG, although not statistically significant, did seem to plateau and to reach a steady state by 50 hours and was confirmed by surface characteristics using atomic force microscopy.. Having studied two variables of rifampin coating techniques to Dacron ESGs, the authors propose a rapid real-time perioperative coating protocol by using a 10-mg/mL rifampin solution for a 10-minute incubation period. As rifampin loosely binds to Dacron ESGs by weak intermolecular forces, a rifampin-coated ESG would need to be inserted in a timely fashion to treat the diseased aorta and to deliver its antibiotic affect. A rapid perioperative coating protocol followed by immediate deployment makes our proposed technique especially useful in an urgent and unstable clinical scenario.

Topics: Aneurysm, Infected; Anti-Bacterial Agents; Aortic Aneurysm; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Coated Materials, Biocompatible; Drug Liberation; Endovascular Procedures; Kinetics; Materials Testing; Microscopy, Atomic Force; Polyethylene Terephthalates; Prosthesis Design; Rifampin; Spectrophotometry, Ultraviolet; Stents; Surface Properties

Topics: Aneurysm, Infected; Aortic Aneurysm; Humans; Polyethylene Terephthalates; Rifampin; Stents

The development of multiple infected aortic aneurysms is extremely rare, and treatment remains challenging. We report here a 72-year-old man with multiple infected aortic aneurysms in whom a staged in situ graft replacement for the aortic arch and pararenal abdominal aorta was successfully performed. A rifampicin-bonded graft seemed to be effective in preventing postoperative infection. Perioperative control of infection played a key role in the patient's surviving this critical condition.

Topics: Aged; Aneurysm, Infected; Anti-Bacterial Agents; Aortic Aneurysm; Aortography; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Coated Materials, Biocompatible; Humans; Male; Prosthesis Design; Rifampin; Tomography, X-Ray Computed; Treatment Outcome

Mycotic aortic aneurysm caused by Klebsiella pneumoniae (K. pneumoniae) is extremely rare and 3 cases of K. pneumoniae-induced mycotic aortic aneurysm are present, 2 of which were located in the aortic arch and the other in the suprarenal abdominal aorta. Urgent surgery was performed for 2 cases because of impending aneurysmal rupture and progressive septic shock, whereas elective surgery was performed after radical antibiotic chemotherapy for the other case. In-situ reconstruction with rifampicin-bonded prosthetic grafts was performed, and no infective complications have occurred in any of the cases.

Topics: Aged; Aged, 80 and over; Aorta, Abdominal; Aorta, Thoracic; Aortic Aneurysm; Blood Vessel Prosthesis Implantation; Humans; Klebsiella pneumoniae; Male; Rifampin; Tomography, X-Ray Computed