Clostridial aortic graft infection

ECM-based materials in cardiovascular applications: Inherent healing potential and augmentation of native regenerative processes

The in vivo healing process of vascular grafts involves the interaction of many contributing factors. The ability of vascular grafts to provide an environment which allows successful accomplishment of this process is extremely difficult. Poor endothelisation, inflammation, infection, occlusion, thrombosis, hyperplasia and pseudoaneurysms are common issues with synthetic grafts in vivo. Advanced materials composed of decellularised extracellular matrices (ECM) have been shown to promote the healing process via modulation of the host immune response, resistance to bacterial infections, allowing re-innervation and reestablishing homeostasis in the healing region. The physiological balance within the newly developed vascular tissue is maintained via the recreation of correct biorheology and mechanotransduction factors including host immune response, infection control, homing and the attraction of progenitor cells and infiltration by host tissue. Here, we review the progress in this tissue engineering approach, the enhancement potential of ECM materials and future prospects to reach the clinical environment.

Aortic Paraprosthetic-colonic Fistulae: A Review of the Literature

BACKGROUND

Aortic graft-colonic fistulae are a rare complication of aortic reconstructive surgery.

METHODS AND FINDINGS

A comprehensive review of this entity was performed based on the available literature from 1950 until 2006. Available reports were analyzed with respect to demographics, prior surgical intervention and its indication, prosthetic material used during the initial intervention, clinical presentation, the time interval in between the initial operation and symptoms, the method of treatment of the aortic graft-colonic fistula and its outcome.

Lower intestinal bleeding due to aorto-enteric fistula

The case is described of a man who complained of intermittent fever and fatigue. After three digestive endoscopies and computed tomography, a 99m technetium-HM-PAO-labelled white cell scan was usefully employed to establish diagnosis. Anaerobic aortic Graft infection and anaemia due to lower intermittent occult intestinal bleeding were found. The intestinal bleeding was caused by secondary aorto-jejunal fistula. This condition is rare, but should be suspected whenever a patient with aortic prosthesis presents with occult digestive bleeding and unexplained fever.

Anaerobic cellulitis as the result of Clostridium perfringens: a rare cause of vascular access graft infection

Infection of prosthetic vascular access grafts is the second most common complication of vascular access and represents a challenge encountered by the vascular surgeon. Anaerobic graft infections are rare. We report on a case of a prosthetic vascular access graft infection with Clostridium perfringens. To our knowledge, only one other case with an infected arteriovenous shunt caused by C perfringens has been reported. The patient, a 67-year-old woman with end-stage renal failure as the result of polycystic renal disease, was seen with an infected pseudoaneurysm at the arterial puncture site of the loop graft on the left arm. There was associated purulence at the time of operation. Surgical management consisted of complete graft removal because of the presence of small tunnel abscesses. C perfringens was found in the resected pseudoaneurysm and graft material. Infected pseudoaneurysms most likely are attributable to repetitive punctures in one small area and to a break in sterile technique. A compromised vascular supply, not infrequent in patients for hemodialysis, may lower the oxidation reduction potential, which allows anaerobic bacteria, such as C perfringens, to cause infection.