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Diagnosis and Management of Aortic Disease

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88 Treatment Table 36. Management of Aortic Mycotic Aneurysm: Comparison of Resection and Extra-Anatomic Reconstruction, In Situ Reconstruction, or Endovascular Device Repair Procedure Potential Indications* Extra-anatomic reconstruction Infrarenal location with gross purulence, psoas or retroperitoneal abscess, vertebral osteomyelitis, inadequate response to antibiotic therapy, selected aortoenteric fistulae In situ reconstruction • Thoracic, suprarenal, infrarenal, or visceral location • Selected aortoenteric fistulae Endovascular device repair Bridge procedure ‡ : hemodynamic instability, uncontrolled bleeding, rupture or impending rupture, selected patients with aortocentric fistulae, patients who are not fit for open surgery * Potential indication; must be individualized for each patient. † Polyester gras, rifampin-soaked or silver-coated; less experience reported with cryopreserved arterial allogras or venous autogras. ‡ Bridge procedure, used to stabilize patients until device explantation and arterial reconstruction. Adapted from: Wilson WR, Bower TC, Creager MA, et al. Vascular gra infections, mycotic aneurysms, and endovascular infections: a scientific statement from the American Heart Association. Circulation. 2016;134:e412-e460.

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