PMC9257328_01
Representative slides from the pre-operative [F18] fluorodeoxyglucose PET-CT scan. The yellow emission shows the level of accumulation of the tracer substance around the stent graft in the thoracic aorta as a sign of active inflammation.
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To rule out the aortic stent graft as a focus of infection, a [F18] fluorodeoxyglucose PET-CT was performed (Fig. 1).
Intra-operative images from the first step of treatment. The aortic arch and the proximal descending aorta were debrided and prepared for vacuum sponge placement (A). Two endosponges were placed around the aorta (B). Finally, another vacuum sponge was applied for ventral coverage of the aorta (C) before the thorax was closed.
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After obtaining local swab specimens for microbiological analysis, debridement and jet lavage were performed (Fig. 2A). Germany) were placed on the lesser and greater curvatures of the aortic arch and the proximal descending aorta (Fig. 2B), followed by a V.A.C. GRANFOAM dressing sponge (18 x 12.5 x 3.2 cm, KCI Medizinprodukte GmbH, Wiesbaden, Germany) (Fig. 2C).
For local endovascular bacteriophage application, two RELAY NBS PLUS stent grafts were released and externally coated with a bacteriophage gel (A) before re-assembly (B) and endovascular placement at the site of the infected stent graft in the thoracic aorta. Final angiography confirmed placement of the bacteriophage covered stent grafts (C).
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Three days later, two sterile RELAY NBS PLUS stent grafts (Vascutek Terumo-Bolton Medical, Vascutek Germany GmbH, Hamburg, Germany) were unsheathed and externally coated with a mixture of 40 mL SniPha 360 and 15.8% hydroxyethylcellulose gel (Fig. 3A). Afterwards the externally bacteriophage coated grafts were re-assembled for endovascular placement (Fig. 3B). After overview angiography, the two grafts were placed with small overlapping of the infected stent graft by 2 cm cranially (without covering the left subclavian artery) and caudally to line the infected stent graft completely with the bacteriophage coated one (Fig. 3C).
Representative slides from the post-operative [F18] fluorodeoxyglucose PET-CT scan three months (A and B) and 12 months (C and D) after bacteriophage therapy. No enhanced accumulation of the tracer around the aorta or the stent grafts could be visualised.
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PET-CT scans performed three months and one year after the bacteriophage treatment did not reveal signs of infection in or around the thoracic aorta (Fig. 4).