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Contemporary Outcomes After Partial Resection of Infected Aortic Grafts.
- Source :
-
Annals of vascular surgery [Ann Vasc Surg] 2021 Oct; Vol. 76, pp. 202-210. Date of Electronic Publication: 2021 Aug 23. - Publication Year :
- 2021
-
Abstract
- Introduction: Aortic graft infection remains a considerable clinical challenge, and it is unclear which variables are associated with adverse outcomes among patients undergoing partial resection.<br />Methods: A retrospective, multi-institutional study of patients who underwent partial resection of infected aortic grafts from 2002 to 2014 was performed using a standard database. Baseline demographics, comorbidities, operative, and postoperative variables were recorded. The primary outcome was mortality. Descriptive statistics, Kaplan-Meier (KM) survival analysis, and Cox regression analysis were performed.<br />Results: One hundred fourteen patients at 22 medical centers in 6 countries underwent partial resection of an infected aortic graft. Seventy percent were men with median age 70 years. Ninety-seven percent had a history of open aortic bypass graft: 88 (77%) patients had infected aortobifemoral bypass, 18 (16%) had infected aortobiiliac bypass, and 1 (0.8%) had an infected thoracic graft. Infection was diagnosed at a median 4.3 years post-implant. All patients underwent partial resection followed by either extra-anatomic (47%) or in situ (53%) vascular reconstruction. Median follow-up period was 17 months (IQR 1, 50 months). Thirty-day mortality was 17.5%. The KM-estimated median survival from time of partial resection was 3.6 years. There was no significant survival difference between those undergoing in situ reconstruction or extra-anatomic bypass (P = 0.6). During follow up, 72% of repairs remained patent and 11% of patients underwent major amputation. On univariate Cox regression analysis, Candida infection was associated with increased risk of mortality (HR 2.4; P = 0.01) as well as aortoenteric fistula (HR 1.9, P = 0.03). Resection of a single graft limb only to resection of abdominal (graft main body) infection was associated with decreased risk of mortality (HR 0.57, P = 0.04), as well as those with American Society of Anesthesiologists classification less than 3 (HR 0.35, P = 0.04). Multivariate analysis did not reveal any factors significantly associated with mortality. Persistent early infection was noted in 26% of patients within 30 days postoperatively, and 39% of patients were found to have any post-repair infection during the follow-up period. Two patients (1.8%) were found to have a late reinfection without early persistent postoperative infection. Patients with any post-repair infection were older (67 vs. 60 years, P = 0.01) and less likely to have patent repairs during follow up (59% vs. 32%, P = 0.01). Patients with aortoenteric fistula had a higher rate of any post-repair infection (63% vs. 29%, P < 0.01) CONCLUSION: This large multi-center study suggests that patients who have undergone partial resection of infected aortic grafts may be at high risk of death or post-repair infection, especially older patients with abdominal infection not isolated to a single graft limb, or with Candida infection or aortoenteric fistula. Late reinfection correlated strongly with early persistent postoperative infection, raising concern for occult retained infected graft material.<br /> (Copyright © 2021. Published by Elsevier Inc.)
- Subjects :
- Aged
Blood Vessel Prosthesis Implantation instrumentation
Blood Vessel Prosthesis Implantation mortality
Endovascular Procedures instrumentation
Endovascular Procedures mortality
Female
Humans
Male
Middle Aged
Prosthesis-Related Infections diagnosis
Prosthesis-Related Infections microbiology
Prosthesis-Related Infections mortality
Reoperation
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
Aorta surgery
Blood Vessel Prosthesis adverse effects
Blood Vessel Prosthesis Implantation adverse effects
Device Removal adverse effects
Device Removal mortality
Endovascular Procedures adverse effects
Prosthesis-Related Infections surgery
Subjects
Details
- Language :
- English
- ISSN :
- 1615-5947
- Volume :
- 76
- Database :
- MEDLINE
- Journal :
- Annals of vascular surgery
- Publication Type :
- Academic Journal
- Accession number :
- 34437963
- Full Text :
- https://doi.org/10.1016/j.avsg.2021.07.002