@article{3032695,
    title = "Contemporary Outcomes After Partial Resection of Infected Aortic Grafts",
    author = "Janko, Matthew and Hubbard, Grant and Woo, Karen and Kashyap, Vikram S. and and Mitchell, Megan and Murugesan, Arun and Chen, Lin and Gardner, and Rachel and Baril, Donald and Hacker, Robert I. and Szeberin, Zoltan and and ElSayed, Ramsey and Magee, Gregory A. and Motta, Fernando and Zhou, Wei and and Lemmon, Gary and Coleman, Dawn and Behrendt, Christian-Alexander and and Aziz, Faisal and Black, James H. and Tran, Kimberly and Dao, Allen and and Shutze, William and Garrett, H. Edward and De Caridi, Giovanni and and Patel, Rhusheet and Liapis, Christos D. and Geroulakos, George and and Kakisis, John and Moulakakis, Konstantinos and Kakkos, Starvos K. and and Obara, Hideaki and Wang, Grace and Stoecker, Jordan and Rheaume, Pascal and and Davila, Victor and Ravin, Reid and DeMartino, Randall and Milner, and Ross and Shalhub, Sherene and Jim, Jeffrey and Lee, Jason and Dubuis, and Celine and Ricco, Jean-Baptiste and Coselli, Joseph and Lemaire, Scott and and Fatima, Javairiah and Sanford, Jennifer and Yoshida, Winston and and Schermerhorn, Marc L. and Menard, Matthew and Belkin, Michael and and Blackwood, Stuart and Conrad, Mark and Wang, Linda and Crofts, Sara and and Nixon, Thomas and Wu, Timothy and Chiesa, Roberto and Bose, Saideep and and Turner, Jason and Moore, Ryan and Smith, Justin and Irshad, Ali and Hsu, and Jeffrey and Czerny, Martin and Cullen, Jonathan and Kahlberg, Andrea and and Setacci, Carlo and Joh, Jin Hyun and Senneville, Eric and Garrido, Pedro and and Sarac, Timur P. and Rizzo, Anthony and Go, Michael R. and Bjorck, and Martin and Gavali, Hamid and Wanhainen, Anders and D'Oria, Mario and and Lepidi, Sandro and Mastrorilli, Davide and Veraldi, Gianfranco and and Piazza, Michele and Squizzato, Francesco and Beck, Adam and St John, and Rebecca and Wishy, Andrew and Humphries, Misty and Shah, Samir K. and and Back, Martin and Chung, Jayer and Lawrence, Peter F. and Bath, Jonathan and and Smeds, Matthew R.",
    journal = "Annals of Vascular Surgery",
    year = "2021",
    volume = "76",
    pages = "202-210",
    publisher = "EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC",
    issn = "0890-5096",
    doi = "10.1016/j.avsg.2021.07.002",
    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.
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.
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."
}