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