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Semi-Conservative Treatment Versus Surgery in Abdominal Aortic Graft and Endograft Infections
Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden.
Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden.
Department of Medical Sciences, Section of Infectious Diseases, Uppsala University, Uppsala, Sweden.
Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden.
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2023 (English)In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 66, no 3, p. 397-406Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: Abdominal aortic graft and endograft infections (AGIs) are rare complications following aortic surgery. Radical surgery (RS) with resection of the infected graft and reconstruction with extra-anatomical bypass or in situ reconstruction is the preferred therapy. For patients unfit for RS, a semi-conservative (SC), graft-preserving strategy is possible. This paper aimed to compare survival and infection outcomes between RS and SC treatment for AGI in a nationwide cohort.

METHODS: Patients with abdominal AGI-related surgery in Sweden between January 1995 and May 2017 were identified. The Management of Aortic Graft Infection Collaboration (MAGIC) criteria were used for definition of AGI. Multivariable regression was performed to identify factors associated with mortality.

RESULTS: A total of 169 patients with surgically treated abdominal AGI were identified, comprising 43 SC [14 endografts; 53% with a graft-enteric fistula (GEF) in total] and 126 RS [26 endografts; 50% with a GEF in total]. The SC cohort was older and had a higher frequency of cardiac comorbidities. There was a non-significant trend towards lower Kaplan-Meier estimated 5-year survival for SC versus RS (30.2% vs. 48.4%; p = .066). A non-significant trend was identified towards worse Kaplan-Meier estimated 5-year survival for SC patients with a GEF versus without a GEF (21.7% vs. 40.1%; p = .097). There were significantly more recurrent graft infections comparing SC versus RS (45.4% vs. 19.3%; p < .001). In a Cox regression model adjusting for confounders, there was no difference in 5-year survival comparing SC versus RS (HR 1.0, 95% CI 0.6 - 1.5).

CONCLUSION: In this national AGI cohort, we could not identify any mortality difference comparing SC versus RS for AGI when adjusting for comorbidities. Presence of GEF likely negatively impacts survival outcomes of SC patients. Rates of recurrent infection remain high for SC-treated patients.

Place, publisher, year, edition, pages
Elsevier, 2023. Vol. 66, no 3, p. 397-406
Keywords [en]
Aortic graft infection, Multicentre, Nationwide, Radical surgery, Semi-conservative
National Category
Surgery
Identifiers
URN: urn:nbn:se:oru:diva-106588DOI: 10.1016/j.ejvs.2023.06.019ISI: 001073895800001PubMedID: 37356704Scopus ID: 2-s2.0-85166665977OAI: oai:DiVA.org:oru-106588DiVA, id: diva2:1779713
Available from: 2023-07-04 Created: 2023-07-04 Last updated: 2024-03-06Bibliographically approved

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Hörer, Tal M.

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