Semi-Conservative Treatment Versus Surgery in Abdominal Aortic Graft and Endograft Infections

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Semi-Conservative Treatment Versus Surgery in Abdominal Aortic Graft and Endograft Infections

Gavali, Hamid (author): Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden

Mani, Kevin (author): Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden

Furebring, Mia (author): Department of Medical Sciences, Section of Infectious Diseases, Uppsala University, Uppsala, Sweden

Olsson, Karl Wilhelm (author): Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden

Lindstrom, David (author): Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden

Sorelius, Karl (author): Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark

Sigvant, Birgitta (author): Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden; Department of Vascular Surgery, Karlstad Central Hospital, Karlstad, Sweden

Torstensson, Gustav (author): Department of Surgery, Helsingborg Regional Hospital, Helsingborg, Sweden

Andersson, Manne (author): Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden; Department of Surgery, County Hospital Ryhov, Ryhov, Jönköping County, Sweden

Forssell, Claes (author): Department of Cardiovascular Surgery, Division of Vascular Surgery, Linköping University Hospital, Linköping, Sweden

Astrand, Håkan (author): Department of Surgery, County Hospital Ryhov, Ryhov, Jönköping County, Sweden

Lundstrom, Tobias (author): Department of Surgery and Urology, Eskilstuna Hospital, Eskilstuna, Sweden

Khan, Shahzad (author): Department of Surgery, Malmö University Hospital, Lund University, Malmö, Sweden

Sonesson, Bjorn (author): Department of Surgery, Malmö University Hospital, Lund University, Malmö, Sweden

Stackelberg, Otto (author): Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden; Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden

Gillgren, Peter (author): Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden; Department of Vascular Surgery, Södersjukhuset, Stockholm, Sweden

Isaksson, Jon (author): Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden

Kragsterman, Björn (author): Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden; Department of Surgery, Västerås Central Hospital, Västerås, Sweden

Gidlund, Khatereh Djavani, 1967- (author): Department of Cardiothoracic and Vascular Surgery and Department of Surgery

Hörer, Tal M., 1971- (author): Örebro universitet,Institutionen för medicinska vetenskaper,Region Örebro län,Department of Cardiothoracic and Vascular Surgery and Department of Surgery

Sadeghi, Mitra (author): Department of Medical Sciences, Section of Infectious Diseases, Uppsala University, Uppsala, Sweden

Wanhainen, Anders (author): Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden

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Elsevier, 2023
2023
English.
In: European Journal of Vascular and Endovascular Surgery. - : Elsevier. - 1078-5884 .- 1532-2165. ; 66:3, s. 397-406

Related links:: https://doi.org/10.1...; show more...; https://urn.kb.se/re...; https://doi.org/10.1...; show less...

Journal article (peer-reviewed)

Abstract Subject headings

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.

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MEDICAL AND HEALTH SCIENCES: MEDICAL AND HEAL ...; and Clinical Medicin ...; and Surgery

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Semi-Conservative Treatment Versus Surgery in Abdominal Aortic Graft and Endograft Infections

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