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  • Gavali, HamidDepartment of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden (author)

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

  • Article/chapterEnglish2023

Publisher, publication year, extent ...

  • Elsevier,2023
  • printrdacarrier

Numbers

  • LIBRIS-ID:oai:DiVA.org:oru-106588
  • https://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-106588URI
  • https://doi.org/10.1016/j.ejvs.2023.06.019DOI

Supplementary language notes

  • Language:English
  • Summary in:English

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  • Subject category:ref swepub-contenttype
  • Subject category:art swepub-publicationtype

Notes

  • 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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  • Mani, KevinDepartment of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden (author)
  • Furebring, MiaDepartment of Medical Sciences, Section of Infectious Diseases, Uppsala University, Uppsala, Sweden (author)
  • Olsson, Karl WilhelmDepartment of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden (author)
  • Lindstrom, DavidDepartment of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden (author)
  • Sorelius, KarlDepartment of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark (author)
  • Sigvant, BirgittaDepartment of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden; Department of Vascular Surgery, Karlstad Central Hospital, Karlstad, Sweden (author)
  • Torstensson, GustavDepartment of Surgery, Helsingborg Regional Hospital, Helsingborg, Sweden (author)
  • Andersson, ManneDepartment of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden; Department of Surgery, County Hospital Ryhov, Ryhov, Jönköping County, Sweden (author)
  • Forssell, ClaesDepartment of Cardiovascular Surgery, Division of Vascular Surgery, Linköping University Hospital, Linköping, Sweden (author)
  • Astrand, HåkanDepartment of Surgery, County Hospital Ryhov, Ryhov, Jönköping County, Sweden (author)
  • Lundstrom, TobiasDepartment of Surgery and Urology, Eskilstuna Hospital, Eskilstuna, Sweden (author)
  • Khan, ShahzadDepartment of Surgery, Malmö University Hospital, Lund University, Malmö, Sweden (author)
  • Sonesson, BjornDepartment of Surgery, Malmö University Hospital, Lund University, Malmö, Sweden (author)
  • Stackelberg, OttoDepartment of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden; Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden (author)
  • Gillgren, PeterDepartment of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden; Department of Vascular Surgery, Södersjukhuset, Stockholm, Sweden (author)
  • Isaksson, JonDepartment of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden (author)
  • Kragsterman, BjörnDepartment of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden; Department of Surgery, Västerås Central Hospital, Västerås, Sweden (author)
  • Gidlund, Khatereh Djavani,1967-Department of Cardiothoracic and Vascular Surgery and Department of Surgery (author)
  • Hörer, Tal M.,1971-Örebro universitet,Institutionen för medicinska vetenskaper,Region Örebro län,Department of Cardiothoracic and Vascular Surgery and Department of Surgery(Swepub:oru)thr (author)
  • Sadeghi, MitraDepartment of Medical Sciences, Section of Infectious Diseases, Uppsala University, Uppsala, Sweden (author)
  • Wanhainen, AndersDepartment of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden (author)
  • Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, SwedenDepartment of Medical Sciences, Section of Infectious Diseases, Uppsala University, Uppsala, Sweden (creator_code:org_t)

Related titles

  • In:European Journal of Vascular and Endovascular Surgery: Elsevier66:3, s. 397-4061078-58841532-2165

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