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Contemporary Outcom...
Contemporary Outcomes After Partial Resection of Infected Aortic Grafts
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Janko, Matthew (author)
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Hubbard, Grant (author)
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Woo, Karen (author)
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Kashyap, Vikram S (author)
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Mitchell, Megan (author)
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Murugesan, Arun (author)
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Chen, Lin (author)
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Gardner, Rachel (author)
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Baril, Donald (author)
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Hacker, Robert I (author)
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Szeberin, Zoltan (author)
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ElSayed, Ramsey (author)
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Magee, Gregory A (author)
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Motta, Fernando (author)
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Zhou, Wei (author)
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Lemmon, Gary (author)
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Coleman, Dawn (author)
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Behrendt, Christian-Alexander (author)
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Aziz, Faisal (author)
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Black, James H (author)
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Tran, Kimberly (author)
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Dao, Allen (author)
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Shutze, William (author)
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Garrett, H Edward (author)
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De Caridi, Giovanni (author)
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Patel, Rhusheet (author)
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Liapis, Christos D (author)
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Geroulakos, George (author)
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Kakisis, John (author)
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Moulakakis, Konstantinos (author)
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Kakkos, Starvos K (author)
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Obara, Hideaki (author)
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Wang, Grace (author)
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Stoecker, Jordan (author)
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Rhéaume, Pascal (author)
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Davila, Victor (author)
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Ravin, Reid (author)
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DeMartino, Randall (author)
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Milner, Ross (author)
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Shalhub, Sherene (author)
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Jim, Jeffrey (author)
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Lee, Jason (author)
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Dubuis, Celine (author)
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Ricco, Jean-Baptiste (author)
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Coselli, Joseph (author)
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Lemaire, Scott (author)
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Fatima, Javairiah (author)
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Sanford, Jennifer (author)
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Yoshida, Winston (author)
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Schermerhorn, Marc L (author)
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Menard, Matthew (author)
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Belkin, Michael (author)
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Blackwood, Stuart (author)
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Conrad, Mark (author)
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Wang, Linda (author)
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Crofts, Sara (author)
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Nixon, Thomas (author)
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Wu, Timothy (author)
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Chiesa, Roberto (author)
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Bose, Saideep (author)
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Turner, Jason (author)
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Moore, Ryan (author)
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Smith, Justin (author)
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Irshad, Ali (author)
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Hsu, Jeffrey (author)
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Czerny, Martin (author)
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Cullen, Jonathan (author)
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Kahlberg, Andrea (author)
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Setacci, Carlo (author)
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Joh, Jin Hyun (author)
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Senneville, Eric (author)
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Garrido, Pedro (author)
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Sarac, Timur P (author)
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Rizzo, Anthony (author)
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Go, Michael R (author)
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- Björck, Martin (author)
- Uppsala universitet,Kärlkirurgi
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- Gavali, Hamid (author)
- Uppsala universitet,Kärlkirurgi
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- Wanhainen, Anders (author)
- Uppsala universitet,Kärlkirurgi
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D'Oria, Mario (author)
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Lepidi, Sandro (author)
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Mastrorilli, Davide (author)
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Veraldi, Gianfranco (author)
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Piazza, Michele (author)
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Squizzato, Francesco (author)
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Beck, Adam (author)
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St John, Rebecca (author)
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Wishy, Andrew (author)
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Humphries, Misty (author)
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Shah, Samir K (author)
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Back, Martin (author)
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Chung, Jayer (author)
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Lawrence, Peter F (author)
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Bath, Jonathan (author)
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Smeds, Matthew R (author)
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(creator_code:org_t)
- Elsevier, 2021
- 2021
- English.
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In: Annals of Vascular Surgery. - : Elsevier. - 0890-5096 .- 1615-5947. ; 76, s. 202-210
- Related links:
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https://urn.kb.se/re...
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https://doi.org/10.1...
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Abstract
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- 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.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kirurgi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Surgery (hsv//eng)
Publication and Content Type
- ref (subject category)
- art (subject category)
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- By the author/editor
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Janko, Matthew
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Hubbard, Grant
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Woo, Karen
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Kashyap, Vikram ...
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Mitchell, Megan
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Murugesan, Arun
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show more...
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Chen, Lin
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Gardner, Rachel
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Baril, Donald
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Hacker, Robert I
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Szeberin, Zoltan
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ElSayed, Ramsey
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Magee, Gregory A
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Motta, Fernando
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Zhou, Wei
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Lemmon, Gary
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Coleman, Dawn
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Behrendt, Christ ...
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Aziz, Faisal
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Black, James H
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Tran, Kimberly
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Dao, Allen
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Shutze, William
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Garrett, H Edwar ...
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De Caridi, Giova ...
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Patel, Rhusheet
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Liapis, Christos ...
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Geroulakos, Geor ...
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Kakisis, John
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Moulakakis, Kons ...
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Kakkos, Starvos ...
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Obara, Hideaki
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Wang, Grace
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Stoecker, Jordan
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Rhéaume, Pascal
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Davila, Victor
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Ravin, Reid
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DeMartino, Randa ...
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Milner, Ross
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Shalhub, Sherene
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Jim, Jeffrey
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Lee, Jason
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Dubuis, Celine
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Ricco, Jean-Bapt ...
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Coselli, Joseph
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Lemaire, Scott
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Fatima, Javairia ...
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Sanford, Jennife ...
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Yoshida, Winston
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Schermerhorn, Ma ...
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Menard, Matthew
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Belkin, Michael
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Blackwood, Stuar ...
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Conrad, Mark
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Wang, Linda
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Crofts, Sara
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Nixon, Thomas
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Wu, Timothy
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Chiesa, Roberto
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Bose, Saideep
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Turner, Jason
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Moore, Ryan
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Smith, Justin
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Irshad, Ali
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Hsu, Jeffrey
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Czerny, Martin
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Cullen, Jonathan
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Kahlberg, Andrea
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Setacci, Carlo
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Joh, Jin Hyun
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Senneville, Eric
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Garrido, Pedro
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Sarac, Timur P
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Rizzo, Anthony
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Go, Michael R
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Björck, Martin
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Gavali, Hamid
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Wanhainen, Ander ...
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D'Oria, Mario
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Lepidi, Sandro
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Mastrorilli, Dav ...
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Veraldi, Gianfra ...
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Piazza, Michele
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Squizzato, Franc ...
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Beck, Adam
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St John, Rebecca
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Wishy, Andrew
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Humphries, Misty
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Shah, Samir K
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Back, Martin
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Chung, Jayer
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Lawrence, Peter ...
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Bath, Jonathan
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Smeds, Matthew R
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- About the subject
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Surgery
- Articles in the publication
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Annals of Vascul ...
- By the university
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Uppsala University