In-situ bypass is associated with superior infection-free survival compared with extra-anatomic bypass for the management of secondary aortic graft infections without enteric involvement

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Janko, Matthew R.Case Western Reserve Univ, Sch Med, Univ Hosp Cleveland Med Ctr, Div Vasc Surg & Endovasc Therapy, Cleveland, OH 44106 USA. (författare)

In-situ bypass is associated with superior infection-free survival compared with extra-anatomic bypass for the management of secondary aortic graft infections without enteric involvement

Artikel/kapitelEngelska2022

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Elsevier,2022
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LIBRIS-ID:oai:DiVA.org:uu-482791
https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-482791URI
https://doi.org/10.1016/j.jvs.2022.03.869DOI

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Språk:engelska
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Objective: The optimal revascularization modality following complete resection of aortic graft infection (AGI) without enteric involvement remains unclear. The purpose of this investigation is to determine the revascularization approach associated with the lowest morbidity and mortality using real-world data in patients undergoing complete excision of AGI. Methods: A retrospective, multi-institutional study of AGI from 2002 to 2014 was performed using a standardized database. Baseline demographics, comorbidities, and perioperative variables were recorded. The primary outcome was infection-free survival. Descriptive statistics, Kaplan-Meier survival analysis, and univariate and multivariable analyses were performed. Results: A total of 241 patients at 34 institutions from seven countries presented with AGI during the study period (median age, 68 years; 75% male). The initial aortic procedures that resulted in AGI were 172 surgical grafts (71%), 66 endografts (27%), and three unknown (2%). Of the patients, 172 (71%) underwent complete excision of infected aortic graft material followed by in situ (in-line) bypass (ISB), including antibiotic-treated prosthetic graft (35%), autogenous femoral vein (neo-aortoiliac surgery) (24%), and cryopreserved allograft (41%). Sixty-nine patients (29%) underwent extra-anatomic bypass (EAB). Overall median Kaplan-Meier estimated survival was 5.8 years. Perioperative mortality was 16%. When stratified by ISB vs EAB, there was a significant difference in Kaplan-Meier estimated infection-free survival (2910 days; interquartile range, 391-3771 days vs 180 days; interquartile range, 27-3750 days; P <.001). There were otherwise no significant differences in presentation, comorbidities, or perioperative variables. Multivariable Cox regression showed lower infection-free survival among patients with EAB (hazard ratio [HR], 2.4; 95% confidence interval [CI], 1.6-3.6; P <.001), polymicrobial infection (HR, 2.2; 95% CI, 1.4-3.5; P = .001), methicillin-resistant Staphylococcus aureus infection (HR, 1.7; 95% CI, 1.1-2.7; P = .02), as well as the protective effect of omental/muscle flap coverage (HR, 0.59; 95% CI, 0.37-0.92; P = .02). Conclusions: After complete resection of AGI, perioperative mortality is 16% and median overall survival is 5.8 years. EAB is associated with nearly a two and one-half-fold higher reinfection/mortality compared with ISB. Omental and/or muscle flap coverage of the repair appear protective.

Ämnesord och genrebeteckningar

MEDICIN OCH HÄLSOVETENSKAP Klinisk medicin Kirurgi hsv//swe
MEDICAL AND HEALTH SCIENCES Clinical Medicine Surgery hsv//eng
Antibiotic-soaked Dacron
Aortic graft infection
Axillofemoral bypass
Cryopreserved allograft
Extra-anatomic bypass
In situ bypass
Neo-aortoiliac surgery (NAIS)

Biuppslag (personer, institutioner, konferenser, titlar ...)

Hubbard, GrantCase Western Reserve Univ, Sch Med, Univ Hosp Cleveland Med Ctr, Div Vasc Surg & Endovasc Therapy, Cleveland, OH 44106 USA. (författare)
Back, MartinUniv Florida, Dept Surg, Div Vasc Surg, Gainesville, FL USA. (författare)
Shah, Samir K.Univ Florida, Dept Surg, Div Vasc Surg, Gainesville, FL USA. (författare)
Pomozi, EnikoSemmelweis Univ, Dept Vasc & Endovasc Surg, Budapest, Hungary. (författare)
Szeberin, ZoltanSemmelweis Univ, Dept Vasc & Endovasc Surg, Budapest, Hungary. (författare)
DeMartino, RandallMayo Clin, Div Vasc & Endovasc Surg, Rochester, MN USA. (författare)
Wang, Linda J.Massachusetts Gen Hosp, Dept Vasc & Endovasc Surg, Boston, MA 02114 USA. (författare)
Crofts, SarahMassachusetts Gen Hosp, Dept Vasc & Endovasc Surg, Boston, MA 02114 USA. (författare)
Belkin, MichaelHarvard Med Sch, Brigham & Womens Hosp, Dept Vasc & Endovasc Surg, Boston, MA 02115 USA. (författare)
Davila, Victor J.Mayo Clin Arizona, Div Vasc Surg, Dept Gen Surg, Phoenix, AZ USA. (författare)
Lemmon, Gary W.Indiana Univ, Dept Surg, Div Vasc Surg, Indianapolis, IN USA. (författare)
Wang, Shihuan K.Indiana Univ, Dept Surg, Div Vasc Surg, Indianapolis, IN USA. (författare)
Czerny, MartinUniv Heart Ctr Freiburg Bad Krozingen, Dept Cardiovasc Surg, Freiburg, Germany. (författare)
Kreibich, MaximilianUniv Heart Ctr Freiburg Bad Krozingen, Dept Cardiovasc Surg, Freiburg, Germany. (författare)
Humphries, Misty D.UC Davis Hlth, Div Vasc Surg, Dept Surg, Sacramento, CA USA. (författare)
Shutze, WilliamHeart Hosp Plano, Texas Vasc Associates, Plano, TX USA. (författare)
Joh, Jin HyunKyung Hee Univ Hosp Gangdong, Dept Surg, Div Vasc Surg, Seoul, South Korea. (författare)
Cho, SungsinUniv Med Ctr Hamburg Eppendorf, Dept Vasc Med, GermanVasc Res Grp, Hamburg, Germany. (författare)
Behrendt, Christian-AlexanderUniv Med Ctr Hamburg Eppendorf, Dept Vasc Med, GermanVasc Res Grp, Hamburg, Germany. (författare)
Setacci, CarloUniv Siena, Dept Vasc & Endovasc Surg, Siena, Italy. (författare)
Hacker, Robert, ISurg Arts St Louis, Div Vasc Surg, Bridgeton, MO USA. (författare)
Sobreira, Marcone LimaUniv Estadual Paulista, Botucatu Sch Med, Dept Surg & Orthoped, Sao Paulo, Brazil. (författare)
Yoshida, Winston BonettiUniv Estadual Paulista, Botucatu Sch Med, Dept Surg & Orthoped, Sao Paulo, Brazil. (författare)
D'Oria, MarioUniv Hosp Trieste, Cardiovasc Dept, Div Vasc & Endovasc Surg, Trieste, Italy. (författare)
Lepidi, SandroUniv Hosp Trieste, Cardiovasc Dept, Div Vasc & Endovasc Surg, Trieste, Italy. (författare)
Chiesa, RobertoIst Sci San Raffaele, Dept Vasc Surg, Milan, Italy. (författare)
Kahlberg, AndreaIst Sci San Raffaele, Dept Vasc Surg, Milan, Italy. (författare)
Go, Michael R.Ohio State Univ, Coll Med, Dept Surg, Div Vasc Dis & Surg, Columbus, OH 43210 USA. (författare)
Rizzo, Anthony N.Ohio State Univ, Coll Med, Dept Surg, Div Vasc Dis & Surg, Columbus, OH 43210 USA. (författare)
Black, James H.Johns Hopkins Univ Hosp, Div Vasc Surg & Endovasc Therapy, Dept Surg, Baltimore, MD 21287 USA. (författare)
Magee, Gregory A.Univ Southern Calif, Dept Surg, Div Vasc Surg & Endovasc Therapy, Los Angeles, CA USA. (författare)
Elsayed, RamseyUniv Southern Calif, Dept Surg, Div Vasc Surg & Endovasc Therapy, Los Angeles, CA USA. (författare)
Baril, Donald T.Cedars Sinai Med Ctr, Dept Surg, Div Vasc Surg, Los Angeles, CA 90048 USA. (författare)
Beck, Adam W.Univ Alabama Birmingham, Div Vasc Surg & Endovasc Therapy, Birmingham, AL USA. (författare)
McFarland, Graeme E.Univ Alabama Birmingham, Div Vasc Surg & Endovasc Therapy, Birmingham, AL USA. (författare)
Gavali, HamidUppsala universitet,Institutionen för medicinsk cellbiologi,Science for Life Laboratory, SciLifeLab,Kärlkirurgi(Swepub:uu)hamga922 (författare)
Wanhainen, AndersUppsala universitet,Kärlkirurgi(Swepub:uu)anwan103 (författare)
Kashyap, Vikram S.Case Western Reserve Univ, Sch Med, Univ Hosp Cleveland Med Ctr, Div Vasc Surg & Endovasc Therapy, Cleveland, OH 44106 USA. (författare)
Stoecker, Jordan B.Hosp Univ Penn, Dept Surg, Div Vasc Surg & Endovasc Therapy, 3400 Spruce St, Philadelphia, PA 19104 USA. (författare)
Wang, Grace J.Hosp Univ Penn, Dept Surg, Div Vasc Surg & Endovasc Therapy, 3400 Spruce St, Philadelphia, PA 19104 USA. (författare)
Zhou, WeiUniv Arizona, Dept Surg, Div Vasc Surg, Tucson, AZ USA. (författare)
Fujimura, NaokiKeio Univ, Dept Surg, Sch Med, Shinjuku Ku, Tokyo, Japan. (författare)
Obara, HideakiBrooke Army Med Ctr, Div Vasc & Endovasc Surg, San Antonio, TX USA. (författare)
Wishy, Andrew M.St Louis Univ, Div Vasc Surg, Dept Surg, St Louis, MO USA. (författare)
Bose, SaideepSt Louis Univ, Div Vasc Surg, Dept Surg, St Louis, MO USA. (författare)
Smeds, MatthewHarvard Med Sch, Beth Israel Deaconess Med Ctr, Div Vasc & Endovasc Surg, Boston, MA 02115 USA. (författare)
Liang, PatricHarvard Med Sch, Beth Israel Deaconess Med Ctr, Div Vasc & Endovasc Surg, Boston, MA 02115 USA. (författare)
Schermerhorn, MarcSt Elizabeth Hosp, Div Vasc Surg, Brighton, MA USA. (författare)
Conrad, Mark F.Kaiser Permanente, Div Vasc Surg, Fontana, CA USA. (författare)
Hsu, Jeffrey H.Kaiser Permanente, Div Vasc Surg, Fontana, CA USA. (författare)
Patel, RhusheetUniv Calif Los Angeles, David Geffen Sch Med, Dept Surg, Div Vasc Surg & Endovasc Therapy, Los Angeles, CA 90095 USA. (författare)
Lee, Jason T.Stanford Univ, Med Ctr, Dept Surg, Div Vasc Surg, Stanford, CA 94305 USA. (författare)
Liapis, Christos D.Natl & Kapodistrian Univ Athens, Attikon Univ Hosp, Dept Vasc Surg, Athens, Greece. (författare)
Moulakakis, Konstantinos G.Natl & Kapodistrian Univ Athens, Attikon Univ Hosp, Dept Vasc Surg, Athens, Greece. (författare)
Farber, Mark A.Univ N Carolina, Dept Surg, Div Vasc Surg, Chapel Hill, NC USA. (författare)
Motta, FernandoUniv N Carolina, Dept Surg, Div Vasc Surg, Chapel Hill, NC USA. (författare)
Ricco, Jean-BaptisteUniv Poitiers Med Sch, Dept Clin Res, Poitiers, France. (författare)
Bath, JonathanUniv Missouri, Cardiovasc Surg Clin, Columbia, MO USA. (författare)
Coselli, Joseph S.Baylor Coll Med, Michael E DeBakey Dept Surg, Div Cardiothorac Surg, Houston, TX 77030 USA. (författare)
Aziz, FaisalPenn State Hlth Heart & Vasc Inst, Div Vasc Surg, Hershey, PA USA. (författare)
Coleman, Dawn M.Univ Michigan, Dept Surg, Sect Vasc Surg, Ann Arbor, MI 48109 USA. (författare)
Davis, Frank M.Univ Michigan, Dept Surg, Sect Vasc Surg, Ann Arbor, MI 48109 USA. (författare)
Fatima, JavairiahGeorgetown Univ, MedStar Heart & Vasc Inst, Washington, DC USA. (författare)
Irshad, AliTufts Univ, Sch Med, Cardiovasc Ctr Tufts Med Ctr, Boston, MA 02111 USA. (författare)
Shalhub, ShereneUniv Washington, Sch Med, Dept Surg, Div Vasc Surg, Seattle, WA 98195 USA. (författare)
Kakkos, StavrosUniv Patras, Dept Vasc Surg, Med Sch, Patras, Greece. (författare)
Zhang, QianziBaylor Coll Med, Michael E DeBakey Dept Surg, Div Vasc & Endovasc Therapy, One Baylor Plaza,BCM 390, Houston, TX 77030 USA. (författare)
Lawrence, Peter F.Univ Calif Los Angeles, David Geffen Sch Med, Dept Surg, Div Vasc Surg & Endovasc Therapy, Los Angeles, CA 90095 USA. (författare)
Woo, KarenUniv Calif Los Angeles, David Geffen Sch Med, Dept Surg, Div Vasc Surg & Endovasc Therapy, Los Angeles, CA 90095 USA. (författare)
Chung, JayerBaylor Coll Med, Michael E DeBakey Dept Surg, Div Vasc & Endovasc Therapy, One Baylor Plaza,BCM 390, Houston, TX 77030 USA. (författare)
Case Western Reserve Univ, Sch Med, Univ Hosp Cleveland Med Ctr, Div Vasc Surg & Endovasc Therapy, Cleveland, OH 44106 USA.Univ Florida, Dept Surg, Div Vasc Surg, Gainesville, FL USA. (creator_code:org_t)

Sammanhörande titlar

Ingår i:Journal of Vascular Surgery: Elsevier76:2, s. 546-0741-52141097-6809

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Av författaren/redakt...: Janko, Matthew R ...; Hubbard, Grant; Back, Martin; Shah, Samir K.; Pomozi, Eniko; Szeberin, Zoltan; visa fler...; DeMartino, Randa ...; Wang, Linda J.; Crofts, Sarah; Belkin, Michael; Davila, Victor J ...; Lemmon, Gary W.; Wang, Shihuan K.; Czerny, Martin; Kreibich, Maximi ...; Humphries, Misty ...; Shutze, William; Joh, Jin Hyun; Cho, Sungsin; Behrendt, Christ ...; Setacci, Carlo; Hacker, Robert, ...; Sobreira, Marcon ...; Yoshida, Winston ...; D'Oria, Mario; Lepidi, Sandro; Chiesa, Roberto; Kahlberg, Andrea; Go, Michael R.; Rizzo, Anthony N ...; Black, James H.; Magee, Gregory A ...; Elsayed, Ramsey; Baril, Donald T.; Beck, Adam W.; McFarland, Graem ...; Gavali, Hamid; Wanhainen, Ander ...; Kashyap, Vikram ...; Stoecker, Jordan ...; Wang, Grace J.; Zhou, Wei; Fujimura, Naoki; Obara, Hideaki; Wishy, Andrew M.; Bose, Saideep; Smeds, Matthew; Liang, Patric; Schermerhorn, Ma ...; Conrad, Mark F.; Hsu, Jeffrey H.; Patel, Rhusheet; Lee, Jason T.; Liapis, Christos ...; Moulakakis, Kons ...; Farber, Mark A.; Motta, Fernando; Ricco, Jean-Bapt ...; Bath, Jonathan; Coselli, Joseph ...; Aziz, Faisal; Coleman, Dawn M.; Davis, Frank M.; Fatima, Javairia ...; Irshad, Ali; Shalhub, Sherene; Kakkos, Stavros; Zhang, Qianzi; Lawrence, Peter ...; Woo, Karen; Chung, Jayer; visa färre...

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