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

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

Gavali, Hamid (författare): Uppsala University,Uppsala universitet,Kärlkirurgi,Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden,Uppsala Univ, Sweden

Mani, Kevin, 1975- (författare): Uppsala University,Uppsala universitet,Kärlkirurgi,Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden,Uppsala Univ, Sweden

Furebring, Mia (författare): Uppsala University,Uppsala universitet,Infektionsmedicin,Department of Medical Sciences, Section of Infectious Diseases, Uppsala University, Uppsala, Sweden,Uppsala Univ, Sweden

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Olsson, Karl Wilhelm, 1985- (författare): Uppsala University,Uppsala universitet,Kärlkirurgi,Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden,Uppsala Univ, Sweden

Lindström, David (författare): Uppsala University,Uppsala universitet,Kärlkirurgi,Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden,Uppsala Univ, Sweden

Sörelius, Karl (författare): Rigshospitalet, Dept Vasc Surg, Copenhagen, Denmark.,Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark; and Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark,Copenhagen University Hospital

Sigvant, Birgitta (författare): Uppsala University,Uppsala universitet,Kärlkirurgi,Karlstad Cent Hosp, Dept Vasc Surg, Karlstad, Sweden.,Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden; Department of Vascular Surgery, Karlstad Central Hospital, Karlstad, Sweden,Uppsala Univ, Sweden; Karlstad Cent Hosp, Sweden

Torstensson, Gustav (författare): Helsingborg Hosp, Dept Surg, Helsingborg, Sweden.,Department of Surgery, Helsingborg Regional Hospital, Helsingborg, Sweden

Andersson, Manne (författare): Linköping University,Linköpings universitet,Avdelningen för kirurgi, ortopedi och onkologi,Medicinska fakulteten,Cty Hosp Ryhov, Sweden,Ryhov County Hospital, Jönköping

Forssell, Claes (författare): Linköping Univ Hosp, Dept Cardiovasc Surg, Div Vasc Surg, Linköping, Sweden.,Department of Cardiovascular Surgery, Division of Vascular Surgery, Linköping University Hospital, Linköping, Sweden,Region Östergötland, Thorax-kärlkliniken i Östergötland

Åstrand, Håkan (författare): Cty Hosp Ryhov, Dept Surg, Jönköping, Sweden.,Department of Surgery, County Hospital Ryhov, Ryhov, Jönköping County, Sweden

Lundström, Tobias (författare): Eskilstuna Hosp, Dept Surg & Urol, Eskilstuna, Sweden.,Department of Surgery and Urology, Eskilstuna Hospital, Eskilstuna, Sweden

Khan, Shahzad (författare): Lund Univ, Malmö Univ Hosp, Dept Surg, Malmö, Sweden.,Department of Surgery, Malmö University Hospital, Lund University, Malmö, Sweden,Skåne University Hospital

Sonesson, Björn (författare): Lund University,Lunds universitet,Vaskulära sjukdomar - kliniska studier,Forskargrupper vid Lunds universitet,Vascular Diseases - Clinical Research,Lund University Research Groups,Skåne University Hospital

Stackelberg, Otto (författare): Karolinska Institute

Gillgren, Peter (författare): Karolinska Institute,Karolinska Institutet,Stockholm South General Hospital

Isaksson, Jon (författare): Umeå University,Umeå universitet,Institutionen för kirurgisk och perioperativ vetenskap,Umeå Univ, Dept Surg & Perioperat Sci, Umeå, Sweden.

Kragsterman, Björn (författare): Uppsala University,Uppsala universitet,Kärlkirurgi,Västerås Hosp, Dept Surg, Västerås, Sweden.,Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden; Department of Surgery, Västerås Central Hospital, Västerås, Sweden,Uppsala Univ, Sweden; Vasteras Hosp, Sweden,Västmanland Hospital

Gidlund, Khatereh Djavani (författare): Örebro University

Horer, Tal (författare): Örebro University

Sadeghi, Mitra (författare): Örebro University

Wanhainen, Anders (författare): Uppsala University,Umeå University,Uppsala universitet,Kärlkirurgi,Umeå Univ, Dept Surg & Perioperat Sci, Umeå, Sweden.,Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden,Uppsala Univ, Sweden; Umea Univ, Sweden

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

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Tidskriftsartikel (refereegranskat)

Abstract Ämnesord

Stäng

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 the definition of AGI. Multivariable regression was performed to identify factors associated with mortality.Results: One hundred and sixty-nine 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 five year survival for SC vs. RS (30.2% vs. 48.4%; p = .066). A non-significant trend was identified towards worse Kaplan -Meier estimated five year survival for SC patients with a GEF vs. without a GEF (21.7% vs. 40.1%; p = .097). There were significantly more recurrent graft infections comparing SC with RS (45.4% vs. 19.3%; p < .001). In a Cox regression model adjusting for confounders, there was no difference in five year survival comparing SC vs. RS (HR 1.0, 95% CI 0.6 -1.5).Conclusion: In this national AGI cohort, there was no mortality difference comparing SC and RS for AGI when adjusting for comorbidities. Presence of GEF probably negatively impacts survival outcomes of SC patients. Rates of recurrent infection remain high for SC treated patients.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kirurgi (hsv//swe)
MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Surgery (hsv//eng)
MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kardiologi (hsv//swe)
MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)

Nyckelord

Aortic graft infection
Multicentre
Nationwide
Radical surgery
Semi-conservative
Aortic graft infection
Multicentre
Nationwide
Radical surgery
Semi-conservative

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MEDICIN OCH HÄLSOVETENSKAP: MEDICIN OCH HÄLS ...; och Klinisk medicin; och Kirurgi

MEDICIN OCH HÄLSOVETENSKAP: MEDICIN OCH HÄLS ...; och Klinisk medicin; och Kardiologi

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Av lärosätet: Uppsala universitet; Umeå universitet; Linköpings universitet; Karolinska Institutet; Lunds universitet

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