TY - JOUR
T1 - Semi-Conservative Treatment Versus Radical Surgery in Abdominal Aortic Graft and Endograft Infections
AU - Gavali, Hamid
AU - Mani, Kevin
AU - Furebring, Mia
AU - Olsson, Karl Wilhelm
AU - Lindstrom, David
AU - Sorelius, Karl
AU - Sigvant, Birgitta
AU - Torstensson, Gustav
AU - Andersson, Manne
AU - Forssell, Claes
AU - Astrand, Håkan
AU - Lundstrom, Tobias
AU - Khan, Shahzad
AU - Sonesson, Bjorn
AU - Stackelberg, Otto
AU - Gillgren, Peter
AU - Isaksson, Jon
AU - Kragsterman, Björn
AU - Gidlund, Khatereh Djavani
AU - Horer, Tal
AU - Sadeghi, Mitra
AU - Wanhainen, Anders
N1 - Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.
PY - 2023/9
Y1 - 2023/9
N2 - 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.
AB - 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.
KW - Aortic Aneurysm, Abdominal/diagnostic imaging
KW - Blood Vessel Prosthesis Implantation/adverse effects
KW - Blood Vessel Prosthesis/adverse effects
KW - Conservative Treatment/adverse effects
KW - Endovascular Procedures/adverse effects
KW - Humans
KW - Postoperative Complications/etiology
KW - Prosthesis-Related Infections/surgery
KW - Retrospective Studies
KW - Risk Factors
KW - Treatment Outcome
KW - Aortic graft infection
KW - Nationwide
KW - Multicentre
KW - Semi-conservative
KW - Radical surgery
UR - http://www.scopus.com/inward/record.url?scp=85166665977&partnerID=8YFLogxK
U2 - 10.1016/j.ejvs.2023.06.019
DO - 10.1016/j.ejvs.2023.06.019
M3 - Journal article
C2 - 37356704
SN - 1078-5884
VL - 66
SP - 397
EP - 406
JO - European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery
JF - European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery
IS - 3
ER -