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

Hamid Gavali*, Kevin Mani, Mia Furebring, Karl Wilhelm Olsson, David Lindstrom, Karl Sorelius, Birgitta Sigvant, Gustav Torstensson, Manne Andersson, Claes Forssell, Håkan Astrand, Tobias Lundstrom, Shahzad Khan, Bjorn Sonesson, Otto Stackelberg, Peter Gillgren, Jon Isaksson, Björn Kragsterman, Khatereh Djavani Gidlund, Tal HorerMitra Sadeghi, Anders Wanhainen

*Corresponding author af dette arbejde
5 Citationer (Scopus)

Abstract

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.

OriginalsprogEngelsk
TidsskriftEuropean journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery
Vol/bind66
Udgave nummer3
Sider (fra-til)397-406
Antal sider10
ISSN1078-5884
DOI
StatusUdgivet - sep. 2023

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