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Editor's Choice - Outcome of Radical Surgical Treatment of Abdominal Aortic Graft and Endograft Infections Comparing Extra-anatomic Bypass with In Situ Reconstruction: A Nationwide Multicentre Study

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  • Hamid Gavali
  • Kevin Mani
  • Mia Furebring
  • Karl W Olsson
  • David Lindström
  • Karl Sörelius
  • Birgitta Sigvant
  • Khatereh D Gidlund
  • Gustav Torstensson
  • Manne Andersson
  • Claes Forssell
  • Håkan Åstrand
  • Tobias Lundström
  • Shahzad Khan
  • Björn Sonesson
  • Otto Stackelberg
  • Peter Gillgren
  • Jon Isaksson
  • Björn Kragsterman
  • Tal Horer
  • Mitra Sadeghi
  • Anders Wanhainen
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OBJECTIVE: Abdominal aortic graft and endograft infection (AGI) is primarily treated by resection of the infected graft and restoration of distal perfusion through extra-anatomic bypass (EAB) or in situ reconstruction/repair (ISR). The aim of this study was to compare these surgical strategies in a nationwide multicentre retrospective cohort study.

METHODS: The Swedish Vascular Registry (Swedvasc) was used to identify surgically treated abdominal AGIs in Sweden between January 1995 and May 2017. The primary aim was to compare short and long term survival, as well as complications for EAB and ISR.

RESULTS: Some 126 radically surgically treated AGI patients were identified - 102 graft infections and 24 endograft infections - treated by EAB: 71 and ISR: 55 (23 neo-aorto-iliac systems, NAISs). No differences in early 30 day (EAB 81.7% vs. ISR 76.4%, p = .46), or long term five year survival (48.2% vs. 49.9%, p = .87) were identified. There was no survival difference comparing NAIS to other ISR strategies. The frequency of recurrent graft infection during follow up was similar: EAB 20.3% vs. ISR 17.0% (p = .56). Survival and re-infection rates of the new conduit did not differ between NAIS and other ISR strategies. Age ≥ 75 years (odds ratio [OR] 4.0, confidence interval [CI] 1.1 - 14.8), coronary artery disease (OR 4.2, CI 1.2 - 15.1) and post-operative circulatory complications (OR 5.2, CI 1.2 - 22.5) were associated with early death. Prolonged antimicrobial therapy (> 3 months) was associated with reduced long term mortality (HR 0.3, CI 0.1 - 0.9).

CONCLUSION: In this nationwide multicentre study comparing outcomes of radically treated AGI, no differences in survival or re-infection rate could be identified comparing EAB and ISR.

Original languageEnglish
JournalEuropean journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery
Issue number6
Pages (from-to)918-926
Number of pages9
Publication statusPublished - Dec 2021

Bibliographical note

Copyright © 2021 The Author(s). Published by Elsevier B.V. All rights reserved.

    Research areas

  • Aged, Aorta, Abdominal/diagnostic imaging, Blood Vessel Prosthesis Implantation/adverse effects, Blood Vessel Prosthesis/adverse effects, Endovascular Procedures/adverse effects, Female, Humans, Male, Middle Aged, Prosthesis-Related Infections/diagnostic imaging, Registries, Reoperation, Retrospective Studies, Risk Assessment, Risk Factors, Sweden, Time Factors, Treatment Outcome

ID: 74849571