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

Mitra Sadeghi, Anders Wanhainen, Khatereh Djavani Gidlund, Peter Gillgren, Håkan Åstrand, Manne Andersson, Gustav Torstensson, Birgitta Sigvant, Karl Sörelius, Karl Wilhelm Olsson, David Lindström, Hamid Gavali, Tal Horer, Björn Kragsterman, Jon Isaksson, Otto Stackelberg, Björn Sonesson, Shahzad Khan, Tobias Lundström, Claes Forssell, Mia Furebring, Kevin Mani

Journal: European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery 2023;66(3):397-406

PMID: 37356704

Free Full Text on Elsevier Science View on PubMed

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.

Address: Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden. Electronic address: [email protected].; Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden.; Department of Medical Sciences, Section of Infectious Diseases, Uppsala University, Uppsala, Sweden.; Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark; and Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.; Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden; Department of Vascular Surgery, Karlstad Central Hospital, Karlstad, Sweden.; Department of Surgery, Helsingborg Regional Hospital, Helsingborg, Sweden.; Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden; Department of Surgery, County Hospital Ryhov, Ryhov, Jönköping County, Sweden.; Department of Cardiovascular Surgery, Division of Vascular Surgery, Linköping University Hospital, Linköping, Sweden.; Department of Surgery, County Hospital Ryhov, Ryhov, Jönköping County, Sweden.; Department of Surgery and Urology, Eskilstuna Hospital, Eskilstuna, Sweden.; Department of Surgery, Malmö University Hospital, Lund University, Malmö, Sweden.; Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden; Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.; Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden; Department of Vascular Surgery, Södersjukhuset, Stockholm, Sweden.; Department of Surgical and Peri-operative Sciences, Umeå University, Umeå, Sweden.; Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden; Department of Surgery, Västerås Central Hospital, Västerås, Sweden.; Department of Cardiothoracic and Vascular Surgery and Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.; Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden; Department of Surgical and Peri-operative Sciences, Umeå University, Umeå, Sweden.

DOI: 10.1016/j.ejvs.2023.06.019

Link outs

Free resources

Full Text Sources:

Subscription / membership required

Full Text Sources:

https://www.clinicalkey.com/content/playBy/pii?v=S...

MeSH Terms: Humans, Blood Vessel Prosthesis, Blood Vessel Prosthesis Implantation, Conservative Treatment, Risk Factors, Retrospective Studies, Endovascular Procedures, Postoperative Complications, Prosthesis-Related Infections, Treatment Outcome, Aortic Aneurysm, Abdominal