Contemporary Outcomes After Partial Resection of Infected Aortic Grafts

Janko, Matthew; Hubbard, Grant; Woo, Karen; Kashyap, Vikram S.; Mitchell, Megan; Murugesan, Arun; Chen, Lin; Gardner, Rachel; Baril, Donald T.; Hacker, Robert I.; Szeberin, Zoltán; Elsayed, Ramsey S.; Magee, Gregory A.; Motta, Fernando; Wei, Zhou; Lemmon, Gary W.; Coleman, Dawn M.; Behrendt, Christian‐Alexander; Aziz, Faisal; Black, James H.; Tran, Kimberly D.; Dao, Allen; Shutze, William P.; Garrett, H. Edward; Caridi, Giovanni De; Patel, Rahul; Liapis, Christos D.; Geroulakos, George; Kakisis, John D.; Moulakakis, Konstantinos G.; Sk, Kakkos; Obara, Hideaki; Wang, Grace; Stoecker, Jordan B.; Rhéaume, Pascal; Davila, Victor J.; Ravin, Reid A.; DeMartino, Randall R.; Milner, Ross; Shalhub, Sherene; Jim, Jeffrey; Lee, Jason; Dubuis, Céline; Ricco, Jean-Baptiste; Coselli, Joseph S.; LeMaire, Scott A.; Fatima, Javairiah; Sanford, Jennifer; Yoshida, Winston Bonetti; Schermerhorn, Marc L.; Menard, Matthew T.; Belkin, Michael; Blackwood, Stuart; Conrad, Mark F.; Wang, Linda; Crofts, Sara; Nixon, T.; Wu, Terence; Chiesa, Roberto; Bose, Saideep; Turner, J.; Moore, Ryan; Smith, Justin A.; Irshad, Ali; Hsu, Jeffrey H.; Czerny, Martin; Cullen, J. Michael; Kahlberg, Andrea; Setacci, Carlo; Joh, Jin Hyun; Senneville, É.; Garrido, Pedro; Sarac, Timur P.; Rizzo, Anthony; Go, Michael R.; Björck, Martin; Gavali, Hamid; Wanhainen, Anders; D’Oria, Mario; Lepidi, Sandro; Mastrorilli, Davide; Veraldi, Gian Franco; Piazza, Michele; Squizzato, Francesco; Beck, Adam W.; John, Rebecca St.; Wishy, Andrew; Humphries, Misty D.; Shah, Samir K.; Back, Martin R.; Chung, Jayer; Lawrence, Peter F.; Bath, Jonathan; Smeds, Matthew R.

doi:10.1016/j.avsg.2021.07.002

Cited by 14 publications

(4 citation statements)

References 21 publications

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“…Similar to other studies, 25 - 27 the frequency of Candida was significantly higher in the cohort with a GEF than in patients with aortic graft infections without a GEF. In addition, we found similar results in the Candida and non-Candida groups according to the complication and mortality rates.…”

Section: Discussionsupporting

confidence: 89%

Outcomes of Candida and Non-Candida Aortic Graft Infection

Omran

Gröger

Shafei

et al. 2022

Vasc Endovascular Surg

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Objective To evaluate and compare the outcomes of Candida- and non-Candida-associated aortic graft infections. Methods We retrospectively analyzed the data from patients treated for aortic graft infection from 2015 to 2021 in our hospital. Results A total of 66 patients (56 men; median age, 69 years; range, 50-87 years) were admitted with aortic graft infection, including 21 (32%) patients in the Candida group and 45 (68%) in the non-Candida group. The average time between initial operation and presentation of aortic graft infection was 50 months (range, 1-332 months). Graft-enteric fistulas (GEFs) were more often in the Candida group (57% vs 27%, P = .017). The most proven causative fungal specimen was C. albicans in 16 (76%) patients. Non-albicans Candida was found in 9% of all patients and 29% of the Candida patients. The median ICU length of stay was longer in the Candida group than non-Candida (10 vs 9 days, P = .012). Additionally, the median hospital length of stay was longer in the Candida group (33 vs 22 days, P = .048). There were no statistically significant differences between Candida and non-Candida groups according to the in-hospital mortality (24% vs 24%, P = .955), and 1-year mortality (38% vs 38%, P = .980). Conclusions Patients with bacterial and fungal aortic graft infections have high rates of morbidity and mortality. We found no significant differences in postoperative morbidity and mortality between Candida and non-Candida patients. However, the ICU and hospital length of stay were longer in the Candida group.

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Section: Discussionsupporting

confidence: 89%

Outcomes of Candida and Non-Candida Aortic Graft Infection

Omran

Gröger

Shafei

et al. 2022

Vasc Endovascular Surg

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“…Here, anatomic reconstruction has proven favorable in terms of infection-free survival [ 33 ]. However, despite a clear definition bias, the rate of persistent infection and/or reinfection is high after operative treatment and reached 39.5% in our study ( Table 4 ) [ 34 ]. Various groups have published their experiences with specific materials used for reconstruction, mostly for the abdominal aorta, with a lack of direct comparisons.…”

Section: Discussionmentioning

confidence: 81%

“…However, approx. one-third of blood cultures remain negative, and a polymicrobial flora is frequent [ 12 , 17 , 34 ]. Hence, preoperative classification according to a single microorganism identified might not be justified [ 36 , 37 ].…”

Section: Discussionmentioning

confidence: 99%

Aortic Vascular Graft and Endograft Infection–Patient Outcome Cannot Be Determined Based on Pre-Operative Characteristics

Puttini,

Kapalla,

Braune

et al. 2024

JCM

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Vascular graft/endograft infection (VGEI) is a serious complication after aortic surgery. This study investigates VGEI and patient characteristics, PET/CT quantification before surgical or conservative management of VGEI and post-intervention outcomes in order to identify patients who might benefit from such a procedure. PET standard uptake values (SUV) were quantitatively assessed and compared to a non-VGEI cohort. The primary endpoints were in-hospital mortality and aortic reintervention-free survival at six months. Ninety-three patients (75% male, 65 ± 10 years, 82% operated) were included. The initial operation was mainly for aneurysm (67.7%: 31% EVAR, 12% TEVAR, 57% open aortic repair). Thirty-two patients presented with fistulae. PET SUVTLR (target-to-liver ratio) showed 94% sensitivity and 89% specificity. Replacement included silver-coated Dacron (21.3%), pericardium (61.3%) and femoral vein (17.3%), yet the material did not influence the overall survival (p = 0.745). In-hospital mortality did not differ between operative and conservative treatment (19.7% vs. 17.6%, p = 0.84). At six months, 50% of the operated cohort survived without aortic reintervention. Short- and midterm morbidity and mortality remained high after aortic graft removal. Neither preoperative characteristics nor the material used for reconstruction influenced the overall survival, and, with limitations, both the in-hospital and midterm survival were similar between the surgically and conservatively managed patients.

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“…Although perioperative outcomes were better, mortality was higher during follow-up. Other authors have also addressed this important topic [54,75] . In this specific scenario where patients often are hemodynamically unstable due to bleeding or sepsis, an endovascular treatment might be used as a stabilization strategy and "bridge to surgery".…”

Section: Special Situations: Fistula and Partial Graft Resectionmentioning

confidence: 99%

Vascular graft infections

Hemelrijck¹,

Sromicki²,

Husmann³

et al. 2022

Vessel Plus

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Vascular graft infections are rare complications after surgical and endovascular treatment of aortic diseases. This condition is characterized by complexity in diagnosis and medico-surgical management. Moreover, even if properly treated, morbidity and mortality rates are high. Although several advances have been made over the years and guidelines of treatment have been published, there is still debate on the optimal care for this disease. With local microbiological patterns and multiresistant strains conditioning antimicrobial treatment as well as several surgical debridement techniques in the armamentarium, it is difficult to offer recommendations that can be generalized for every single case. In this review, we aim at describing thoracic and abdominal vascular graft infections and providing current information on diagnosis, medical treatment, and surgical management.

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Contemporary Outcomes After Partial Resection of Infected Aortic Grafts

Cited by 14 publications

References 21 publications

Outcomes of Candida and Non-Candida Aortic Graft Infection

Outcomes of Candida and Non-Candida Aortic Graft Infection

Aortic Vascular Graft and Endograft Infection–Patient Outcome Cannot Be Determined Based on Pre-Operative Characteristics

Vascular graft infections

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