In-situ bypass is associated with superior infection-free survival compared with extra-anatomic bypass for the management of secondary aortic graft infections without enteric involvement

Janko, Matthew; Hubbard, Grant; Back, Martin R.; Shah, Samir K.; Pomozi, Enikő; Szeberin, Zoltán; DeMartino, Randall R.; Wang, Linda J.; Crofts, Sarah C.; Belkin, Michael; Davila, Victor J.; Lemmon, Gary W.; Wang, Shihuan K.; Czerny, Martin; Kreibich, Maximilian; Humphries, Misty D.; Shutze, William P.; Joh, Jin Hyun; Cho, Sungsin; Behrendt, Christian‐Alexander; Setacci, Carlo; Hacker, Robert I.; Sobreira, Marcone Lima; Yoshida, Winston Bonetti; D’Oria, Mario; Lepidi, Sandro; Chiesa, Roberto; Kahlberg, Andrea; Go, Michael R.; Rizzo, Anthony; Black, James H.; Magee, Gregory A.; Elsayed, Ramsey S.; Baril, Donald T.; Beck, Adam W.; McFarland, Graeme E.; Gavali, Hamid; Wanhainen, Anders; Kashyap, Vikram S.; Stoecker, Jordan B.; Wang, Grace J.; Wei, Zhou; Fujimura, Naoki; Obara, Hideaki; Wishy, Andrew; Bose, Saideep; Liang, Patric; Schermerhorn, Marc L.; Conrad, Mark F.; Hsu, Jeffrey H.; Patel, Rahul; Lee, Jason T.; Liapis, Christos D.; Moulakakis, Konstantinos G.; Motta, Fernando; Ricco, Jean-Baptiste; Bath, Jonathan; Coselli, Joseph S.; Aziz, Faisal; Coleman, Dawn M.; Davis, Frank M.; Fatima, Javairiah; Irshad, Ali; Shalhub, Sherene; Zhang, Qianzi; Lawrence, Peter F.; Woo, Karen; Chung, Jayer

doi:10.1016/j.jvs.2022.03.869

Cited by 9 publications

(6 citation statements)

References 20 publications

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“…The included 22 studies described 1118 patients and were published from 1991 to 2023 6 , 22–42 . Patients with AEF received specific treatment, such as prolonged antibiotic therapy and bowel repair intraoperatively by an abdominal surgeon.…”

Section: Resultsmentioning

confidence: 99%

“…Among multi-arm studies, a total of ten studies reported the 30-day mortality rate. The direct meta-analysis of the 30-day mortality rate was feasible for the following comparisons: CR + ISR versus CR + EAR (7 cohort studies, CR + ISR n = 327, CR + EAR = 169) 22–25 , 29–31 and CR + ISR versus PR + ISR (3 cohort studies, CR + ISR n = 51, PR + ISR n = 36) 6 , 26 , 27 . The comparison of CR + EAR versus PR + ISR was established in an indirect meta-analysis.…”

Section: Resultsmentioning

confidence: 99%

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Surgical management of abdominal aortic graft infection: network meta-analysis

Shu,

Wang,

Wang

et al. 2024

BJS Open

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Background A paucity of evidence exists regarding the optimal management for abdominal aortic graft infection. The aim of this paper was to assess short- and long-term outcomes following different surgical options in aortic graft infection patients. Methods Medline, Embase and the Cochrane Library were searched from inception to February 2023. Network meta-analysis was performed using a frequentist method. Patients were divided into four treatment groups: complete graft removal with in situ repair, complete graft removal with extra-anatomic repair, partial graft removal with in situ repair and partial graft removal with extra-anatomic repair. The mortality rate at 30-days and 1-year was the primary outcome. Secondary outcomes were longer-term mortality rate, primary patency and reinfections. For included RCTs, the Cochrane risk-of-bias tool was utilized to assess the risk of bias. The methodological quality of cohort studies was evaluated using the Newcastle–Ottawa scale. Results Among 4559 retrieved studies, 22 studies with 1118 patients (11 multi-arm and 11 single-arm studies) were included. Patients received complete graft removal with in situ repair (N = 852), partial graft removal with in situ repair (N = 36), complete graft removal with extra-anatomic repair (N = 228) and partial graft removal with extra-anatomic repair (N = 2). Both network meta-analysis results and pooled results of multi- and single-arm cohorts indicated that partial graft removal with in situ repair has the lowest 30-day and 1-year mortality rates (0% and 6.1% respectively), followed by complete graft removal with in situ repair (11.9% and 23.8% respectively) and complete graft removal with extra-anatomic repair (16.6% and 41.4% respectively). In addition, complete graft removal with in situ repair had a lower 3-year (complete graft removal with in situ repair versus complete graft removal with extra-anatomic repair: 32.1% versus 90%) and 5-year (complete graft removal with in situ repair versus complete graft removal with extra-anatomic repair: 45.6% versus 67.9%) mortality rate when compared with complete graft removal with extra-anatomic repair. Patients in the complete graft removal with in situ repair group had the lowest reinfections (8%), followed by partial graft removal with in situ repair (9.3%) and complete graft removal with extra-anatomic repair (22.4%). Conclusion Partial graft removal with in situ repair was associated with lower 30-day and 1-year mortality rates when compared with complete graft removal with in situ repair and complete graft removal with extra-anatomic repair. Partial graft removal with in situ repair might be a feasible treatment for specific aortic graft infection patients.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Surgical management of abdominal aortic graft infection: network meta-analysis

Shu,

Wang,

Wang

et al. 2024

BJS Open

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“…In-situ reconstruction has been shown to be a safe and effective method to address aortic graft infection and may be favored over aortic ligation and extra-anatomic bypass. 4,5,8,9 A report from the Vascular Low Frequency Disease Consortium (VLFDC) concluded that in-situ bypass was associated with fewer infectious complications than extra-anatomic bypass in patients with prosthetic aortic graft infection. 5 Another VLFDC study reported that even in the face of aortoenteric fistula, in-situ bypass yielded similar survival to extra-anatomic bypass.…”

Section: Discussionmentioning

confidence: 99%

“…4,5,8,9 A report from the Vascular Low Frequency Disease Consortium (VLFDC) concluded that in-situ bypass was associated with fewer infectious complications than extra-anatomic bypass in patients with prosthetic aortic graft infection. 5 Another VLFDC study reported that even in the face of aortoenteric fistula, in-situ bypass yielded similar survival to extra-anatomic bypass. 9 Medical therapy alone using antibiotics as a primary treatment strategy for primary aortic infection is not likely to be effective.…”

Section: Discussionmentioning

confidence: 99%

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Management and Outcome of Non-Aneurysmal Primary Aortic Infection

Kumins

Wogsland

Smith

et al. 2022

Vasc Endovascular Surg

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Introduction Aortic infection without prior intervention or aneurysm is exceedingly rare. We report the presentation, diagnosis, management, and outcome of patients with this unusual entity. Methods Retrospective chart and imaging review of patients with primary aortic infection. Results 5 patients (3 male, mean age 71.2 years) presented between 2014 and 2022. All had abdominal, back, or flank pain. Four had constitutional symptoms. All were evaluated with a complete blood count; 3 had leukocytosis. Both serum C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were elevated in the 4 patients evaluated with these tests. All were studied with peripheral blood culture on the first hospital day prior to any antibiotic administration. Blood culture was positive in only 1 patient. Computed tomography (CT) scan showed periaortic inflammation without aneurysm in all. Fluorodeoxyglucose positron emission tomography (PET) was obtained in 3 and a radiolabeled leukocyte single-photon emission CT (SPECT) scan was performed in 2. All demonstrated periaortic concentration of the radioisotope consistent with inflammation or infection. Intraoperative cultures were positive in 3. One patient who had a negative intraoperative culture was examined with broad range polymerase chain reaction (PCR) and DNA sequencing which identified a causative bacterium. The other patient with a negative intraoperative culture had periaortic abscess but was on antibiotics preoperatively, potentially confounding the culture. All patients underwent in-situ repair with rifampin impregnated polyester (N = 2), cryopreserved aortic allograft (N = 2), or autogenous femoral vein (N = 1). No patient developed recurrent infection or aortic related complications following surgery with an average follow up of 31.8 months (range 8-88 months). Conclusions Patients with primary aortic infection present similarly with the triad of abdominal or back pain, laboratory markers of infection, and imaging demonstrating periaortic inflammation. Patients were treated successfully with in-situ repair. Preoperative identification of a causative organism was difficult, and PCR may be useful to help identify an organism.

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