Systematic Review and Meta: Analysis of Aortic Graft Infections following Abdominal Aortic Aneurysm Repair

Abstract

Introduction. Aortic graft infection (AGI) is a rare complication following AAA repair and is associated with high morbidity and mortality. Management is variable, and there are no evidence-based guidelines. The aim of this study was to systematically review and analyse management options for AGI. Methods. Data was collected between July and August 2018. A full HDAS search was conducted on the following databases: MEDLINE, EMBASE, CINAHL, and PUBMED. Meta-analysis was conducted using RevMan 5 software. Results. 1,365 patient outcomes were assessed (10 cohort studies and 12 comparative studies). The most common treatment was in situ replacement of the graft (ISR) followed by extra-anatomical replacement (EAR). Various grafts were used for ISR, such as fresh/cryopreserved allograft, venous graft, and prosthetic grafts. No graft material was shown to be superior. Axillobifemoral graft was the commonest type of EAR used. In the majority of cohort studies, ISR was the main treatment for AGI. There was no significant difference in the overall mortality rate (ISR n = 70/176 vs. EAR n = 47/126, OR 0.93 [95% CI 0.36-2.36], P = 0:87). Graft occlusion rate was significantly lower in the ISR group vs. the EAR group (n = 14/115 vs. n = 29/60 OR 0.16 [95% CI 0.07-0.36], P < 0:001). There was no significant difference in the amputation rate between the surgical treatments (ISR n = 9/141 vs. EAR n = 8/82, OR 0.75 [95% CI 0.07-8.39], P = 0:82). Discussion. In situ replacement is the preferred method of treatment as it had lower rates of occlusion. Further strong evidence is required, such as a multicentre trial to establish a management pathway for the condition.

Deep Femoral Vein Reconstruction for Abdominal Aortic Graft Infections is Associated with Low Aneurysm Related Mortality and a High Rate of Permanent Discontinuation of Antimicrobial Treatment

“…Aortic graft infection is a devastating complication of both open (surgical) and endovascular aortic repair (EVAR). 1,2 Aortic graft infections may cause sepsis, aortic rupture, and aorto-enteric fistula (AEF), and therefore represent a major threat to the patient's life. Traditionally, abdominal aortic graft infections have been treated by removal of the aortic prosthesis, closure of the aortic stump below the renal arteries, surgical debridement of infected tissue, and extra-anatomic bypass.…”

Outcome in Patients after Autologous Femoral Vein Reconstruction for Primary Aortic Infection and Aortic Graft Infection: A Case Series

“…[6][7][8][9][10][11][12][13][14][15][16] A recent meta-analysis on 1,365 patients with aortic graft infection showed similar mortality rates between extra-anatomical reconstructions and in situ reconstruction (both prosthetic and autologous material), but a good comparison was limited due to the heterogenicity of the data from all 22 included studies. 17 A distinct finding in this study was the use of either one or two femoral veins for the vascular reconstruction and its concomitant outcome. In general, aorto-iliac reconstruction with one single femoral vein can be performed when only an aortic tube graft or mono-iliac graft is needed, or a bifurcated graft that extents to the proximal common iliac arteries.…”

Surgical Management and Bacteriological Outcome of Infrarenal Abdominal Aortic Graft Infection at a Single Centre

“…Nowadays, inline replacement over extra-anatomic reconstruction is more favorable (10)(11)(12). Whatever the conduit to be used; femoral vein or synthetic graft They have their own unique set of conduit-specific complications.…”