Total excision and extra-anatomic bypass for aortic graft infection

Area of Science:

• Vascular Surgery
• Infectious Disease Management

Background:

• Aortic graft infection presents significant challenges with high reported mortality and amputation rates.
• Alternative treatments like local antibiotics and partial resection have been explored due to concerns about traditional methods.

Purpose of the Study:

• To review experience with aortic graft infection to determine current morbidity and mortality rates.
• To evaluate the efficacy of total excision and extra-anatomic bypass compared to other approaches.

Main Methods:

• Retrospective review of 32 patients with aortic graft infection.
• Analysis of treatment strategies including partial or total removal with or without revascularization (extra-anatomic route).
• Comparison of outcomes based on treatment modality, focusing on morbidity, mortality, and late complications.

Main Results:

• Overall morbidity and mortality were significantly lower in revascularized groups (p = 0.01).
• Late complications, including amputation, were exclusively observed after partial graft removal (p < 0.01).
• Total excision with extra-anatomic bypass demonstrated the best outcomes, with no late infections or amputations in a mean follow-up of 34 months.

Conclusions:

• Total excision and extra-anatomic bypass for aortic graft infection yield lower complication rates than commonly perceived.
• This approach remains the gold standard for managing aortic graft infections, outperforming alternative strategies.
• The study supports continued use of total excision with extra-anatomic bypass as the preferred treatment for aortic graft infections.