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Improving survival and limb salvage in patients with aortic graft infection
R A Yeager1, G L Moneta, L M Taylor
1Department of Surgery, Oregon Health Sciences University, Portland.
Abstract:
A 15-year experience with 38 aortic graft infections, including 15 patients with graft enteric fistulas, is reviewed in order to analyze modern-day surgical results utilizing extra-anatomic bypass and aortic graft excision. Perioperative mortality was 14% during the most recent 7-year interval, which was a notable improvement compared with the earlier time interval (p = 0.06). Extended follow-up of the perioperative survivors demonstrated a 77% cumulative 5-year survival and a 76% cumulative 5-year limb salvage rate. Subsequent axillofemoral graft infection occurred in 22% of survivors and resulted in a significantly higher amputation rate compared with those patients with no axillofemoral graft infection (p less than 0.001). The results suggest good perioperative and long-term survival in patients with aortic graft infection, with excellent limb salvage if subsequent axillofemoral graft infection can be avoided.
Insights
Surgical outcomes for aortic graft infections have improved, with extra-anatomic bypass and graft excision offering good survival and limb salvage rates. Avoiding secondary axillofemoral graft infections is crucial for better long-term results.
Area of Science:
- Vascular Surgery
- Infectious Disease Management
- Surgical Outcomes Research
Background:
- Aortic graft infections are serious complications requiring complex management.
- Graft enteric fistulas present a significant surgical challenge.
- Historically, outcomes for these infections have been poor.
Purpose of the Study:
- To analyze surgical results for aortic graft infections using extra-anatomic bypass and aortic graft excision.
- To evaluate perioperative mortality and long-term survival and limb salvage rates.
- To identify factors influencing long-term outcomes, particularly secondary infections.
Main Methods:
- Retrospective review of 38 cases of aortic graft infection over 15 years.
- Inclusion of 15 patients with graft enteric fistulas.
- Analysis of surgical techniques including extra-anatomic bypass and aortic graft excision.
- Assessment of perioperative mortality, long-term survival, and limb salvage.
Main Results:
- Perioperative mortality decreased significantly in the recent 7-year interval (14%) compared to the earlier period (p=0.06).
- Cumulative 5-year survival was 77% and limb salvage was 76% among survivors.
- Subsequent axillofemoral graft infection occurred in 22% of survivors, leading to a higher amputation rate (p<0.001).
Conclusions:
- Extra-anatomic bypass and aortic graft excision offer favorable perioperative and long-term survival for aortic graft infections.
- Excellent limb salvage is achievable, contingent on avoiding secondary axillofemoral graft infections.
- Improved surgical strategies have led to better outcomes in managing these complex infections.