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Systematic Review and Meta-Analysis on the Management of Open Abdominal Aortic Graft Infections
Ivo C J H Post1, Cornelis G Vos2
1Department of Surgery, Albert Schweitzer Hospital, Dordrecht, the Netherlands.
Objective:
Aortic graft infection (AGI) is a disastrous complication with an incidence of 0.2-6% in operated patients. With little or no high quality evidence, the best treatment option remains unclear. Therefore, the literature on the management of open abdominal AGI was systematically reviewed to determine optimal treatment.
Methods:
In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic review and meta-analysis was conducted for AGI. MEDLINE, Embase, and the Cochrane Database of Systematic Reviews were searched. Methodological quality was assessed using the Methodological Index for Non-randomised Studies (MINORS) score. Primary outcomes were 30 day mortality and one year survival. Secondary outcomes were survival, infection recurrence, limb salvage, and graft patency.
Results:
Of 1574 studies identified, 32 papers were included in the study. The overall quality of the studies was moderate, with an average MINORS score of 11.9. Pooled overall 30 day mortality and one year survival were 13.5% (95% CI 10.5-16.4) and 73.6% (95% CI 68.8-78.4), respectively. The lowest 30 day mortality and highest one year survival were found for in situ repair compared with extra-anatomic repair and for prosthetic grafts compared with venous grafts or arterial allografts. The infection recurrence rate was highest for prosthetic grafts.
Conclusions:
There is a lack of well designed, qualitative comparative studies making conclusive recommendations impossible. The current best available data suggests that partial graft removal should be avoided and the lowest 30 day mortality and best one year survival are achieved with in situ repair using prosthetic grafts. Initiatives such as the MAGIC database to collaboratively collect prospective data are an important step forward in obtaining more solid answers on this topic.
Insights
In situ repair using prosthetic grafts offers the best outcomes for aortic graft infection (AGI), reducing 30-day mortality and improving one-year survival. Partial graft removal should be avoided in AGI management.
Area of Science:
- Vascular Surgery
- Infectious Diseases
- Systematic Review and Meta-Analysis
Background:
- Aortic graft infection (AGI) is a severe complication following aortic surgery, occurring in 0.2-6% of patients.
- Optimal management strategies for AGI lack high-quality evidence, leading to uncertainty in treatment decisions.
Purpose of the Study:
- To systematically review the literature on managing open abdominal aortic graft infections.
- To determine the optimal treatment strategies for AGI based on available evidence.
Main Methods:
- A systematic review and meta-analysis adhering to PRISMA guidelines was performed.
- Searches were conducted in MEDLINE, Embase, and the Cochrane Database of Systematic Reviews.
- Methodological quality was assessed using the Methodological Index for Non-randomised Studies (MINORS) score.
Main Results:
- Thirty-two studies involving 1574 initially identified papers were included, with moderate overall quality (average MINORS score 11.9).
- Pooled 30-day mortality was 13.5% and one-year survival was 73.6%.
- In situ repair demonstrated lower 30-day mortality and higher one-year survival compared to extra-anatomic repair; prosthetic grafts showed better survival than venous grafts or arterial allografts, but with higher infection recurrence.
Conclusions:
- High-quality comparative studies are lacking, limiting definitive recommendations for AGI management.
- Current data suggest avoiding partial graft removal and favoring in situ repair with prosthetic grafts for better survival outcomes.
- Collaborative prospective data collection initiatives are crucial for advancing understanding and treatment of AGI.
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