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Published on: August 1, 2025
Comparing Venous Reconstructions and Antimicrobial Graft Reconstructions in Mycotic Abdominal Aortic Aneurysms and
Jetty Ipema1, Michiel A Schreve2, Rob H W van de Mortel3
1Department of Vascular Surgery, Alkmaar, The Netherlands; Department of Vascular Surgery, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands.
Background:
The perioperative mortality and morbidity rates of surgical repair of mycotic abdominal aortic aneurysms and aortic graft infections are high, and the appropriate treatment is debated. This retrospective study compared venous and antimicrobial prosthetic aortic graft reconstructions.
Methods:
All patients of the Northwest Clinics and St. Antonius Hospital who were treated for mycotic abdominal aortic aneurysms or aortic graft infections between January 1, 2008, and January 1, 2018, were analyzed. Exclusion criterion was treatment other than venous or antimicrobial reconstructions. Primary end points were 30-day complications and mortality rates and 3-year overall survival. Secondary end points were reintervention-free survival, persistent infection and reinfection rates, and hospital length of stay.
Results:
Fifty-one patients met the inclusion criteria, of whom 32 underwent venous reconstructions and 19 antimicrobial prosthetic aortic graft reconstructions. Baseline characteristics did not differ significantly between these groups, except for duration of surgical repair, which was longer in the venous group. The 30-day and 1-year mortality rates, reinfection rates, complication rates, and hospital length of stay did not significantly differ between the groups. The 3-year overall survival was 77% for venous reconstruction compared with 66% for antimicrobial reconstruction (P = 0.781). The 30-day reintervention rate was 19% for the venous group compared with 42% for the prosthetic group (P = 0.071). Reintervention-free survival at 3 years was 46% for the venous group compared with 52% for the prosthetic group (P = 0.615).
Conclusions:
Venous reconstruction tends to have better 3-year overall survival and lower 30-day reintervention rates compared with antimicrobial prosthetic graft reconstruction in patients with mycotic abdominal aortic aneurysms or abdominal aortic graft infections. In the acute setting, antimicrobial prosthetic graft reconstruction is a valuable solution due to the shorter operation time and similar 30-day mortality and complication rates.
Insights
Surgical repair of mycotic abdominal aortic aneurysms (MAAA) and graft infections shows promising results with venous reconstruction, offering better long-term survival and fewer early reinterventions compared to antimicrobial prosthetic grafts.
Area of Science:
- Vascular Surgery
- Infectious Disease Management
- Aortic Aneurysm Treatment
Background:
- Mycotic abdominal aortic aneurysms (MAAA) and aortic graft infections present high perioperative risks.
- Optimal surgical treatment strategies remain a subject of debate.
- This study evaluates venous versus antimicrobial prosthetic reconstructions.
Purpose of the Study:
- To compare the outcomes of venous and antimicrobial prosthetic aortic graft reconstructions.
- To assess 30-day complications, mortality, and 3-year survival rates.
- To analyze reintervention, infection, and length of stay.
Main Methods:
- Retrospective analysis of patients treated for MAAA or aortic graft infections (2008-2018).
- Inclusion criteria: venous or antimicrobial prosthetic reconstructions.
- Primary endpoints: 30-day outcomes and 3-year survival; Secondary endpoints: reintervention, infection, and hospital stay.
Main Results:
- 51 patients included: 32 venous, 19 antimicrobial prosthetic reconstructions.
- No significant differences in 30-day mortality, complications, or reinfection rates.
- Venous reconstruction showed higher 3-year survival (77% vs. 66%) and lower 30-day reintervention rates (19% vs. 42%).
Conclusions:
- Venous reconstruction may offer superior 3-year survival and reduced early reintervention for MAAA and graft infections.
- Antimicrobial prosthetic reconstruction is a viable option in acute settings due to shorter operative times and comparable short-term outcomes.
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