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Contemporary Outcomes After Partial Resection of Infected Aortic Grafts.
Matthew Janko1, Grant Hubbard1, Karen Woo2
1University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH.
Annals of Vascular Surgery
|August 26, 2021
Summary
Partial resection of infected aortic grafts carries a high risk of mortality and post-repair infection, particularly in older patients or those with specific complications like Candida infection. Early detection and management of persistent infection are crucial for better outcomes.
Area of Science:
- Vascular Surgery
- Infectious Diseases
- Medical Outcomes Research
Background:
- Aortic graft infection is a significant clinical challenge.
- Identifying factors associated with adverse outcomes after partial resection of infected aortic grafts is unclear.
Purpose of the Study:
- To investigate variables associated with mortality and post-repair infection in patients undergoing partial resection of infected aortic grafts.
Main Methods:
- A retrospective, multi-institutional study of 114 patients who underwent partial resection of infected aortic grafts between 2002 and 2014.
- Data included demographics, comorbidities, operative, and postoperative variables.
- Kaplan-Meier survival and Cox regression analyses were performed to assess outcomes.
Main Results:
- Thirty-day mortality was 17.5%, with a median survival of 3.6 years post-resection.
- Candida infection and aortoenteric fistula were associated with increased mortality risk on univariate analysis.
- Persistent early infection (26%) and any post-repair infection (39%) were common, correlating with poorer outcomes.
Conclusions:
- Partial resection of infected aortic grafts is associated with high risks of mortality and post-repair infection.
- Older age, abdominal infection not limited to a single graft limb, Candida infection, and aortoenteric fistula are risk factors.
- Late reinfection is linked to early persistent infection, suggesting potential retained graft material.
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