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An eight year experience of conservative management for aortic graft sepsis
Abstract:
This paper describes the results of conservative management of 15 patients with aortic graft infection. The median time to presentation was 4 months. Six of eight grafts that were sent for culture grew organisms, of which the commonest were streptococci and coagulase negative staphylococci. Four patients did not receive intensive antibiotic treatment and all died of sepsis. Eleven patients received intensive intravenous and oral antibiotic therapy and appropriate surgical management; two of these died, one of a stroke and the other of an unknown cause. Two of the nine surviving patients had no surgery and the remainder had procedures to drain pus and unblock occluded grafts, including minimal graft excision in four patients, although two of these subsequently required total graft excision. The follow-up period for six of these nine patients is more than 4 years. For most patients with aortic graft infection aggressive antibiotic treatment supplemented by minimalist surgery is preferable to primary radical surgery.
Insights
Aggressive antibiotic treatment combined with minimalist surgery offers a better outcome for patients with aortic graft infection compared to radical surgery. Early intensive treatment improves survival rates significantly.
Area of Science:
- Vascular Surgery
- Infectious Diseases
- Medical Management
Background:
- Aortic graft infection is a serious complication following aortic reconstructive surgery.
- Conservative management strategies are debated, with radical surgery often considered the standard.
- Understanding outcomes of different management approaches is crucial for patient care.
Purpose of the Study:
- To evaluate the results of conservative management in patients with aortic graft infection.
- To compare outcomes between intensive antibiotic therapy with minimal surgery versus no intensive treatment.
- To determine the preferred management strategy for aortic graft infections.
Main Methods:
- Retrospective analysis of 15 patients with aortic graft infection.
- Categorization of patients based on treatment: intensive antibiotic therapy with appropriate surgery vs. no intensive treatment.
- Microbiological analysis of graft cultures.
- Assessment of patient survival, complications, and need for further surgical intervention.
Main Results:
- The median time to presentation was 4 months.
- Common organisms identified included streptococci and coagulase-negative staphylococci.
- Patients not receiving intensive antibiotics had a 100% mortality rate due to sepsis.
- Eleven patients receiving intensive therapy and surgery had a 18% mortality rate (2/11).
- Survivors often required procedures like pus drainage or graft unblocking, with some needing minimal graft excision.
Conclusions:
- Aggressive antibiotic treatment, supplemented by minimalist surgery, is generally preferable to primary radical surgery for aortic graft infection.
- Intensive antibiotic therapy is critical for improving survival in patients with aortic graft infection.
- Conservative management, including drainage and antibiotics, can be effective in selected cases, potentially avoiding extensive reoperations.