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Semi-Conservative Treatment Versus Radical Surgery in Abdominal Aortic Graft and Endograft Infections

Gavali, Hamid ; Mani, Kevin ; Furebring, Mia ; Olsson, Karl Wilhelm ; Lindström, David ; Sörelius, Karl ; Sigvant, Birgitta ; Torstensson, Gustav LU ; Andersson, Manne and Forssell, Claes , et al. (2023) In European journal of vascular and endovascular surgery 66(3). p.397-406
Abstract

Objective: Abdominal aortic graft and endograft infections (AGIs) are rare complications following aortic surgery. Radical surgery (RS) with resection of the infected graft and reconstruction with extra-anatomical bypass or in situ reconstruction is the preferred therapy. For patients unfit for RS, a semi-conservative (SC), graft preserving strategy is possible. This paper aimed to compare survival and infection outcomes between RS and SC treatment for AGI in a nationwide cohort. Methods: Patients with abdominal AGI related surgery in Sweden between January 1995 and May 2017 were identified. The Management of Aortic Graft Infection Collaboration (MAGIC) criteria were used for the definition of AGI. Multivariable regression was performed... (More)

Objective: Abdominal aortic graft and endograft infections (AGIs) are rare complications following aortic surgery. Radical surgery (RS) with resection of the infected graft and reconstruction with extra-anatomical bypass or in situ reconstruction is the preferred therapy. For patients unfit for RS, a semi-conservative (SC), graft preserving strategy is possible. This paper aimed to compare survival and infection outcomes between RS and SC treatment for AGI in a nationwide cohort. Methods: Patients with abdominal AGI related surgery in Sweden between January 1995 and May 2017 were identified. The Management of Aortic Graft Infection Collaboration (MAGIC) criteria were used for the definition of AGI. Multivariable regression was performed to identify factors associated with mortality. Results: One hundred and sixty-nine patients with surgically treated abdominal AGI were identified, comprising 43 SC (14 endografts; 53% with a graft enteric fistula [GEF] in total) and 126 RS (26 endografts; 50% with a GEF in total). The SC cohort was older and had a higher frequency of cardiac comorbidities. There was a non-significant trend towards lower Kaplan–Meier estimated five year survival for SC vs. RS (30.2% vs. 48.4%; p = .066). A non-significant trend was identified towards worse Kaplan–Meier estimated five year survival for SC patients with a GEF vs. without a GEF (21.7% vs. 40.1%; p = .097). There were significantly more recurrent graft infections comparing SC with RS (45.4% vs. 19.3%; p < .001). In a Cox regression model adjusting for confounders, there was no difference in five year survival comparing SC vs. RS (HR 1.0, 95% CI 0.6 – 1.5). Conclusion: In this national AGI cohort, there was no mortality difference comparing SC and RS for AGI when adjusting for comorbidities. Presence of GEF probably negatively impacts survival outcomes of SC patients. Rates of recurrent infection remain high for SC treated patients.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Aortic graft infection, Multicentre, Nationwide, Radical surgery, Semi-conservative
in
European journal of vascular and endovascular surgery
volume
66
issue
3
pages
10 pages
publisher
Elsevier
external identifiers
  • pmid:37356704
  • scopus:85166665977
ISSN
1078-5884
DOI
10.1016/j.ejvs.2023.06.019
language
English
LU publication?
yes
id
4338375c-a6d6-453f-9a99-18941c7c5e37
date added to LUP
2023-10-30 14:39:33
date last changed
2024-04-19 03:04:34
@article{4338375c-a6d6-453f-9a99-18941c7c5e37,
  abstract     = {{<p>Objective: Abdominal aortic graft and endograft infections (AGIs) are rare complications following aortic surgery. Radical surgery (RS) with resection of the infected graft and reconstruction with extra-anatomical bypass or in situ reconstruction is the preferred therapy. For patients unfit for RS, a semi-conservative (SC), graft preserving strategy is possible. This paper aimed to compare survival and infection outcomes between RS and SC treatment for AGI in a nationwide cohort. Methods: Patients with abdominal AGI related surgery in Sweden between January 1995 and May 2017 were identified. The Management of Aortic Graft Infection Collaboration (MAGIC) criteria were used for the definition of AGI. Multivariable regression was performed to identify factors associated with mortality. Results: One hundred and sixty-nine patients with surgically treated abdominal AGI were identified, comprising 43 SC (14 endografts; 53% with a graft enteric fistula [GEF] in total) and 126 RS (26 endografts; 50% with a GEF in total). The SC cohort was older and had a higher frequency of cardiac comorbidities. There was a non-significant trend towards lower Kaplan–Meier estimated five year survival for SC vs. RS (30.2% vs. 48.4%; p = .066). A non-significant trend was identified towards worse Kaplan–Meier estimated five year survival for SC patients with a GEF vs. without a GEF (21.7% vs. 40.1%; p = .097). There were significantly more recurrent graft infections comparing SC with RS (45.4% vs. 19.3%; p &lt; .001). In a Cox regression model adjusting for confounders, there was no difference in five year survival comparing SC vs. RS (HR 1.0, 95% CI 0.6 – 1.5). Conclusion: In this national AGI cohort, there was no mortality difference comparing SC and RS for AGI when adjusting for comorbidities. Presence of GEF probably negatively impacts survival outcomes of SC patients. Rates of recurrent infection remain high for SC treated patients.</p>}},
  author       = {{Gavali, Hamid and Mani, Kevin and Furebring, Mia and Olsson, Karl Wilhelm and Lindström, David and Sörelius, Karl and Sigvant, Birgitta and Torstensson, Gustav and Andersson, Manne and Forssell, Claes and Åstrand, Håkan and Lundström, Tobias and Khan, Shahzad and Sonesson, Björn and Stackelberg, Otto and Gillgren, Peter and Isaksson, Jon and Kragsterman, Björn and Gidlund, Khatereh Djavani and Horer, Tal and Sadeghi, Mitra and Wanhainen, Anders}},
  issn         = {{1078-5884}},
  keywords     = {{Aortic graft infection; Multicentre; Nationwide; Radical surgery; Semi-conservative}},
  language     = {{eng}},
  number       = {{3}},
  pages        = {{397--406}},
  publisher    = {{Elsevier}},
  series       = {{European journal of vascular and endovascular surgery}},
  title        = {{Semi-Conservative Treatment Versus Radical Surgery in Abdominal Aortic Graft and Endograft Infections}},
  url          = {{http://dx.doi.org/10.1016/j.ejvs.2023.06.019}},
  doi          = {{10.1016/j.ejvs.2023.06.019}},
  volume       = {{66}},
  year         = {{2023}},
}