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Editor's Choice – Outcome of Radical Surgical Treatment of Abdominal Aortic Graft and Endograft Infections Comparing Extra-anatomic Bypass with In Situ Reconstruction : A Nationwide Multicentre Study

Gavali, Hamid ; Mani, Kevin ; Furebring, Mia ; Olsson, Karl W. ; Lindström, David ; Sörelius, Karl ; Sigvant, Birgitta ; Gidlund, Khatereh D. ; Torstensson, Gustav LU and Andersson, Manne , et al. (2021) In European journal of vascular and endovascular surgery 62(6). p.918-926
Abstract

Objective: Abdominal aortic graft and endograft infection (AGI) is primarily treated by resection of the infected graft and restoration of distal perfusion through extra-anatomic bypass (EAB) or in situ reconstruction/repair (ISR). The aim of this study was to compare these surgical strategies in a nationwide multicentre retrospective cohort study. Methods: The Swedish Vascular Registry (Swedvasc) was used to identify surgically treated abdominal AGIs in Sweden between January 1995 and May 2017. The primary aim was to compare short and long term survival, as well as complications for EAB and ISR. Results: Some 126 radically surgically treated AGI patients were identified – 102 graft infections and 24 endograft infections – treated by... (More)

Objective: Abdominal aortic graft and endograft infection (AGI) is primarily treated by resection of the infected graft and restoration of distal perfusion through extra-anatomic bypass (EAB) or in situ reconstruction/repair (ISR). The aim of this study was to compare these surgical strategies in a nationwide multicentre retrospective cohort study. Methods: The Swedish Vascular Registry (Swedvasc) was used to identify surgically treated abdominal AGIs in Sweden between January 1995 and May 2017. The primary aim was to compare short and long term survival, as well as complications for EAB and ISR. Results: Some 126 radically surgically treated AGI patients were identified – 102 graft infections and 24 endograft infections – treated by EAB: 71 and ISR: 55 (23 neo-aorto-iliac systems, NAISs). No differences in early 30 day (EAB 81.7% vs. ISR 76.4%, p =.46), or long term five year survival (48.2% vs. 49.9%, p =.87) were identified. There was no survival difference comparing NAIS to other ISR strategies. The frequency of recurrent graft infection during follow up was similar: EAB 20.3% vs. ISR 17.0% (p =.56). Survival and re-infection rates of the new conduit did not differ between NAIS and other ISR strategies. Age ≥ 75 years (odds ratio [OR] 4.0, confidence interval [CI] 1.1 – 14.8), coronary artery disease (OR 4.2, CI 1.2 – 15.1) and post-operative circulatory complications (OR 5.2, CI 1.2 – 22.5) were associated with early death. Prolonged antimicrobial therapy (> 3 months) was associated with reduced long term mortality (HR 0.3, CI 0.1 – 0.9). Conclusion: In this nationwide multicentre study comparing outcomes of radically treated AGI, no differences in survival or re-infection rate could be identified comparing EAB and ISR.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Aortic graft infection, Extra-anatomical bypass, In situ repair, Multicentre, NAIS, Nationwide
in
European journal of vascular and endovascular surgery
volume
62
issue
6
pages
9 pages
publisher
Elsevier
external identifiers
  • scopus:85119035010
  • pmid:34782231
ISSN
1078-5884
DOI
10.1016/j.ejvs.2021.09.033
language
English
LU publication?
yes
id
b7e78df2-5fd3-47d7-a649-30eaebd1b969
date added to LUP
2021-12-20 11:32:07
date last changed
2024-06-29 23:59:36
@article{b7e78df2-5fd3-47d7-a649-30eaebd1b969,
  abstract     = {{<p>Objective: Abdominal aortic graft and endograft infection (AGI) is primarily treated by resection of the infected graft and restoration of distal perfusion through extra-anatomic bypass (EAB) or in situ reconstruction/repair (ISR). The aim of this study was to compare these surgical strategies in a nationwide multicentre retrospective cohort study. Methods: The Swedish Vascular Registry (Swedvasc) was used to identify surgically treated abdominal AGIs in Sweden between January 1995 and May 2017. The primary aim was to compare short and long term survival, as well as complications for EAB and ISR. Results: Some 126 radically surgically treated AGI patients were identified – 102 graft infections and 24 endograft infections – treated by EAB: 71 and ISR: 55 (23 neo-aorto-iliac systems, NAISs). No differences in early 30 day (EAB 81.7% vs. ISR 76.4%, p =.46), or long term five year survival (48.2% vs. 49.9%, p =.87) were identified. There was no survival difference comparing NAIS to other ISR strategies. The frequency of recurrent graft infection during follow up was similar: EAB 20.3% vs. ISR 17.0% (p =.56). Survival and re-infection rates of the new conduit did not differ between NAIS and other ISR strategies. Age ≥ 75 years (odds ratio [OR] 4.0, confidence interval [CI] 1.1 – 14.8), coronary artery disease (OR 4.2, CI 1.2 – 15.1) and post-operative circulatory complications (OR 5.2, CI 1.2 – 22.5) were associated with early death. Prolonged antimicrobial therapy (&gt; 3 months) was associated with reduced long term mortality (HR 0.3, CI 0.1 – 0.9). Conclusion: In this nationwide multicentre study comparing outcomes of radically treated AGI, no differences in survival or re-infection rate could be identified comparing EAB and ISR.</p>}},
  author       = {{Gavali, Hamid and Mani, Kevin and Furebring, Mia and Olsson, Karl W. and Lindström, David and Sörelius, Karl and Sigvant, Birgitta and Gidlund, Khatereh D. 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 Horer, Tal and Sadeghi, Mitra and Wanhainen, Anders}},
  issn         = {{1078-5884}},
  keywords     = {{Aortic graft infection; Extra-anatomical bypass; In situ repair; Multicentre; NAIS; Nationwide}},
  language     = {{eng}},
  number       = {{6}},
  pages        = {{918--926}},
  publisher    = {{Elsevier}},
  series       = {{European journal of vascular and endovascular surgery}},
  title        = {{Editor's Choice – Outcome of Radical Surgical Treatment of Abdominal Aortic Graft and Endograft Infections Comparing Extra-anatomic Bypass with In Situ Reconstruction : A Nationwide Multicentre Study}},
  url          = {{http://dx.doi.org/10.1016/j.ejvs.2021.09.033}},
  doi          = {{10.1016/j.ejvs.2021.09.033}},
  volume       = {{62}},
  year         = {{2021}},
}