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Conservative Management First Strategy in Aortic Vascular Graft and Endograft Infections

Ljungquist, Oskar LU ; Haidl, Sven LU ; Dias, Nuno LU orcid ; Sonesson, Björn LU ; Sörelius, Karl ; Trägårdh, Elin LU and Ahl, Jonas LU (2023) In European Journal of Vascular and Endovascular Surgery 65(6). p.896-904
Abstract

OBJECTIVE: The aim of this study was to describe and present the outcomes of a specific treatment protocol for aortic vascular graft and endograft infections (VGEIs) without explantation of the infected graft.

METHODS: This was a retrospective, observational single centre cohort study carried out between 2012 and 2022 at a tertiary hospital. An aortic VGEI was defined according to the Management of Aortic Graft Infection Collaboration (MAGIC) criteria. Fitness for graft excision was assessed by a multidisciplinary team and included an evaluation of the patient's general condition, septic status, and anatomical complexity. Antimicrobial treatments were individualised. The primary outcome was survival at the last available follow... (More)

OBJECTIVE: The aim of this study was to describe and present the outcomes of a specific treatment protocol for aortic vascular graft and endograft infections (VGEIs) without explantation of the infected graft.

METHODS: This was a retrospective, observational single centre cohort study carried out between 2012 and 2022 at a tertiary hospital. An aortic VGEI was defined according to the Management of Aortic Graft Infection Collaboration (MAGIC) criteria. Fitness for graft excision was assessed by a multidisciplinary team and included an evaluation of the patient's general condition, septic status, and anatomical complexity. Antimicrobial treatments were individualised. The primary outcome was survival at the last available follow up; secondary outcomes were antimicrobial treatment duration, infection eradication, treatment failure despite antimicrobial treatment, and the development of aortic fistulation.

RESULTS: Fifty patients were included in the study, of whom 42 (84%) had previous endovascular repair. Median patient age was 72 years (range 51 - 82 years) and median duration of treatment with antimicrobials was 18 months (range 1 - 164 months). Kaplan-Meier analysis estimated the 30 day survival rate to be 98% (95% confidence interval [CI] 96 - 100), the one year survival rate to be 88% (95% CI 83.4 - 92.6), and the three year survival rate to be 79% (95% CI 72.7 - 84.7). Twenty-four (48%) patients were able to discontinue antibiotic treatment after a median of 16 months (range 4 - 81 months). When categorised according to infected graft location, deaths occurred in four (40%) patients with thoracic, four (40%) with paravisceral, seven (30%) with infrarenal VGEIs, and in one (25%) patient with an aorto-iliac VGEI; no (0%) patient with a thoraco-abdominal VGEI died.

CONCLUSION: Identifying the microbiological aetiology in patients with aortic VGEI enables individualised, specific antibiotic treatment, which may be useful in patients with a VGEI excluded from surgery. This single centre retrospective analysis of patients with VGEIs without fistula selected for conservative treatment suggests that conservative management of aortic VGEIs with targeted antibiotic therapy without graft excision is potentially effective, and that antimicrobial treatment will not necessarily be needed indefinitely.

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author
; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
European Journal of Vascular and Endovascular Surgery
volume
65
issue
6
pages
896 - 904
publisher
Elsevier
external identifiers
  • pmid:36921753
  • scopus:85152946894
ISSN
1532-2165
DOI
10.1016/j.ejvs.2023.03.003
language
English
LU publication?
yes
additional info
Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.
id
bdc881fb-49cf-4361-98d8-72c426e6a07f
date added to LUP
2023-03-20 09:41:39
date last changed
2024-04-19 20:28:55
@article{bdc881fb-49cf-4361-98d8-72c426e6a07f,
  abstract     = {{<p>OBJECTIVE: The aim of this study was to describe and present the outcomes of a specific treatment protocol for aortic vascular graft and endograft infections (VGEIs) without explantation of the infected graft.</p><p>METHODS: This was a retrospective, observational single centre cohort study carried out between 2012 and 2022 at a tertiary hospital. An aortic VGEI was defined according to the Management of Aortic Graft Infection Collaboration (MAGIC) criteria. Fitness for graft excision was assessed by a multidisciplinary team and included an evaluation of the patient's general condition, septic status, and anatomical complexity. Antimicrobial treatments were individualised. The primary outcome was survival at the last available follow up; secondary outcomes were antimicrobial treatment duration, infection eradication, treatment failure despite antimicrobial treatment, and the development of aortic fistulation.</p><p>RESULTS: Fifty patients were included in the study, of whom 42 (84%) had previous endovascular repair. Median patient age was 72 years (range 51 - 82 years) and median duration of treatment with antimicrobials was 18 months (range 1 - 164 months). Kaplan-Meier analysis estimated the 30 day survival rate to be 98% (95% confidence interval [CI] 96 - 100), the one year survival rate to be 88% (95% CI 83.4 - 92.6), and the three year survival rate to be 79% (95% CI 72.7 - 84.7). Twenty-four (48%) patients were able to discontinue antibiotic treatment after a median of 16 months (range 4 - 81 months). When categorised according to infected graft location, deaths occurred in four (40%) patients with thoracic, four (40%) with paravisceral, seven (30%) with infrarenal VGEIs, and in one (25%) patient with an aorto-iliac VGEI; no (0%) patient with a thoraco-abdominal VGEI died.</p><p>CONCLUSION: Identifying the microbiological aetiology in patients with aortic VGEI enables individualised, specific antibiotic treatment, which may be useful in patients with a VGEI excluded from surgery. This single centre retrospective analysis of patients with VGEIs without fistula selected for conservative treatment suggests that conservative management of aortic VGEIs with targeted antibiotic therapy without graft excision is potentially effective, and that antimicrobial treatment will not necessarily be needed indefinitely.</p>}},
  author       = {{Ljungquist, Oskar and Haidl, Sven and Dias, Nuno and Sonesson, Björn and Sörelius, Karl and Trägårdh, Elin and Ahl, Jonas}},
  issn         = {{1532-2165}},
  language     = {{eng}},
  month        = {{03}},
  number       = {{6}},
  pages        = {{896--904}},
  publisher    = {{Elsevier}},
  series       = {{European Journal of Vascular and Endovascular Surgery}},
  title        = {{Conservative Management First Strategy in Aortic Vascular Graft and Endograft Infections}},
  url          = {{http://dx.doi.org/10.1016/j.ejvs.2023.03.003}},
  doi          = {{10.1016/j.ejvs.2023.03.003}},
  volume       = {{65}},
  year         = {{2023}},
}