Contemporary Outcomes After Partial Resection of Infected Aortic Grafts

Detalhes bibliográficos
Autor(a) principal: Janko, Matthew
Data de Publicação: 2021
Outros Autores: Hubbard, Grant, Woo, Karen, Kashyap, Vikram S., Mitchell, Megan, Murugesan, Arun, Chen, Lin, Gardner, Rachel, Baril, Donald, Hacker, Robert I., Szeberin, Zoltan, ElSayed, Ramsey, Magee, Gregory A., Motta, Fernando, Zhou, Wei, Lemmon, Gary, Coleman, Dawn, Behrendt, Christian-Alexander, Aziz, Faisal, Black, James H., Tran, Kimberly, Dao, Allen, Shutze, William, Garrett, H. Edward, De Caridi, Giovanni, Patel, Rhusheet, Liapis, Christos D., Geroulakos, George, Kakisis, John, Moulakakis, Konstantinos, Kakkos, Starvos K., Obara, Hideaki, Wang, Grace, Stoecker, Jordan, Rhéaume, Pascal, Davila, Victor, Ravin, Reid, DeMartino, Randall, Milner, Ross, Shalhub, Sherene, Jim, Jeffrey, Lee, Jason, Dubuis, Celine, Ricco, Jean-Baptiste, Coselli, Joseph, Lemaire, Scott, Fatima, Javairiah, Sanford, Jennifer, Yoshida, Winston [UNESP], Schermerhorn, Marc L, Menard, Matthew, Belkin, Michael, Blackwood, Stuart, Conrad, Mark, Wang, Linda, Crofts, Sara, Nixon, Thomas, Wu, Timothy, Chiesa, Roberto, Bose, Saideep, Turner, Jason, Moore, Ryan, Smith, Justin, Irshad, Ali, Hsu, Jeffrey, Czerny, Martin, Cullen, Jonathan, Kahlberg, Andrea, Setacci, Carlo, Joh, Jin Hyun, Senneville, Eric, Garrido, Pedro, Sarac, Timur P., Rizzo, Anthony, Go, Michael R., Bjorck, Martin, Gavali, Hamid, Wanhainen, Anders, D'Oria, Mario, Lepidi, Sandro, Mastrorilli, Davide, Veraldi, Gianfranco, Piazza, Michele, Squizzato, Francesco, Beck, Adam, St. John, Rebecca, Wishy, Andrew, Humphries, Misty, Shah, Samir K., Back, Martin, Chung, Jayer, Lawrence, Peter F, Bath, Jonathan, Smeds, Matthew R.
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Repositório Institucional da UNESP
Texto Completo: http://dx.doi.org/10.1016/j.avsg.2021.07.002
http://hdl.handle.net/11449/222821
Resumo: Introduction: Aortic graft infection remains a considerable clinical challenge, and it is unclear which variables are associated with adverse outcomes among patients undergoing partial resection. Methods: A retrospective, multi-institutional study of patients who underwent partial resection of infected aortic grafts from 2002 to 2014 was performed using a standard database. Baseline demographics, comorbidities, operative, and postoperative variables were recorded. The primary outcome was mortality. Descriptive statistics, Kaplan-Meier (KM) survival analysis, and Cox regression analysis were performed. Results: One hundred fourteen patients at 22 medical centers in 6 countries underwent partial resection of an infected aortic graft. Seventy percent were men with median age 70 years. Ninety-seven percent had a history of open aortic bypass graft: 88 (77%) patients had infected aortobifemoral bypass, 18 (16%) had infected aortobiiliac bypass, and 1 (0.8%) had an infected thoracic graft. Infection was diagnosed at a median 4.3 years post-implant. All patients underwent partial resection followed by either extra-anatomic (47%) or in situ (53%) vascular reconstruction. Median follow-up period was 17 months (IQR 1, 50 months). Thirty-day mortality was 17.5%. The KM-estimated median survival from time of partial resection was 3.6 years. There was no significant survival difference between those undergoing in situ reconstruction or extra-anatomic bypass (P = 0.6). During follow up, 72% of repairs remained patent and 11% of patients underwent major amputation. On univariate Cox regression analysis, Candida infection was associated with increased risk of mortality (HR 2.4; P = 0.01) as well as aortoenteric fistula (HR 1.9, P = 0.03). Resection of a single graft limb only to resection of abdominal (graft main body) infection was associated with decreased risk of mortality (HR 0.57, P = 0.04), as well as those with American Society of Anesthesiologists classification less than 3 (HR 0.35, P = 0.04). Multivariate analysis did not reveal any factors significantly associated with mortality. Persistent early infection was noted in 26% of patients within 30 days postoperatively, and 39% of patients were found to have any post-repair infection during the follow-up period. Two patients (1.8%) were found to have a late reinfection without early persistent postoperative infection. Patients with any post-repair infection were older (67 vs. 60 years, P = 0.01) and less likely to have patent repairs during follow up (59% vs. 32%, P = 0.01). Patients with aortoenteric fistula had a higher rate of any post-repair infection (63% vs. 29%, P < 0.01) Conclusion: This large multi-center study suggests that patients who have undergone partial resection of infected aortic grafts may be at high risk of death or post-repair infection, especially older patients with abdominal infection not isolated to a single graft limb, or with Candida infection or aortoenteric fistula. Late reinfection correlated strongly with early persistent postoperative infection, raising concern for occult retained infected graft material.
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spelling Contemporary Outcomes After Partial Resection of Infected Aortic GraftsIntroduction: Aortic graft infection remains a considerable clinical challenge, and it is unclear which variables are associated with adverse outcomes among patients undergoing partial resection. Methods: A retrospective, multi-institutional study of patients who underwent partial resection of infected aortic grafts from 2002 to 2014 was performed using a standard database. Baseline demographics, comorbidities, operative, and postoperative variables were recorded. The primary outcome was mortality. Descriptive statistics, Kaplan-Meier (KM) survival analysis, and Cox regression analysis were performed. Results: One hundred fourteen patients at 22 medical centers in 6 countries underwent partial resection of an infected aortic graft. Seventy percent were men with median age 70 years. Ninety-seven percent had a history of open aortic bypass graft: 88 (77%) patients had infected aortobifemoral bypass, 18 (16%) had infected aortobiiliac bypass, and 1 (0.8%) had an infected thoracic graft. Infection was diagnosed at a median 4.3 years post-implant. All patients underwent partial resection followed by either extra-anatomic (47%) or in situ (53%) vascular reconstruction. Median follow-up period was 17 months (IQR 1, 50 months). Thirty-day mortality was 17.5%. The KM-estimated median survival from time of partial resection was 3.6 years. There was no significant survival difference between those undergoing in situ reconstruction or extra-anatomic bypass (P = 0.6). During follow up, 72% of repairs remained patent and 11% of patients underwent major amputation. On univariate Cox regression analysis, Candida infection was associated with increased risk of mortality (HR 2.4; P = 0.01) as well as aortoenteric fistula (HR 1.9, P = 0.03). Resection of a single graft limb only to resection of abdominal (graft main body) infection was associated with decreased risk of mortality (HR 0.57, P = 0.04), as well as those with American Society of Anesthesiologists classification less than 3 (HR 0.35, P = 0.04). Multivariate analysis did not reveal any factors significantly associated with mortality. Persistent early infection was noted in 26% of patients within 30 days postoperatively, and 39% of patients were found to have any post-repair infection during the follow-up period. Two patients (1.8%) were found to have a late reinfection without early persistent postoperative infection. Patients with any post-repair infection were older (67 vs. 60 years, P = 0.01) and less likely to have patent repairs during follow up (59% vs. 32%, P = 0.01). Patients with aortoenteric fistula had a higher rate of any post-repair infection (63% vs. 29%, P < 0.01) Conclusion: This large multi-center study suggests that patients who have undergone partial resection of infected aortic grafts may be at high risk of death or post-repair infection, especially older patients with abdominal infection not isolated to a single graft limb, or with Candida infection or aortoenteric fistula. Late reinfection correlated strongly with early persistent postoperative infection, raising concern for occult retained infected graft material.University Hospitals Cleveland Medical Center Case Western Reserve University School of Medicinethe Ronald Reagan UCLA Medical Center University of California Los AngelesSSM HealthcareSemmelweis UniversityKeck School of Medicine University of Southern CaliforniaUniversity of North Carolina School of MedicineUniversity of Arizonathe Indiana University Health Physicians Vascular SurgeryMichigan Medicine University of MichiganUniversity Heart Center Hamburg University Medical Center Hamburg-EppendorfPenn State Heart and Vascular Institute Milton S. Hershey Medical CenterJohns Hopkins HospitalThe Heart Hospital Baylor Planothe Cardiovascular Surgery ClinicUniversity of MessinaNational & Kapodistrian University of AthensUniversity of PatrasKeio UniversityUniversity of PennsylvaniaVancouver General Hospital & University of British ColumbiaMayo ClinicChristiana Health SystemUniversity of ChicagoHarborview Medical Center University of WashingtonWashington UniversityStanford UniversityCHU de PoitiersBaylor College of MedicineMedStar Georgetown University HospitalSSM Health St. Louis UniversityFaculdade de Medicina de Botucatu-UnespBeth Israel Deaconness Medical CenterBrigham and Women's HospitalSt. Joseph's HospitalMassachusetts General HospitalRobert Wood Johnson Medical School Rutgers UniversityVita-Salute University School of Medicine San Raffaele Scientific InstituteKaiser PermanenteUniversity Heart Center Freiburg-Bad Krozingen FreiburgUniversity of Virginia Medical CenterUniversity of SienaKyung Hee UniversityGustave Dron HospitalCentro Hospitalar de Lisboa NorteWexner Medical Center Ohio State UniversityUppsala UniversityUniversity Hospital of TriesteUniversity Hospital of VeronaUniversity Hospital of PadovaUniversity of AlabamaUniversity of California DavisUniversity of FloridaMichael E. DeBakey Department of Surgery Baylor College of MedicineUniversity Hospital University of MissouriFaculdade de Medicina de Botucatu-UnespCase Western Reserve University School of MedicineUniversity of California Los AngelesSSM HealthcareSemmelweis UniversityUniversity of Southern CaliforniaUniversity of North Carolina School of MedicineUniversity of Arizonathe Indiana University Health Physicians Vascular SurgeryUniversity of MichiganUniversity Medical Center Hamburg-EppendorfMilton S. Hershey Medical CenterJohns Hopkins HospitalThe Heart Hospital Baylor Planothe Cardiovascular Surgery ClinicUniversity of MessinaNational & Kapodistrian University of AthensUniversity of PatrasKeio UniversityUniversity of PennsylvaniaVancouver General Hospital & University of British ColumbiaMayo ClinicChristiana Health SystemUniversity of ChicagoUniversity of WashingtonWashington UniversityStanford UniversityCHU de PoitiersBaylor College of MedicineMedStar Georgetown University HospitalSSM Health St. Louis UniversityUniversidade Estadual Paulista (UNESP)Beth Israel Deaconness Medical CenterBrigham and Women's HospitalSt. Joseph's HospitalMassachusetts General HospitalRutgers UniversitySan Raffaele Scientific InstituteKaiser PermanenteUniversity Heart Center Freiburg-Bad Krozingen FreiburgUniversity of Virginia Medical CenterUniversity of SienaKyung Hee UniversityGustave Dron HospitalCentro Hospitalar de Lisboa NorteOhio State UniversityUppsala UniversityUniversity Hospital of TriesteUniversity Hospital of VeronaUniversity Hospital of PadovaUniversity of AlabamaUniversity of California DavisUniversity of FloridaUniversity of MissouriJanko, MatthewHubbard, GrantWoo, KarenKashyap, Vikram S.Mitchell, MeganMurugesan, ArunChen, LinGardner, RachelBaril, DonaldHacker, Robert I.Szeberin, ZoltanElSayed, RamseyMagee, Gregory A.Motta, FernandoZhou, WeiLemmon, GaryColeman, DawnBehrendt, Christian-AlexanderAziz, FaisalBlack, James H.Tran, KimberlyDao, AllenShutze, WilliamGarrett, H. EdwardDe Caridi, GiovanniPatel, RhusheetLiapis, Christos D.Geroulakos, GeorgeKakisis, JohnMoulakakis, KonstantinosKakkos, Starvos K.Obara, HideakiWang, GraceStoecker, JordanRhéaume, PascalDavila, VictorRavin, ReidDeMartino, RandallMilner, RossShalhub, ShereneJim, JeffreyLee, JasonDubuis, CelineRicco, Jean-BaptisteCoselli, JosephLemaire, ScottFatima, JavairiahSanford, JenniferYoshida, Winston [UNESP]Schermerhorn, Marc LMenard, MatthewBelkin, MichaelBlackwood, StuartConrad, MarkWang, LindaCrofts, SaraNixon, ThomasWu, TimothyChiesa, RobertoBose, SaideepTurner, JasonMoore, RyanSmith, JustinIrshad, AliHsu, JeffreyCzerny, MartinCullen, JonathanKahlberg, AndreaSetacci, CarloJoh, Jin HyunSenneville, EricGarrido, PedroSarac, Timur P.Rizzo, AnthonyGo, Michael R.Bjorck, MartinGavali, HamidWanhainen, AndersD'Oria, MarioLepidi, SandroMastrorilli, DavideVeraldi, GianfrancoPiazza, MicheleSquizzato, FrancescoBeck, AdamSt. John, RebeccaWishy, AndrewHumphries, MistyShah, Samir K.Back, MartinChung, JayerLawrence, Peter FBath, JonathanSmeds, Matthew R.2022-04-28T19:47:00Z2022-04-28T19:47:00Z2021-10-01info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/article202-210http://dx.doi.org/10.1016/j.avsg.2021.07.002Annals of Vascular Surgery, v. 76, p. 202-210.1615-59470890-5096http://hdl.handle.net/11449/22282110.1016/j.avsg.2021.07.0022-s2.0-85118700372Scopusreponame:Repositório Institucional da UNESPinstname:Universidade Estadual Paulista (UNESP)instacron:UNESPengAnnals of Vascular Surgeryinfo:eu-repo/semantics/openAccess2022-04-28T19:47:01Zoai:repositorio.unesp.br:11449/222821Repositório InstitucionalPUBhttp://repositorio.unesp.br/oai/requestopendoar:29462024-08-05T18:12:57.352405Repositório Institucional da UNESP - Universidade Estadual Paulista (UNESP)false
dc.title.none.fl_str_mv Contemporary Outcomes After Partial Resection of Infected Aortic Grafts
title Contemporary Outcomes After Partial Resection of Infected Aortic Grafts
spellingShingle Contemporary Outcomes After Partial Resection of Infected Aortic Grafts
Janko, Matthew
title_short Contemporary Outcomes After Partial Resection of Infected Aortic Grafts
title_full Contemporary Outcomes After Partial Resection of Infected Aortic Grafts
title_fullStr Contemporary Outcomes After Partial Resection of Infected Aortic Grafts
title_full_unstemmed Contemporary Outcomes After Partial Resection of Infected Aortic Grafts
title_sort Contemporary Outcomes After Partial Resection of Infected Aortic Grafts
author Janko, Matthew
author_facet Janko, Matthew
Hubbard, Grant
Woo, Karen
Kashyap, Vikram S.
Mitchell, Megan
Murugesan, Arun
Chen, Lin
Gardner, Rachel
Baril, Donald
Hacker, Robert I.
Szeberin, Zoltan
ElSayed, Ramsey
Magee, Gregory A.
Motta, Fernando
Zhou, Wei
Lemmon, Gary
Coleman, Dawn
Behrendt, Christian-Alexander
Aziz, Faisal
Black, James H.
Tran, Kimberly
Dao, Allen
Shutze, William
Garrett, H. Edward
De Caridi, Giovanni
Patel, Rhusheet
Liapis, Christos D.
Geroulakos, George
Kakisis, John
Moulakakis, Konstantinos
Kakkos, Starvos K.
Obara, Hideaki
Wang, Grace
Stoecker, Jordan
Rhéaume, Pascal
Davila, Victor
Ravin, Reid
DeMartino, Randall
Milner, Ross
Shalhub, Sherene
Jim, Jeffrey
Lee, Jason
Dubuis, Celine
Ricco, Jean-Baptiste
Coselli, Joseph
Lemaire, Scott
Fatima, Javairiah
Sanford, Jennifer
Yoshida, Winston [UNESP]
Schermerhorn, Marc L
Menard, Matthew
Belkin, Michael
Blackwood, Stuart
Conrad, Mark
Wang, Linda
Crofts, Sara
Nixon, Thomas
Wu, Timothy
Chiesa, Roberto
Bose, Saideep
Turner, Jason
Moore, Ryan
Smith, Justin
Irshad, Ali
Hsu, Jeffrey
Czerny, Martin
Cullen, Jonathan
Kahlberg, Andrea
Setacci, Carlo
Joh, Jin Hyun
Senneville, Eric
Garrido, Pedro
Sarac, Timur P.
Rizzo, Anthony
Go, Michael R.
Bjorck, Martin
Gavali, Hamid
Wanhainen, Anders
D'Oria, Mario
Lepidi, Sandro
Mastrorilli, Davide
Veraldi, Gianfranco
Piazza, Michele
Squizzato, Francesco
Beck, Adam
St. John, Rebecca
Wishy, Andrew
Humphries, Misty
Shah, Samir K.
Back, Martin
Chung, Jayer
Lawrence, Peter F
Bath, Jonathan
Smeds, Matthew R.
author_role author
author2 Hubbard, Grant
Woo, Karen
Kashyap, Vikram S.
Mitchell, Megan
Murugesan, Arun
Chen, Lin
Gardner, Rachel
Baril, Donald
Hacker, Robert I.
Szeberin, Zoltan
ElSayed, Ramsey
Magee, Gregory A.
Motta, Fernando
Zhou, Wei
Lemmon, Gary
Coleman, Dawn
Behrendt, Christian-Alexander
Aziz, Faisal
Black, James H.
Tran, Kimberly
Dao, Allen
Shutze, William
Garrett, H. Edward
De Caridi, Giovanni
Patel, Rhusheet
Liapis, Christos D.
Geroulakos, George
Kakisis, John
Moulakakis, Konstantinos
Kakkos, Starvos K.
Obara, Hideaki
Wang, Grace
Stoecker, Jordan
Rhéaume, Pascal
Davila, Victor
Ravin, Reid
DeMartino, Randall
Milner, Ross
Shalhub, Sherene
Jim, Jeffrey
Lee, Jason
Dubuis, Celine
Ricco, Jean-Baptiste
Coselli, Joseph
Lemaire, Scott
Fatima, Javairiah
Sanford, Jennifer
Yoshida, Winston [UNESP]
Schermerhorn, Marc L
Menard, Matthew
Belkin, Michael
Blackwood, Stuart
Conrad, Mark
Wang, Linda
Crofts, Sara
Nixon, Thomas
Wu, Timothy
Chiesa, Roberto
Bose, Saideep
Turner, Jason
Moore, Ryan
Smith, Justin
Irshad, Ali
Hsu, Jeffrey
Czerny, Martin
Cullen, Jonathan
Kahlberg, Andrea
Setacci, Carlo
Joh, Jin Hyun
Senneville, Eric
Garrido, Pedro
Sarac, Timur P.
Rizzo, Anthony
Go, Michael R.
Bjorck, Martin
Gavali, Hamid
Wanhainen, Anders
D'Oria, Mario
Lepidi, Sandro
Mastrorilli, Davide
Veraldi, Gianfranco
Piazza, Michele
Squizzato, Francesco
Beck, Adam
St. John, Rebecca
Wishy, Andrew
Humphries, Misty
Shah, Samir K.
Back, Martin
Chung, Jayer
Lawrence, Peter F
Bath, Jonathan
Smeds, Matthew R.
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dc.contributor.none.fl_str_mv Case Western Reserve University School of Medicine
University of California Los Angeles
SSM Healthcare
Semmelweis University
University of Southern California
University of North Carolina School of Medicine
University of Arizona
the Indiana University Health Physicians Vascular Surgery
University of Michigan
University Medical Center Hamburg-Eppendorf
Milton S. Hershey Medical Center
Johns Hopkins Hospital
The Heart Hospital Baylor Plano
the Cardiovascular Surgery Clinic
University of Messina
National & Kapodistrian University of Athens
University of Patras
Keio University
University of Pennsylvania
Vancouver General Hospital & University of British Columbia
Mayo Clinic
Christiana Health System
University of Chicago
University of Washington
Washington University
Stanford University
CHU de Poitiers
Baylor College of Medicine
MedStar Georgetown University Hospital
SSM Health St. Louis University
Universidade Estadual Paulista (UNESP)
Beth Israel Deaconness Medical Center
Brigham and Women's Hospital
St. Joseph's Hospital
Massachusetts General Hospital
Rutgers University
San Raffaele Scientific Institute
Kaiser Permanente
University Heart Center Freiburg-Bad Krozingen Freiburg
University of Virginia Medical Center
University of Siena
Kyung Hee University
Gustave Dron Hospital
Centro Hospitalar de Lisboa Norte
Ohio State University
Uppsala University
University Hospital of Trieste
University Hospital of Verona
University Hospital of Padova
University of Alabama
University of California Davis
University of Florida
University of Missouri
dc.contributor.author.fl_str_mv Janko, Matthew
Hubbard, Grant
Woo, Karen
Kashyap, Vikram S.
Mitchell, Megan
Murugesan, Arun
Chen, Lin
Gardner, Rachel
Baril, Donald
Hacker, Robert I.
Szeberin, Zoltan
ElSayed, Ramsey
Magee, Gregory A.
Motta, Fernando
Zhou, Wei
Lemmon, Gary
Coleman, Dawn
Behrendt, Christian-Alexander
Aziz, Faisal
Black, James H.
Tran, Kimberly
Dao, Allen
Shutze, William
Garrett, H. Edward
De Caridi, Giovanni
Patel, Rhusheet
Liapis, Christos D.
Geroulakos, George
Kakisis, John
Moulakakis, Konstantinos
Kakkos, Starvos K.
Obara, Hideaki
Wang, Grace
Stoecker, Jordan
Rhéaume, Pascal
Davila, Victor
Ravin, Reid
DeMartino, Randall
Milner, Ross
Shalhub, Sherene
Jim, Jeffrey
Lee, Jason
Dubuis, Celine
Ricco, Jean-Baptiste
Coselli, Joseph
Lemaire, Scott
Fatima, Javairiah
Sanford, Jennifer
Yoshida, Winston [UNESP]
Schermerhorn, Marc L
Menard, Matthew
Belkin, Michael
Blackwood, Stuart
Conrad, Mark
Wang, Linda
Crofts, Sara
Nixon, Thomas
Wu, Timothy
Chiesa, Roberto
Bose, Saideep
Turner, Jason
Moore, Ryan
Smith, Justin
Irshad, Ali
Hsu, Jeffrey
Czerny, Martin
Cullen, Jonathan
Kahlberg, Andrea
Setacci, Carlo
Joh, Jin Hyun
Senneville, Eric
Garrido, Pedro
Sarac, Timur P.
Rizzo, Anthony
Go, Michael R.
Bjorck, Martin
Gavali, Hamid
Wanhainen, Anders
D'Oria, Mario
Lepidi, Sandro
Mastrorilli, Davide
Veraldi, Gianfranco
Piazza, Michele
Squizzato, Francesco
Beck, Adam
St. John, Rebecca
Wishy, Andrew
Humphries, Misty
Shah, Samir K.
Back, Martin
Chung, Jayer
Lawrence, Peter F
Bath, Jonathan
Smeds, Matthew R.
description Introduction: Aortic graft infection remains a considerable clinical challenge, and it is unclear which variables are associated with adverse outcomes among patients undergoing partial resection. Methods: A retrospective, multi-institutional study of patients who underwent partial resection of infected aortic grafts from 2002 to 2014 was performed using a standard database. Baseline demographics, comorbidities, operative, and postoperative variables were recorded. The primary outcome was mortality. Descriptive statistics, Kaplan-Meier (KM) survival analysis, and Cox regression analysis were performed. Results: One hundred fourteen patients at 22 medical centers in 6 countries underwent partial resection of an infected aortic graft. Seventy percent were men with median age 70 years. Ninety-seven percent had a history of open aortic bypass graft: 88 (77%) patients had infected aortobifemoral bypass, 18 (16%) had infected aortobiiliac bypass, and 1 (0.8%) had an infected thoracic graft. Infection was diagnosed at a median 4.3 years post-implant. All patients underwent partial resection followed by either extra-anatomic (47%) or in situ (53%) vascular reconstruction. Median follow-up period was 17 months (IQR 1, 50 months). Thirty-day mortality was 17.5%. The KM-estimated median survival from time of partial resection was 3.6 years. There was no significant survival difference between those undergoing in situ reconstruction or extra-anatomic bypass (P = 0.6). During follow up, 72% of repairs remained patent and 11% of patients underwent major amputation. On univariate Cox regression analysis, Candida infection was associated with increased risk of mortality (HR 2.4; P = 0.01) as well as aortoenteric fistula (HR 1.9, P = 0.03). Resection of a single graft limb only to resection of abdominal (graft main body) infection was associated with decreased risk of mortality (HR 0.57, P = 0.04), as well as those with American Society of Anesthesiologists classification less than 3 (HR 0.35, P = 0.04). Multivariate analysis did not reveal any factors significantly associated with mortality. Persistent early infection was noted in 26% of patients within 30 days postoperatively, and 39% of patients were found to have any post-repair infection during the follow-up period. Two patients (1.8%) were found to have a late reinfection without early persistent postoperative infection. Patients with any post-repair infection were older (67 vs. 60 years, P = 0.01) and less likely to have patent repairs during follow up (59% vs. 32%, P = 0.01). Patients with aortoenteric fistula had a higher rate of any post-repair infection (63% vs. 29%, P < 0.01) Conclusion: This large multi-center study suggests that patients who have undergone partial resection of infected aortic grafts may be at high risk of death or post-repair infection, especially older patients with abdominal infection not isolated to a single graft limb, or with Candida infection or aortoenteric fistula. Late reinfection correlated strongly with early persistent postoperative infection, raising concern for occult retained infected graft material.
publishDate 2021
dc.date.none.fl_str_mv 2021-10-01
2022-04-28T19:47:00Z
2022-04-28T19:47:00Z
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
format article
status_str publishedVersion
dc.identifier.uri.fl_str_mv http://dx.doi.org/10.1016/j.avsg.2021.07.002
Annals of Vascular Surgery, v. 76, p. 202-210.
1615-5947
0890-5096
http://hdl.handle.net/11449/222821
10.1016/j.avsg.2021.07.002
2-s2.0-85118700372
url http://dx.doi.org/10.1016/j.avsg.2021.07.002
http://hdl.handle.net/11449/222821
identifier_str_mv Annals of Vascular Surgery, v. 76, p. 202-210.
1615-5947
0890-5096
10.1016/j.avsg.2021.07.002
2-s2.0-85118700372
dc.language.iso.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv Annals of Vascular Surgery
dc.rights.driver.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv 202-210
dc.source.none.fl_str_mv Scopus
reponame:Repositório Institucional da UNESP
instname:Universidade Estadual Paulista (UNESP)
instacron:UNESP
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repository.name.fl_str_mv Repositório Institucional da UNESP - Universidade Estadual Paulista (UNESP)
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