Contemporary Outcomes After Partial Resection of Infected Aortic Grafts

Matthew Janko, Grant Hubbard, Karen Woo, Vikram S. Kashyap, Megan Mitchell, Arun Murugesan, Lin Chen, Rachel Gardner, Donald Baril, Robert I. Hacker, Zoltan Szeberin, Ramsey ElSayed, Gregory A. Magee, Fernando Motta, Wei Zhou, Gary Lemmon, Dawn Coleman, Christian Alexander Behrendt, Faisal Aziz, James H. BlackKimberly Tran, Allen Dao, William Shutze, H. Edward Garrett, Giovanni De Caridi, Rhusheet Patel, Christos D. Liapis, George Geroulakos, John Kakisis, Konstantinos Moulakakis, Starvos K. Kakkos, Hideaki Obara, Grace Wang, Jordan Stoecker, Pascal Rhéaume, Victor Davila, Reid Ravin, Randall DeMartino, Ross Milner, Sherene Shalhub, Jeffrey Jim, Jason Lee, Celine Dubuis, Jean Baptiste Ricco, Joseph Coselli, Scott Lemaire, Javairiah Fatima, Jennifer Sanford, Winston Yoshida, Marc L. Schermerhorn, Matthew Menard, Michael Belkin, Stuart Blackwood, Mark Conrad, Linda Wang, Sara Crofts, Thomas Nixon, Timothy Wu, Roberto Chiesa, Saideep Bose, Jason Turner, Ryan Moore, Justin Smith, Ali Irshad, Jeffrey Hsu, Martin Czerny, Jonathan Cullen, Andrea Kahlberg, Carlo Setacci, Jin Hyun Joh, Eric Senneville, Pedro Garrido, Timur P. Sarac, Anthony Rizzo, Michael R. Go, Martin Bjorck, Hamid Gavali, Anders Wanhainen, Mario D'Oria, Sandro Lepidi, Davide Mastrorilli, Gianfranco Veraldi, Michele Piazza, Francesco Squizzato, Adam Beck, Rebecca St. John, Andrew Wishy, Misty Humphries, Samir K. Shah, Martin Back, Jayer Chung, Peter F. Lawrence, Jonathan Bath, Matthew R. Smeds

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)202-210
Number of pages9
JournalAnnals of Vascular Surgery
Volume76
DOIs
StatePublished - Oct 2021
Externally publishedYes

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

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