Evolution from axillofemoral to in situ prosthetic reconstruction for the treatment of aortic graft infections at a single center

Gustavo Oderich, Thomas C. Bower, Kenneth J. Cherry, Jean M. Panneton, Timothy M. Sullivan, Audra A. Noel, Michele Carmo, Stephen Cha, Manju Kalra, Peter Gloviczki

Research output: Contribution to journalArticle

84 Citations (Scopus)

Abstract

Objective: The primary purpose of this study was to analyze the clinical outcome in patients treated for aortic graft infections with in situ reconstruction (ISR). As a secondary aim, the outcomes were compared between patients who had similar clinical characteristics and extent of infection, needed total graft excision, and had either ISR or axillofemoral reconstruction (AXFR). Methods: 117 consecutive patients treated for aortic graft infection over a 20 year period from January 1981 to December 2001 were identified. 52 patients had prosthetic ISR, 49 had AXFR, and 16 had other reconstructions. The ISR patients treated with total (n = 35) or partial (n = 17) graft excision comprised the primary analysis. A second analysis was done between 34 ISR and 43 AXFR patients (non-concurrent groups), as stated above. Primary outcome measures were early and late procedure-related death, primary graft patency and limb loss. Secondary outcomes were operative morbidity, patient survival, and graft reinfection rates. Results: There were 40 males and 12 females with a mean age of 69 years treated with ISR. 43 patients had Rifampin-soaked grafts and 39 had omental flap or other autogenous coverage. Operative morbidity occurred in 23 patients (44%). There were 4 early and no late procedure-related deaths after a median follow up of 3.4 years (range, 2 months to 9.6 years). Primary patency and limb salvage rates at 5 years were 89% and 100%, respectively. Graft reinfection occurred in 6 patients (11.5%) and was not associated with procedure-related death. In the comparative analysis, the procedure-related death rate for patients treated with ISR was not different than those treated with AXFR (9% versus 23%; P = 0.11). There was a significant improvement in primary patency between ISR and AXFR at 5 years (89% versus 48%; P = .01). Limb salvage was 100% for ISR and 89% for AXFR at 5 years (P = .06). The incidence of graft reinfection was similar in both groups: 11% for ISR and 17% for AXFR (P = .28). Major complications or procedure-related deaths occurred in 12 patients after ISR (30%) and 26 patients (60%) after AXFR (P < .04). Conclusion: ISR is a safe and effective alternative in the treatment of select patients with aortic graft infection. Graft reinfection occurred in 11.5% of the patients. The graft patency and limb salvages rates are excellent.

Original languageEnglish (US)
Pages (from-to)1166-1174
Number of pages9
JournalJournal of Vascular Surgery
Volume43
Issue number6
DOIs
StatePublished - Jun 1 2006

Fingerprint

Transplants
Infection
Therapeutics
Limb Salvage
Morbidity
Graft Survival
Rifampin
Extremities
Outcome Assessment (Health Care)
Mortality
Incidence

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Evolution from axillofemoral to in situ prosthetic reconstruction for the treatment of aortic graft infections at a single center. / Oderich, Gustavo; Bower, Thomas C.; Cherry, Kenneth J.; Panneton, Jean M.; Sullivan, Timothy M.; Noel, Audra A.; Carmo, Michele; Cha, Stephen; Kalra, Manju; Gloviczki, Peter.

In: Journal of Vascular Surgery, Vol. 43, No. 6, 01.06.2006, p. 1166-1174.

Research output: Contribution to journalArticle

Oderich, G, Bower, TC, Cherry, KJ, Panneton, JM, Sullivan, TM, Noel, AA, Carmo, M, Cha, S, Kalra, M & Gloviczki, P 2006, 'Evolution from axillofemoral to in situ prosthetic reconstruction for the treatment of aortic graft infections at a single center', Journal of Vascular Surgery, vol. 43, no. 6, pp. 1166-1174. https://doi.org/10.1016/j.jvs.2006.02.040
Oderich, Gustavo ; Bower, Thomas C. ; Cherry, Kenneth J. ; Panneton, Jean M. ; Sullivan, Timothy M. ; Noel, Audra A. ; Carmo, Michele ; Cha, Stephen ; Kalra, Manju ; Gloviczki, Peter. / Evolution from axillofemoral to in situ prosthetic reconstruction for the treatment of aortic graft infections at a single center. In: Journal of Vascular Surgery. 2006 ; Vol. 43, No. 6. pp. 1166-1174.
@article{16b1b99482164c828fa922675835ee27,
title = "Evolution from axillofemoral to in situ prosthetic reconstruction for the treatment of aortic graft infections at a single center",
abstract = "Objective: The primary purpose of this study was to analyze the clinical outcome in patients treated for aortic graft infections with in situ reconstruction (ISR). As a secondary aim, the outcomes were compared between patients who had similar clinical characteristics and extent of infection, needed total graft excision, and had either ISR or axillofemoral reconstruction (AXFR). Methods: 117 consecutive patients treated for aortic graft infection over a 20 year period from January 1981 to December 2001 were identified. 52 patients had prosthetic ISR, 49 had AXFR, and 16 had other reconstructions. The ISR patients treated with total (n = 35) or partial (n = 17) graft excision comprised the primary analysis. A second analysis was done between 34 ISR and 43 AXFR patients (non-concurrent groups), as stated above. Primary outcome measures were early and late procedure-related death, primary graft patency and limb loss. Secondary outcomes were operative morbidity, patient survival, and graft reinfection rates. Results: There were 40 males and 12 females with a mean age of 69 years treated with ISR. 43 patients had Rifampin-soaked grafts and 39 had omental flap or other autogenous coverage. Operative morbidity occurred in 23 patients (44{\%}). There were 4 early and no late procedure-related deaths after a median follow up of 3.4 years (range, 2 months to 9.6 years). Primary patency and limb salvage rates at 5 years were 89{\%} and 100{\%}, respectively. Graft reinfection occurred in 6 patients (11.5{\%}) and was not associated with procedure-related death. In the comparative analysis, the procedure-related death rate for patients treated with ISR was not different than those treated with AXFR (9{\%} versus 23{\%}; P = 0.11). There was a significant improvement in primary patency between ISR and AXFR at 5 years (89{\%} versus 48{\%}; P = .01). Limb salvage was 100{\%} for ISR and 89{\%} for AXFR at 5 years (P = .06). The incidence of graft reinfection was similar in both groups: 11{\%} for ISR and 17{\%} for AXFR (P = .28). Major complications or procedure-related deaths occurred in 12 patients after ISR (30{\%}) and 26 patients (60{\%}) after AXFR (P < .04). Conclusion: ISR is a safe and effective alternative in the treatment of select patients with aortic graft infection. Graft reinfection occurred in 11.5{\%} of the patients. The graft patency and limb salvages rates are excellent.",
author = "Gustavo Oderich and Bower, {Thomas C.} and Cherry, {Kenneth J.} and Panneton, {Jean M.} and Sullivan, {Timothy M.} and Noel, {Audra A.} and Michele Carmo and Stephen Cha and Manju Kalra and Peter Gloviczki",
year = "2006",
month = "6",
day = "1",
doi = "10.1016/j.jvs.2006.02.040",
language = "English (US)",
volume = "43",
pages = "1166--1174",
journal = "Journal of Vascular Surgery",
issn = "0741-5214",
publisher = "Mosby Inc.",
number = "6",

}

TY - JOUR

T1 - Evolution from axillofemoral to in situ prosthetic reconstruction for the treatment of aortic graft infections at a single center

AU - Oderich, Gustavo

AU - Bower, Thomas C.

AU - Cherry, Kenneth J.

AU - Panneton, Jean M.

AU - Sullivan, Timothy M.

AU - Noel, Audra A.

AU - Carmo, Michele

AU - Cha, Stephen

AU - Kalra, Manju

AU - Gloviczki, Peter

PY - 2006/6/1

Y1 - 2006/6/1

N2 - Objective: The primary purpose of this study was to analyze the clinical outcome in patients treated for aortic graft infections with in situ reconstruction (ISR). As a secondary aim, the outcomes were compared between patients who had similar clinical characteristics and extent of infection, needed total graft excision, and had either ISR or axillofemoral reconstruction (AXFR). Methods: 117 consecutive patients treated for aortic graft infection over a 20 year period from January 1981 to December 2001 were identified. 52 patients had prosthetic ISR, 49 had AXFR, and 16 had other reconstructions. The ISR patients treated with total (n = 35) or partial (n = 17) graft excision comprised the primary analysis. A second analysis was done between 34 ISR and 43 AXFR patients (non-concurrent groups), as stated above. Primary outcome measures were early and late procedure-related death, primary graft patency and limb loss. Secondary outcomes were operative morbidity, patient survival, and graft reinfection rates. Results: There were 40 males and 12 females with a mean age of 69 years treated with ISR. 43 patients had Rifampin-soaked grafts and 39 had omental flap or other autogenous coverage. Operative morbidity occurred in 23 patients (44%). There were 4 early and no late procedure-related deaths after a median follow up of 3.4 years (range, 2 months to 9.6 years). Primary patency and limb salvage rates at 5 years were 89% and 100%, respectively. Graft reinfection occurred in 6 patients (11.5%) and was not associated with procedure-related death. In the comparative analysis, the procedure-related death rate for patients treated with ISR was not different than those treated with AXFR (9% versus 23%; P = 0.11). There was a significant improvement in primary patency between ISR and AXFR at 5 years (89% versus 48%; P = .01). Limb salvage was 100% for ISR and 89% for AXFR at 5 years (P = .06). The incidence of graft reinfection was similar in both groups: 11% for ISR and 17% for AXFR (P = .28). Major complications or procedure-related deaths occurred in 12 patients after ISR (30%) and 26 patients (60%) after AXFR (P < .04). Conclusion: ISR is a safe and effective alternative in the treatment of select patients with aortic graft infection. Graft reinfection occurred in 11.5% of the patients. The graft patency and limb salvages rates are excellent.

AB - Objective: The primary purpose of this study was to analyze the clinical outcome in patients treated for aortic graft infections with in situ reconstruction (ISR). As a secondary aim, the outcomes were compared between patients who had similar clinical characteristics and extent of infection, needed total graft excision, and had either ISR or axillofemoral reconstruction (AXFR). Methods: 117 consecutive patients treated for aortic graft infection over a 20 year period from January 1981 to December 2001 were identified. 52 patients had prosthetic ISR, 49 had AXFR, and 16 had other reconstructions. The ISR patients treated with total (n = 35) or partial (n = 17) graft excision comprised the primary analysis. A second analysis was done between 34 ISR and 43 AXFR patients (non-concurrent groups), as stated above. Primary outcome measures were early and late procedure-related death, primary graft patency and limb loss. Secondary outcomes were operative morbidity, patient survival, and graft reinfection rates. Results: There were 40 males and 12 females with a mean age of 69 years treated with ISR. 43 patients had Rifampin-soaked grafts and 39 had omental flap or other autogenous coverage. Operative morbidity occurred in 23 patients (44%). There were 4 early and no late procedure-related deaths after a median follow up of 3.4 years (range, 2 months to 9.6 years). Primary patency and limb salvage rates at 5 years were 89% and 100%, respectively. Graft reinfection occurred in 6 patients (11.5%) and was not associated with procedure-related death. In the comparative analysis, the procedure-related death rate for patients treated with ISR was not different than those treated with AXFR (9% versus 23%; P = 0.11). There was a significant improvement in primary patency between ISR and AXFR at 5 years (89% versus 48%; P = .01). Limb salvage was 100% for ISR and 89% for AXFR at 5 years (P = .06). The incidence of graft reinfection was similar in both groups: 11% for ISR and 17% for AXFR (P = .28). Major complications or procedure-related deaths occurred in 12 patients after ISR (30%) and 26 patients (60%) after AXFR (P < .04). Conclusion: ISR is a safe and effective alternative in the treatment of select patients with aortic graft infection. Graft reinfection occurred in 11.5% of the patients. The graft patency and limb salvages rates are excellent.

UR - http://www.scopus.com/inward/record.url?scp=33744737910&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33744737910&partnerID=8YFLogxK

U2 - 10.1016/j.jvs.2006.02.040

DO - 10.1016/j.jvs.2006.02.040

M3 - Article

C2 - 16765233

AN - SCOPUS:33744737910

VL - 43

SP - 1166

EP - 1174

JO - Journal of Vascular Surgery

JF - Journal of Vascular Surgery

SN - 0741-5214

IS - 6

ER -