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

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

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90 Scopus citations

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

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

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    Oderich, G. S., Bower, T. C., Cherry, K. J., Panneton, J. M., Sullivan, T. M., Noel, A. A., 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, 43(6), 1166-1174. https://doi.org/10.1016/j.jvs.2006.02.040