Clinical ResearchTreatment and Outcomes of Aortic Graft Infections Using a Decision Algorithm
Section snippets
INTRODUCTION
Aortic graft infection(AGI) is a rare but devastating complication that usually mandates extirpation of the infected prosthesis and some method of lower extremity revascularization.1., 2., 3., 4., 5., 6., 7., 8. Despite a variety of techniques to treat AGI, there is a paucity of evidence describing comparative effectiveness of different management strategies.2,3,6 This shortcoming is related to the absence of randomized controlled trials to govern clinical decisions, which are largely
MATERIAL AND METHODS
This study was approved by the Institutional Review Board at the University of Florida College of Medicine (IRB# 2230-2019). The need for patient consent was waived due to the minimal risk and retrospective nature of the study.
Study design and database. The institutional data repository research query included the following criteria: procedure occurring between 2002–2019, including one of the following (partial) keywords: “infect”, “excise”, and classified within the database as one of the
DISCUSSION
The current analysis highlights contemporary results for surgical management of AGI. Herein, we provide a detailed description of a decision-algorithm, that when consistently applied, led to acceptable outcomes for one of the most difficult problems vascular surgeons manage. Specifically, a variety of different reconstruction strategies, conduit choices, and operative sequences were employed to effectively manage AGI. Importantly, this series also presents a comparative description of
CONCLUSIONS
AGI results in significant early morbidity and mortality and the need for re-operative procedures is common; however, long-term survival is good in appropriately selected patients. The risk of late re-infection mandates lifelong surveillance and targeted anti-microbial suppression strategies. Management of AGI using multiple operative approaches can result in acceptable and predictable results for most outcomes when occurring at a center with experience managing complex aortic disease that uses
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Conflicts of Interest: The authors have no relevant conflicts of interest.
Funding: This research was not supported by any specific grant from a funding agency in the public, commercial, or not-for-profit sectors.
Meeting Presentation: This work was presented at the 44th Annual Meeting of the Vascular and Endovascular Surgery Society (VESS) January 30 - February 2, 2020 at The Steamboat Grand in Steamboat Springs, CO.
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Shared 1st authorship