Contemporary Outcomes After Partial Resection ...
Type de document :
Article dans une revue scientifique: Article original
PMID :
URL permanente :
Titre :
Contemporary Outcomes After Partial Resection Of Infected Aortic Grafts
Auteur(s) :
Janko, M. [Auteur]
Hubbard, G. [Auteur]
Woo, K. [Auteur]
Kashyap, V. S. [Auteur]
Mitchell, M. [Auteur]
Murugesan, A. [Auteur]
Chen, L. [Auteur]
Gardner, R. [Auteur]
Baril, D. [Auteur]
Hacker, R. I. [Auteur]
Szeberin, Z. [Auteur]
Elsayed, R. [Auteur]
Magee, G. A. [Auteur]
Motta, F. [Auteur]
Zhou, W. [Auteur]
Lemmon, G. [Auteur]
Coleman, D. [Auteur]
Behrendt, C. A. [Auteur]
Aziz, F. [Auteur]
Black, J. H. [Auteur]
Tran, K. [Auteur]
Dao, A. [Auteur]
Shutze, W. [Auteur]
Garrett, H. E. [Auteur]
De Caridi, G. [Auteur]
Patel, R. [Auteur]
Liapis, C. D. [Auteur]
Geroulakos, G. [Auteur]
Kakisis, J. [Auteur]
Moulakakis, K. [Auteur]
Kakkos, S. K. [Auteur]
Obara, H. [Auteur]
Wang, G. [Auteur]
Stoecker, J. [Auteur]
Rhéaume, P. [Auteur]
Davila, V. [Auteur]
Ravin, R. [Auteur]
Demartino, R. [Auteur]
Milner, R. [Auteur]
Shalhub, S. [Auteur]
Jim, J. [Auteur]
Lee, J. [Auteur]
Dubuis, C. [Auteur]
Ricco, J. B. [Auteur]
Coselli, J. [Auteur]
Lemaire, S. [Auteur]
Fatima, J. [Auteur]
Sanford, J. [Auteur]
Yoshida, W. [Auteur]
Schermerhorn, M. L. [Auteur]
Menard, M. [Auteur]
Belkin, M. [Auteur]
Blackwood, S. [Auteur]
Conrad, M. [Auteur]
Wang, L. [Auteur]
Crofts, S. [Auteur]
Nixon, T. [Auteur]
Wu, T. [Auteur]
Chiesa, R. [Auteur]
Bose, S. [Auteur]
Turner, J. [Auteur]
Moore, R. [Auteur]
Smith, J. [Auteur]
Irshad, A. [Auteur]
Hsu, J. [Auteur]
Czerny, M. [Auteur]
Cullen, J. [Auteur]
Kahlberg, A. [Auteur]
Setacci, C. [Auteur]
Joh, J. H. [Auteur]
Senneville, Eric [Auteur]
Evaluation des technologies de santé et des pratiques médicales - ULR 2694 [METRICS]
Garrido, P. [Auteur]
Sarac, T. P. [Auteur]
Rizzo, A. [Auteur]
Go, M. R. [Auteur]
Bjorck, M. [Auteur]
Gavali, H. [Auteur]
Wanhainen, A. [Auteur]
D'oria, M. [Auteur]
Lepidi, S. [Auteur]
Mastrorilli, D. [Auteur]
Veraldi, G. [Auteur]
Piazza, M. [Auteur]
Squizzato, F. [Auteur]
Beck, A. [Auteur]
St John, R. [Auteur]
Wishy, A. [Auteur]
Humphries, M. [Auteur]
Shah, S. K. [Auteur]
Back, M. [Auteur]
Chung, J. [Auteur]
Lawrence, P. F. [Auteur]
Bath, J. [Auteur]
Smeds, M. R. [Auteur]
Hubbard, G. [Auteur]
Woo, K. [Auteur]
Kashyap, V. S. [Auteur]
Mitchell, M. [Auteur]
Murugesan, A. [Auteur]
Chen, L. [Auteur]
Gardner, R. [Auteur]
Baril, D. [Auteur]
Hacker, R. I. [Auteur]
Szeberin, Z. [Auteur]
Elsayed, R. [Auteur]
Magee, G. A. [Auteur]
Motta, F. [Auteur]
Zhou, W. [Auteur]
Lemmon, G. [Auteur]
Coleman, D. [Auteur]
Behrendt, C. A. [Auteur]
Aziz, F. [Auteur]
Black, J. H. [Auteur]
Tran, K. [Auteur]
Dao, A. [Auteur]
Shutze, W. [Auteur]
Garrett, H. E. [Auteur]
De Caridi, G. [Auteur]
Patel, R. [Auteur]
Liapis, C. D. [Auteur]
Geroulakos, G. [Auteur]
Kakisis, J. [Auteur]
Moulakakis, K. [Auteur]
Kakkos, S. K. [Auteur]
Obara, H. [Auteur]
Wang, G. [Auteur]
Stoecker, J. [Auteur]
Rhéaume, P. [Auteur]
Davila, V. [Auteur]
Ravin, R. [Auteur]
Demartino, R. [Auteur]
Milner, R. [Auteur]
Shalhub, S. [Auteur]
Jim, J. [Auteur]
Lee, J. [Auteur]
Dubuis, C. [Auteur]
Ricco, J. B. [Auteur]
Coselli, J. [Auteur]
Lemaire, S. [Auteur]
Fatima, J. [Auteur]
Sanford, J. [Auteur]
Yoshida, W. [Auteur]
Schermerhorn, M. L. [Auteur]
Menard, M. [Auteur]
Belkin, M. [Auteur]
Blackwood, S. [Auteur]
Conrad, M. [Auteur]
Wang, L. [Auteur]
Crofts, S. [Auteur]
Nixon, T. [Auteur]
Wu, T. [Auteur]
Chiesa, R. [Auteur]
Bose, S. [Auteur]
Turner, J. [Auteur]
Moore, R. [Auteur]
Smith, J. [Auteur]
Irshad, A. [Auteur]
Hsu, J. [Auteur]
Czerny, M. [Auteur]
Cullen, J. [Auteur]
Kahlberg, A. [Auteur]
Setacci, C. [Auteur]
Joh, J. H. [Auteur]
Senneville, Eric [Auteur]
Evaluation des technologies de santé et des pratiques médicales - ULR 2694 [METRICS]
Garrido, P. [Auteur]
Sarac, T. P. [Auteur]
Rizzo, A. [Auteur]
Go, M. R. [Auteur]
Bjorck, M. [Auteur]
Gavali, H. [Auteur]
Wanhainen, A. [Auteur]
D'oria, M. [Auteur]
Lepidi, S. [Auteur]
Mastrorilli, D. [Auteur]
Veraldi, G. [Auteur]
Piazza, M. [Auteur]
Squizzato, F. [Auteur]
Beck, A. [Auteur]
St John, R. [Auteur]
Wishy, A. [Auteur]
Humphries, M. [Auteur]
Shah, S. K. [Auteur]
Back, M. [Auteur]
Chung, J. [Auteur]
Lawrence, P. F. [Auteur]
Bath, J. [Auteur]
Smeds, M. R. [Auteur]
Titre de la revue :
Annals of Vascular Surgery
Nom court de la revue :
Ann Vasc Surg
Numéro :
76
Pagination :
p. 202-210
Date de publication :
2021-10
ISSN :
0890-5096
Discipline(s) HAL :
Sciences du Vivant [q-bio]
Résumé en anglais : [en]
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, ...
Lire la suite >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.Lire moins >
Lire la suite >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.Lire moins >
Langue :
Anglais
Audience :
Internationale
Vulgarisation :
Non
Établissement(s) :
Université de Lille
CHU Lille
CHU Lille
Date de dépôt :
2023-11-15T05:58:17Z
2023-12-13T08:40:58Z
2023-12-13T08:40:58Z