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Contemporary Outcomes After Partial Resection of Infected Aortic Grafts

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

In: ANN VASC SURG, Vol. 76, 10.2021, p. 202-210.

Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review

Harvard

Janko, M, Hubbard, G, Woo, K, Kashyap, VS, Mitchell, M, Murugesan, A, Chen, L, Gardner, R, Baril, D, Hacker, RI, Szeberin, Z, ElSayed, R, Magee, GA, Motta, F, Zhou, W, Lemmon, G, Coleman, D, Behrendt, CA, Aziz, F, Black, JH, Tran, K, Dao, A, Shutze, W, Garrett, HE, De Caridi, G, Patel, R, Liapis, CD, Geroulakos, G, Kakisis, J, Moulakakis, K, Kakkos, SK, Obara, H, Wang, G, Stoecker, J, Rhéaume, P, Davila, V, Ravin, R, DeMartino, R, Milner, R, Shalhub, S, Jim, J, Lee, J, Dubuis, C, Ricco, JB, Coselli, J, Lemaire, S, Fatima, J, Sanford, J, Yoshida, W, Schermerhorn, ML, Menard, M, Belkin, M, Blackwood, S, Conrad, M, Wang, L, Crofts, S, Nixon, T, Wu, T, Chiesa, R, Bose, S, Turner, J, Moore, R, Smith, J, Irshad, A, Hsu, J, Czerny, M, Cullen, J, Kahlberg, A, Setacci, C, Joh, JH, Senneville, E, Garrido, P, Sarac, TP, Rizzo, A, Go, MR, Bjorck, M, Gavali, H, Wanhainen, A, D'Oria, M, Lepidi, S, Mastrorilli, D, Veraldi, G, Piazza, M, Squizzato, F, Beck, A, St. John, R, Wishy, A, Humphries, M, Shah, SK, Back, M, Chung, J, Lawrence, PF, Bath, J & Smeds, MR 2021, 'Contemporary Outcomes After Partial Resection of Infected Aortic Grafts', ANN VASC SURG, vol. 76, pp. 202-210. https://doi.org/10.1016/j.avsg.2021.07.002

APA

Janko, M., Hubbard, G., Woo, K., Kashyap, V. S., Mitchell, M., Murugesan, A., Chen, L., Gardner, R., Baril, D., Hacker, R. I., Szeberin, Z., ElSayed, R., Magee, G. A., Motta, F., Zhou, W., Lemmon, G., Coleman, D., Behrendt, C. A., Aziz, F., ... Smeds, M. R. (2021). Contemporary Outcomes After Partial Resection of Infected Aortic Grafts. ANN VASC SURG, 76, 202-210. https://doi.org/10.1016/j.avsg.2021.07.002

Vancouver

Janko M, Hubbard G, Woo K, Kashyap VS, Mitchell M, Murugesan A et al. Contemporary Outcomes After Partial Resection of Infected Aortic Grafts. ANN VASC SURG. 2021 Oct;76:202-210. https://doi.org/10.1016/j.avsg.2021.07.002

Bibtex

@article{e77d38c4a55f43e9b0d492e10198cefe,
title = "Contemporary Outcomes After Partial Resection of Infected Aortic Grafts",
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.",
author = "Matthew Janko and Grant Hubbard and Karen Woo and Kashyap, {Vikram S.} and Megan Mitchell and Arun Murugesan and Lin Chen and Rachel Gardner and Donald Baril and Hacker, {Robert I.} and Zoltan Szeberin and Ramsey ElSayed and Magee, {Gregory A.} and Fernando Motta and Wei Zhou and Gary Lemmon and Dawn Coleman and Behrendt, {Christian Alexander} and Faisal Aziz and Black, {James H.} and Kimberly Tran and Allen Dao and William Shutze and Garrett, {H. Edward} and {De Caridi}, Giovanni and Rhusheet Patel and Liapis, {Christos D.} and George Geroulakos and John Kakisis and Konstantinos Moulakakis and Kakkos, {Starvos K.} and Hideaki Obara and Grace Wang and Jordan Stoecker and Pascal Rh{\'e}aume and Victor Davila and Reid Ravin and Randall DeMartino and Ross Milner and Sherene Shalhub and Jeffrey Jim and Jason Lee and Celine Dubuis and Ricco, {Jean Baptiste} and Joseph Coselli and Scott Lemaire and Javairiah Fatima and Jennifer Sanford and Winston Yoshida and Schermerhorn, {Marc L.} and Matthew Menard and Michael Belkin and Stuart Blackwood and Mark Conrad and Linda Wang and Sara Crofts and Thomas Nixon and Timothy Wu and Roberto Chiesa and Saideep Bose and Jason Turner and Ryan Moore and Justin Smith and Ali Irshad and Jeffrey Hsu and Martin Czerny and Jonathan Cullen and Andrea Kahlberg and Carlo Setacci and Joh, {Jin Hyun} and Eric Senneville and Pedro Garrido and Sarac, {Timur P.} and Anthony Rizzo and Go, {Michael R.} and Martin Bjorck and Hamid Gavali and Anders Wanhainen and Mario D'Oria and Sandro Lepidi and Davide Mastrorilli and Gianfranco Veraldi and Michele Piazza and Francesco Squizzato and Adam Beck and {St. John}, Rebecca and Andrew Wishy and Misty Humphries and Shah, {Samir K.} and Martin Back and Jayer Chung and Lawrence, {Peter F.} and Jonathan Bath and Smeds, {Matthew R.}",
note = "Publisher Copyright: {\textcopyright} 2021",
year = "2021",
month = oct,
doi = "10.1016/j.avsg.2021.07.002",
language = "English",
volume = "76",
pages = "202--210",
journal = "ANN VASC SURG",
issn = "0890-5096",
publisher = "Elsevier Inc.",

}

RIS

TY - JOUR

T1 - Contemporary Outcomes After Partial Resection of Infected Aortic Grafts

AU - Janko, Matthew

AU - Hubbard, Grant

AU - Woo, Karen

AU - Kashyap, Vikram S.

AU - Mitchell, Megan

AU - Murugesan, Arun

AU - Chen, Lin

AU - Gardner, Rachel

AU - Baril, Donald

AU - Hacker, Robert I.

AU - Szeberin, Zoltan

AU - ElSayed, Ramsey

AU - Magee, Gregory A.

AU - Motta, Fernando

AU - Zhou, Wei

AU - Lemmon, Gary

AU - Coleman, Dawn

AU - Behrendt, Christian Alexander

AU - Aziz, Faisal

AU - Black, James H.

AU - Tran, Kimberly

AU - Dao, Allen

AU - Shutze, William

AU - Garrett, H. Edward

AU - De Caridi, Giovanni

AU - Patel, Rhusheet

AU - Liapis, Christos D.

AU - Geroulakos, George

AU - Kakisis, John

AU - Moulakakis, Konstantinos

AU - Kakkos, Starvos K.

AU - Obara, Hideaki

AU - Wang, Grace

AU - Stoecker, Jordan

AU - Rhéaume, Pascal

AU - Davila, Victor

AU - Ravin, Reid

AU - DeMartino, Randall

AU - Milner, Ross

AU - Shalhub, Sherene

AU - Jim, Jeffrey

AU - Lee, Jason

AU - Dubuis, Celine

AU - Ricco, Jean Baptiste

AU - Coselli, Joseph

AU - Lemaire, Scott

AU - Fatima, Javairiah

AU - Sanford, Jennifer

AU - Yoshida, Winston

AU - Schermerhorn, Marc L.

AU - Menard, Matthew

AU - Belkin, Michael

AU - Blackwood, Stuart

AU - Conrad, Mark

AU - Wang, Linda

AU - Crofts, Sara

AU - Nixon, Thomas

AU - Wu, Timothy

AU - Chiesa, Roberto

AU - Bose, Saideep

AU - Turner, Jason

AU - Moore, Ryan

AU - Smith, Justin

AU - Irshad, Ali

AU - Hsu, Jeffrey

AU - Czerny, Martin

AU - Cullen, Jonathan

AU - Kahlberg, Andrea

AU - Setacci, Carlo

AU - Joh, Jin Hyun

AU - Senneville, Eric

AU - Garrido, Pedro

AU - Sarac, Timur P.

AU - Rizzo, Anthony

AU - Go, Michael R.

AU - Bjorck, Martin

AU - Gavali, Hamid

AU - Wanhainen, Anders

AU - D'Oria, Mario

AU - Lepidi, Sandro

AU - Mastrorilli, Davide

AU - Veraldi, Gianfranco

AU - Piazza, Michele

AU - Squizzato, Francesco

AU - Beck, Adam

AU - St. John, Rebecca

AU - Wishy, Andrew

AU - Humphries, Misty

AU - Shah, Samir K.

AU - Back, Martin

AU - Chung, Jayer

AU - Lawrence, Peter F.

AU - Bath, Jonathan

AU - Smeds, Matthew R.

N1 - Publisher Copyright: © 2021

PY - 2021/10

Y1 - 2021/10

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=85118700372&partnerID=8YFLogxK

U2 - 10.1016/j.avsg.2021.07.002

DO - 10.1016/j.avsg.2021.07.002

M3 - SCORING: Journal article

C2 - 34437963

AN - SCOPUS:85118700372

VL - 76

SP - 202

EP - 210

JO - ANN VASC SURG

JF - ANN VASC SURG

SN - 0890-5096

ER -