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Vascular graft infection in the aortoiliac territory – our view in the light of European Society for Vascular Surgery Guidelines − the retrospective observation study

Česká verzia

Authors: L. Bláha;  J. Bulejčík;  D. Říha
Authors place of work: Centrum cévní a miniinvazivní chirurgie, Komplexní kardiovaskulární centrum, Nemocnice AGEL Třinec-Podlesí, a. s
Published in the journal: Rozhl. Chir., 2021, roč. 100, č. 7, s. 330-338.
Category: Original articles
doi: https://doi.org/10.33699/PIS.2021.100.7.330–338

Summary

Introduction: Vascular graft infection in the aortoiliac territory (abdominal VGI) is undoubtedly one of the most serious complications in vascular surgery. The treatment is burdened with high mortality and morbidity rates. In 2020, the Guidelines on the Management of Vascular Graft and Endograft Infections were published by the European Society for Vascular Surgery (ESVS). In the light of these guidelines, we decided to review retrospectively all patients who presented to our institution with abdominal VGI.

Methods: Retrospective observational study of patients presented with abdominal VGI treated in our institution between 2011−2019 (9 years). The primary goal was to elucidate the rate of vascular graft infection in aortoiliac reconstructions performed between 2011−2019 and also the mortality rate in the patient cohort operated for this complication. The secondary goals were to evaluate the success rate and the complication rate in different types of reconstructions.

Results: In the defined period between 2011−2019 we performed 363 open aortoiliac reconstructions. During the same period we treated altogether 15 patients with abdominal VGI, whose primary reconstruction was mostly performed before 2011 (11 patients). In our cohort of patients who underwent reconstruction between 2011−2019 we observed a graft infection only in 4 cases (1.1%). In the group of 15 patients with abdominal VGI, the male gender prevailed (14 patients). The mean age at the time of primary reconstruction was 61 years. Most of our reconstructions were performed for occlusive disease (14 cases). All infected grafts were aortobifemoral (1 unilateral aortofemoral). They were all late infections with an average presentation time of 61 months since the primary reconstruction (15−180 months). Early mortality rate was as high as 27% (4 patients) and overall mortality was 40%. The secondary reinfection rate after primary treatment was 33%.

Conclusion: Treatment of abdominal VGI is still burdened with high mortality and morbidity rates. The current ESVS guidelines provide valuable guidance for the diagnosis and management of VGI. It nevertheless remains obvious that the treatment needs to be tailored individually in a multidisciplinary team environment.

Keywords:

abdominal aorta – graft – infection

Zdroje
  1. Batt M, Feugier P, Camou F, et al. A meta-analysis of outcomes after in situ reconstructions for aortic graft infection. Angiology 2018 May;69(5):370−379. doi: 10.1177/0003319717710114. Epub 2017 Jun 5. PMID: 28578619.
  2. Batt M, Jean-Baptiste E, O´Connor S, et al. Contemporary management of infrarenal aortic graft infection: early and later results in 82 patients. Vascular 2012 Jun;20(3):129−137. doi: 10.1258/vasc.2011.oa0315. Epub 2012 Jun 1. PMID: 22661612.
  3. Chakfé N, Diener H, Lejay A. European Society for Vascular Surgery 2020. Clini­cal practise guidelines on the management of vascular graft nad endograft infection. Eur J Vasc Endovasc Surg. 2020 Mar;59(3):339−384. doi: 10.1016/j.ejvs.2019.10.016.
  4. Vogel TR, Symons R, Flulm DR. The incidence and factors associated with graft infection after aortic aneurysm repair. J Vasc Surg. 2008 Feb;47(2):264−269. doi: 10.1016/j.jvs.2007.10.030. PMID: 18241747.
  5. Berger P, De Borst GJ, Moll Fl. Current opinions about diagnosis and treatment strategy for aortic graft infections in The Netherlands. J Cardiovasc Surg. (Torino) 2015 Dec;56(6):867−876. Epub 2013 Nov 27. PMID: 24284939.
  6. Lyons OT, Baguneid M, Barwick TD, et al. Diagnosis of aortic graft infection: A case definition by the Management of Aortic Graft Infection Collaboration (MAGIC). Eur J Vasc Endovasc Surg. 2016 Dec;52(6):758−763. doi: 10.1016/j.ejvs.2016.09.007. Epub 2016 Oct 19. PMID: 27771318.
  7. Erb S, Sidler JA, Elzi L, et al. Surgical and antimicrobial treatment of prosthetic vascular graft infections and different surgical sites: a retrospective study of treatment outcomes. PLoS One 2014 Nov 13;9(11):e112947. doi: 10.1371/journal.pone.0112947. PMID: 25393400; PMCID: PMC4231097.
  8. FitzGerald SF, Kelly C, Humphreys H. Diagnosis and treatment of prosthetic aortic graft infections: confusion and inconsistency in the absence of evidence or consensus. J Antimicrob Chemother. 2005 Dec;56(6):996−999. doi: 10.1093/jac/dki382. Epub 2005 Nov 3. PMID: 16269550.
  9. Orton DF, LeVeen RF, Saigh JA, et al. Aortic prosthetic graft infections: radiologic manifestations and implications for management. RadioGraphics 2000;20(4). doi.org/10.1148/radiographics.20.4.g00jl12977.
  10. Spartera C, Morettini G, Petrassi C, et al. Role of magnetic resonance imaging in the evaluation of aortic graft healing, perigraft fluid collection, and graft infection. Eur J Vasc Surg. 1990 Feb;4(1):69−73. doi: 10.1016/s0950-821x(05)80041-6. PMID: 2323422.
  11. Reinders Folmer EI, Von Meijenfeldt GCI, van der Laan MJ, et al. Diagnosis imaging in vascular graft infection: a systematic review and meta-analysis. Eur J Vasc Endovasc Surg. 2018 Nov;56(5):719−729. doi: 10.1016/j.ejvs.2018.07.010. Epub 2018 Aug 16. PMID: 30122333.
  12. Rosenman JE, Pearce WH, Kempczinski RF. Bacterial adherence to vascular grafts after in vitro bacteremia. J Surg Res. 1985 Jun;38(6):648−655. doi: 10.1016/0022-4804(85)90088-5. PMID: 3159936.
  13. van der Slegt J, van der Laan L, Veen EJ, et al. Implementation of a bundle of care to reduce surgical site infections in patients undergoing vascular surgery. PLoS One 2013 Aug 13;8(8):e71566. doi: 10.1371/journal.pone.0071566. PMID: 23967222; PMCID: PMC3742500.
  14. Stewart AH, Eyers PS, Earnshaw JJ. Prevention of infection in peripheral arterial reconstruction: a systematic review and meta-analysis. J Vasc Surg. 2007 Jul;46(1):148−155. doi: 10.1016/j.jvs.2007.02.065. PMID: 17606135.
  15. Parizh D, Ascher E, Raza Rizvi SA, et al. Quality improvement initiative: Preventative Surgical Site Infection Protocol in Vascular Surgery. Vascular 2018 Feb;26(1):47−53. doi: 10.1177/1708538117719155. Epub 2017 Jul 14. PMID: 28708024.
  16. Habib G, Lacellotti P, Antunes MJ, et al. 2015 ESC Guidelines for the management of infective endocarditis. Eur Heart J. 2015 Nov 21;36(44):3075−3128. doi: 10.1093/eurheartj/ehv319. Epub 2015 Aug 29. PMID: 26320109.
  17. Revest M, Camou F, Senneville E, et al. Medical treatment of prosthetic vascular graft infections: review of the literature and proposals of a working group. Int J Antimicrob Agents 2015 Sep;46(3):254−265. doi: 10.1016/j.ijantimicag.2015.04.014. Epub 2015 Jun 6. PMID: 26163735.
  18. Jamieson RW, Burns PJ, Dawson AR, et al. Aortic graft preservation by debridement and omental wrapping. Ann Vasc Surg. 2012 Apr;26(3):423.e1−4. doi: 10.1016/j.avsg.2011.07.021. Epub 2012 Feb 8. PMID: 22321485.
  19. Sharif MA, Lee B, Lau LL, et al. Prosthetic stent graft infection after endovascular abdominal aortic aneurysm repair. J Vasc Surg. 2007 Sep;46(3):442−448. doi: 10.1016/j.jvs.2007.05.027. PMID: 17826231.
  20. Staffa R, Kříž Z, Vlachovský R, et al. Autogenní vena femoralis superficialis jako náhrada infikované aorto-iliako-femorální cévní protézy. Rozhl Chir. 2010 Jan;89(1):39−44. PMID: 21351403.
  21. Dorweiler B, Neufang A, Chaban R, et al. Use and durability of femoral vein for autologous reconstruction with infection of the aortoiliofemoral axis. J Vasc Surg. 2014 Mar;59(3):675−683. doi: 10.1016/j.jvs.2013.09.029. Epub 2013 Dec 15. PMID: 24342063.
  22. Heinola I, Kantonen I, Jaroma M, et al. Editor´s choice – treatment of aortic prosthesis infections by graft removal and in situ replacement with autologous femoral veins and fascial strengthening. Eur J Endovasc Surg. 2016;51:232−239. doi.org/10.1016/j.ejvs.2015.09.015.
  23. Oderich GS, Bower TC, Cherry KJ, Jr, et al. Evolution from axillofemoral to in situ prosthetic reconstruction for the treatment of aortic graft infections at a single center. J Vasc Surg. 2006 Jun;43(6):1166−1174. doi: 10.1016/j.jvs.2006.02.040. PMID: 16765233.
  24. Lejay A, Delax C, Girsowicz E, et al. Cryopreserved cadaveric arterial allograft for arterial reconstruction in patients with prosthetic infection. Eur J Vasc Endovasc Surg. 2017 Nov;54(5):636−644. doi: 10.1016/j.ejvs.2017.07.016. Epub 2017 Sep 7. PMID: 28890027.
  25. Šebesta P, Štádler P, Šedivý P, et al. Radikální operace infekce cévní protézy v aortofemorální pozici pomocí čerstvého tepenního alograftu: naše střednědobé zkušenosti. Rozhl Chir. 2011, Jan;90(1):4−13. ISSN 0035-9351.
  26. Young RM, Cherry Jr KJ, Davis PM, et al. The results of in situ prosthetic replacement for infected aortic grafts. Am J Surg. 1999 Aug;178(2):136−140. doi: 10.1016/s0002-9610(99)00146-4. PMID: 10487266.
  27. Mirzaie M, Schmitto JD, Tirilomis T, et al. Surgical management of vascular graft infection in severely ill patients by partial resection of the infected prosthesis. Eur J Vasc Endovasc Surg. 2007 May;33(5):610−613. doi: 10.1016/j.ejvs.2006.11.042. Epub 2007 Feb 2. PMID: 17276101.
  28. Seeger JM, Pretus HA, Welborn MB, et al. Long-term outcome after treatment of aortic graft infection with staged extra-anatomic bypass grafting and aortic graft removal. J Vasc Surg. 2000 Sep;32(3):451−459; discussion 460−461. doi: 10.1067/mva.2000.109471. PMID: 10957651.
  29. Bíró G, Szabó G, Fehérvári M, et al. Late outcome following open surgical management of secondary aortoenteric fistula. Langenbecks Arch Surg. 2011 Dec;396(8):1221−1229. doi: 10.1007/s00423-011-0807-6. Epub 2011 May 21. PMID: 21604007.
  30. O´Connor S, Andrew P, Batt M, et al. A systematic review and meta-analysis of treatments for aortic graft infection. J Vasc Surg. 2006 Jul;44(1):38−45. doi: 10.1016/j.jvs.2006.02.053. PMID: 16828424.
  31. Chick JFB, Castle JC, Cooper KJ, et al. Aortoenteric fistulae temporization and treatment: lessons learned from a multidisciplinary approach to 3 patients. Radiol Case Rep. 2017 Apr 12;12(2):331−334. doi: 10.1016/j.radcr.2017.03.008. PMID: 28491182; PMCID: PMC5417752.
  32. Batt M, Jean-Baptiste E, O´Connor S, et al. Early and late results of contemporary management of 37 secondary aortoenteric fistulae. Eur J Vasc Endovasc Surg. 2011 Jun;41(6):748−757. doi: 10.1016/j.ejvs.2011.02.020. Epub 2011 Mar 16. PMID: 21414817.
  33. Kakkos SK, Antoniadis PN, Klonaris CN, et al. Open or endovascular repair of aortoenteric fistulas? A multicentre comparative study. Eur J Vasc Endovasc Surg. 2011 May;41(5):625−634. doi: 10.1016/j.ejvs.2010.12.026. Epub 2011 Feb 15. PMID: 21324718.
  34. Bergqvist Björck M. Secondary arterioenteric fistulation--a systematic literature analysis. Eur J Vasc Endovasc Surg. 2009 Jan;37(1):31−42. doi: 10.1016/j.ejvs.2008.09.023. Epub 2008 Nov 12. PMID: 19004648.
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