A Meta-Analysis of Outcomes After In Situ Reconstructions for Aortic Graft Infection. (May 2018)

• Record Type: Journal Article
• Authors: Batt, Michel; Feugier, Patrick; Camou, Fabrice; Coffy, Amandine; Senneville, Eric; Caillon, Jocelyne; Calvet, Brigitte; Chidiac, Christian; Laurent, Frederic; Revest, Matthieu; Daures, Jean Pierre
• Is Part Of: Angiology. Volume 69:Number 5(2018)
• Page Start: 370
• Page End: 379
• Publication Date: 2018-05
• Subjects: aortic -- graft -- in situ -- infection -- reconstruction; Blood-vessels -- Diseases -- Periodicals; Cardiovascular system -- Diseases -- Periodicals; 616.13005
• DOI: 10.1177/0003319717710114
• Languages: English
• ISSNs: 0003-3197

Abstract

Objective: To confirm the advantage of in situ reconstruction (ISR) over extra-anatomic reconstruction (EAR) for aortic graft infection and determine the most appropriate conduit including autogenous veins, cryopreserved allografts, and synthetic prosthesis (standard, rifampicin of silver polyesters). Methods: A meta-analysis was conducted with rate of mortality, graft occlusion, amputation, and reinfection. A meta-regression was performed with 4 factors: patients' age, presence of prosthetic-duodenal fistula (PDF), virulent organisms, or nonvirulent organisms. Results: In situ reconstruction over EAR seems to favor all events. For the 5 conduits used for ISR, according to operative mortality, age of the patients looks to have a positive correlation only for silver polyester and no conduit present any advantage in the presence of PDF. Reinfection seems to be not significantly different for the 5 conduits, and only autogenous veins appear to have a positive correlation with infecting organisms. Conclusion: In situ reconstruction may be considered as first-line treatment. Our results suggest that silver polyesters appear to be most appropriate for older patients, and in order to limit reinfection, autogenous veins are probably the most suitable conduit.