Michel Batt1,2, Patrick Feugier2,3, Fabrice Camou2,4, Amandine Coffy2, Eric Senneville2,5, Jocelyne Caillon2,6, Brigitte Calvet2,7, Christian Chidiac2,8, Frederic Laurent2,9, Matthieu Revest2,10, Jean Pierre Daures2. 1. 1 Department of Vascular Surgery, University Nice-Sophia Antipolis, Nice, France. 2. 2 Laboratory of Biostatistics and Epidemiology, University Institute for Clinical Research, Montpellier, France. 3. 3 Department of Vascular Surgery, University Claude Bernard Lyon 1, Hospices Civils de Lyon, Lyon, France. 4. 4 Intensive Care Unit, Saint-Andre University Hospital, Bordeaux, France. 5. 5 Infectious Diseases Department, Gustave Dron Hospital, Lille 2 University, Tourcoing, France. 6. 6 Bactériology Department, Nantes University Hospital, Nantes, France. 7. 7 Anesthesiology Département, Béziers Hospital, Béziers, France. 8. 8 Infectious Diseases Department, Hospices Civils de Lyon and Center for Infectiology Research (CIRI), INSERM U1111, Lyon 1 University, Lyon, France. 9. 9 Bacteriology Department, International Center for Infectiology Research (CIRI), INSERM U1111, Lyon I University, Lyon, France. 10. 10 Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, CIC-INSERM 1414, Rennes 1 University Rennes, France.
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.
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.
Entities:
Keywords:
aortic; graft; in situ; infection; reconstruction
Authors: Anne Coste; Mélanie Poinot; Sophie Panaget; Bénédicte Albert; Adrien Kaladji; Hervé Le Bars; Nasr Bahaa; Badra Ali; Caroline Piau; Vincent Cattoir; Claire de Moreuil; Matthieu Revest; Rozenn Le Berre Journal: Infection Date: 2021-01-02 Impact factor: 3.553
Authors: Igor Lazic; Andreas Obermeier; Bettina Dietmair; Wolfgang E Kempf; Albert Busch; Jutta Tübel; Jochen Schneider; Rüdiger von Eisenhart-Rothe; Peter Biberthaler; Rainer Burgkart; Dominik Pförringer Journal: J Mater Sci Mater Med Date: 2022-03-10 Impact factor: 3.896