Christos Argyriou1, George S Georgiadis1, Miltos K Lazarides1, Efstratios Georgakarakos1, George A Antoniou2. 1. 1 Department of Vascular and Endovascular Surgery, University General Hospital of Alexandroupolis, "Democritus" University of Thrace, Alexandroupolis, Greece. 2. 2 Department of Vascular and Endovascular Surgery, The Royal Oldham Hospital, Pennine Acute Hospitals NHS Trust, Manchester, UK.
Abstract
PURPOSE: To report a meta-analysis of the published evidence on the outcomes of aortic endograft infection after endovascular aneurysm repair (EVAR). METHODS: A search of electronic information sources (PubMed/MEDLINE, SCOPUS, CENTRAL) and bibliographic reference lists identified 12 studies reporting on 362 patients (mean age 72 years; 279 men). The methodological quality of the selected studies was assessed using the Newcastle-Ottawa scale. Endpoints were 30-day/in-hospital mortality and follow-up mortality. Pooled estimates are reported with the 95% confidence interval (CI). The review was registered at the International Prospective Register of Systematic Reviews in Health and Social Care (CRD42016034166). RESULTS: The incidence of graft infection after EVAR was 0.6% (95% CI 0.4% to 0.8%). The time from implantation to diagnosis ranged from 1 to 128 months (mean 25). The majority of patients (293, 81%) underwent surgical treatment (95% CI 77% to 83%); 9 (2.5%) patients (95% CI 21% to 43%) received conservative treatment. Aortic replacement with a prosthetic graft was performed in 58% (95% CI 52% to 62%), whereas cryopreserved allografts and autologous grafts were used in 31% (95% CI 28% to 33%) and 11% (95% CI% 8 to 14%), respectively. Less than half of the patients (40%) had emergency surgery. The pooled estimate of 30-day/in-hospital mortality was 26.6% (95% CI 16.9% to 39.2%). The pooled 30-day/in-hospital mortality for 9 patients treated conservatively was 63.3% (95% CI 30.7% to 87.0%). The pooled overall follow-up mortality was 45.7% (95% CI 36.4% to 55.4%) vs 58.6% (95% CI 28.8% to 83.3%) for the 9 patients receiving conservative treatment. CONCLUSION: Aortic endograft infection is a rare complication after EVAR. Surgical treatment with complete explantation of the infected endograft seems to be the optimal management in selected patients. Supportive medical treatment without surgical intervention has a significant associated mortality.
PURPOSE: To report a meta-analysis of the published evidence on the outcomes of aortic endograft infection after endovascular aneurysm repair (EVAR). METHODS: A search of electronic information sources (PubMed/MEDLINE, SCOPUS, CENTRAL) and bibliographic reference lists identified 12 studies reporting on 362 patients (mean age 72 years; 279 men). The methodological quality of the selected studies was assessed using the Newcastle-Ottawa scale. Endpoints were 30-day/in-hospital mortality and follow-up mortality. Pooled estimates are reported with the 95% confidence interval (CI). The review was registered at the International Prospective Register of Systematic Reviews in Health and Social Care (CRD42016034166). RESULTS: The incidence of graft infection after EVAR was 0.6% (95% CI 0.4% to 0.8%). The time from implantation to diagnosis ranged from 1 to 128 months (mean 25). The majority of patients (293, 81%) underwent surgical treatment (95% CI 77% to 83%); 9 (2.5%) patients (95% CI 21% to 43%) received conservative treatment. Aortic replacement with a prosthetic graft was performed in 58% (95% CI 52% to 62%), whereas cryopreserved allografts and autologous grafts were used in 31% (95% CI 28% to 33%) and 11% (95% CI% 8 to 14%), respectively. Less than half of the patients (40%) had emergency surgery. The pooled estimate of 30-day/in-hospital mortality was 26.6% (95% CI 16.9% to 39.2%). The pooled 30-day/in-hospital mortality for 9 patients treated conservatively was 63.3% (95% CI 30.7% to 87.0%). The pooled overall follow-up mortality was 45.7% (95% CI 36.4% to 55.4%) vs 58.6% (95% CI 28.8% to 83.3%) for the 9 patients receiving conservative treatment. CONCLUSION: Aortic endograft infection is a rare complication after EVAR. Surgical treatment with complete explantation of the infected endograft seems to be the optimal management in selected patients. Supportive medical treatment without surgical intervention has a significant associated mortality.
Authors: Robert Novotny; Tomas Marada; Jiri Novotny; Jakub Kristek; Jaroslav Chlupac; Michal Kudla; Kvetoslav Lipar; Jiri Mendl; Jiri Fronek; Libor Janousek Journal: Case Rep Vasc Med Date: 2020-11-07
Authors: Harith A Alataby; Lloyd G Muzangwa; Muhamed K Atere; Joseph Bibawy; Keith T Diaz; Jay M Nfonoyim Journal: J Community Hosp Intern Med Perspect Date: 2020-09-03