A Meta-Analysis of Outcomes After In Situ Reconstructions for Aortic Graft Infection

• Published in: Angiology 2018-05, Vol.69 (5), p.370-379
• Main Authors: Batt, Michel, Feugier, Patrick, Camou, Fabrice, Coffy, Amandine, Senneville, Eric, Caillon, Jocelyne, Calvet, Brigitte, Chidiac, Christian, Laurent, Frederic, Revest, Matthieu, Daures, Jean Pierre
• Format: Article
• Language: English
• Subjects: Life Sciences
• ISSN: 0003-3197; 1940-1574
• DOI: 10.1177/0003319717710114

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.