In situ versus extra-anatomic reconstruction for primary infected infrarenal abdominal aortic aneurysms

• Published in: Journal of vascular surgery 2011-07, Vol.54 (1), p.64-70
• Main Authors: Lee, Chun-Hui, MD, Hsieh, Hung-Chang, MD, Ko, Po-Jen, MD, Li, Hao-Jui, MD, Kao, Tsung-Chu, MD, Yu, Sheng-Yueh, MD
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Aneurysm, Infected - microbiology; Aneurysm, Infected - mortality; Aneurysm, Infected - surgery; Anti-Bacterial Agents - therapeutic use; Aortic Aneurysm, Abdominal - microbiology; Aortic Aneurysm, Abdominal - mortality; Aortic Aneurysm, Abdominal - surgery; Biological and medical sciences; Blood and lymphatic vessels; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation - adverse effects; Blood Vessel Prosthesis Implantation - instrumentation; Blood Vessel Prosthesis Implantation - mortality; Cardiology. Vascular system; Chi-Square Distribution; Colitis, Ischemic - etiology; Diseases of the aorta; Female; Graft Occlusion, Vascular - etiology; Hospital Mortality; Humans; Kaplan-Meier Estimate; Length of Stay; Male; Medical sciences; Middle Aged; Prosthesis-Related Infections - etiology; Retrospective Studies; Risk Assessment; Risk Factors; Salmonella - isolation & purification; Staphylococcus aureus - isolation & purification; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Survival Rate; Taiwan; Time Factors; Treatment Outcome; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2010.12.032

Background There is no standard procedure for revascularization after infected infrarenal abdominal aortic aneurysm resection. This study examines the outcomes of two contemporary methods. Methods We retrospectively reviewed medical records for patients who underwent repair of infected infrarenal abdominal aortic aneurysms from January 1998 to December 2007 at a single institution. Patients with infected prosthetic aortic grafts were excluded. Results Twenty-eight patients (22 men; mean age, 65 ± 12) had in situ graft (group I, n = 13) or extra-anatomic bypass (group II, n = 15), with a mean follow-up of 22 months. Mean hospital lengths of stay were 36 ± 16 days for group I and 46 ± 17 days for group II. Overall perioperative mortality was 5 of 28 (18%), comprising 1 of 13 in group I (8%) and 4 of 15 in group II (27%; P = .333). No early or late vascular-related complications occurred in group I. In group II, three patients had early vascular-related complications, including, graft infection, graft occlusion and ischemia colitis, and five patients had late vascular-related complications, including graft infection and graft occlusion. One patient ultimately lost a limb. Group I had a 0% late complication rate vs 33% in group II ( P = .044). For cumulative survival rates, Kaplan-Meier analysis and log-rank testing revealed no significant differences between groups I and II. Conclusion In situ graft revascularization is viable in afebrile patients or patients who have good response to preoperative antibiotic therapy. Extra-anatomic bypass grafting for infected infrarenal abdominal aneurysm resection has a similar long-term survival rate and should be considered in patients who are unsuitable for in situ graft revascularization; however, the postoperative complication rate is higher. Further prospective study with large patient populations is needed to determine the selection criteria for using in situ revascularization as alternative methods for treatment of infected abdominal aneurysms.