Treatment and outcomes of aortic endograft infection

Matthew R. Smeds, Audra A. Duncan, Michael P. Harlander-Locke, Peter F. Lawrence*, Sean Lyden, Javariah Fatima, Mark K. Eskandari, Sean P. Steenberge, Tadaki M. Tomita, Mark Morasch, Jeffrey Jim, Lewis C. Lyons, Kristofer Charlton-Ouw, Harith Mushtaq, Samuel S. Leake, Raghu Motaganahalli, Peter Nelson, Godfrey Parkerson, Sherene Shalhub, Paul BoveGregory Modrall, Victor Davila, Samuel Money, Nasim Hedayati, Ahmed Abou-Zamzam, Christopher Abularrage, Catherine Wittgen

*Corresponding author for this work

Research output: Contribution to journalArticle

68 Citations (Scopus)

Abstract

Objective This study examined the medical and surgical management and outcomes of patients with aortic endograft infection after abdominal endovascular aortic repair (EVAR) or thoracic endovascular aortic repair (TEVAR). Methods Patients diagnosed with infected aortic endografts after EVAR/TEVAR between January 1, 2004, and January 1, 2014, were reviewed using a standardized, multi-institutional database. Demographic, comorbidity, medical management, surgical, and outcomes data were included. Results An aortic endograft infection was diagnosed in 206 patients (EVAR, n = 180; TEVAR, n = 26) at a mean 22 months after implant. Clinical findings at presentation included pain (66%), fever/chills (66%), and aortic fistula (27%). Ultimately, 197 patients underwent surgical management after a mean of 153 days. In situ aortic replacement was performed in 186 patients (90%) using cryopreserved allograft in 54, neoaortoiliac system in 21, prosthetic in 111 (83% soaked in antibiotic), and 11 patients underwent axillary-(bi)femoral bypass. Graft cultures were primarily polymicrobial (35%) and gram-positive (22%). Mean hospital length of stay was 23 days, with perioperative 30-day morbidity of 35% and mortality of 11%. Of the nine patients managed only medically, four of five TEVAR patients died after mean of 56 days and two of four EVAR patients died; both deaths were graft-related (mean follow-up, 4 months). Nineteen replacement grafts were explanted after a mean of 540 days and were most commonly associated with prosthetic graft material not soaked in antibiotic and extra-anatomic bypass. Mean follow-up was 21 months, with life-table survival of 70%, 65%, 61%, 56%, and 51% at 1, 2, 3, 4, and 5 years, respectively. Conclusions Aortic endograft infection can be eradicated by excision and in situ or extra-anatomic replacement but is often associated with early postoperative morbidity and mortality and occasionally with a need for late removal for reinfection. Prosthetic graft replacement after explanation is associated with higher reinfection and graft-related complications and decreased survival compared with autogenous reconstruction.

Original languageEnglish (US)
Pages (from-to)332-340
Number of pages9
JournalJournal of Vascular Surgery
Volume63
Issue number2
DOIs
StatePublished - Feb 1 2016

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Infection
Transplants
Thorax
Length of Stay
Anti-Bacterial Agents
Morbidity
Chills
Life Tables
Survival
Mortality
Thigh
Fistula
Allografts
Comorbidity
Fever
Demography
Databases
Pain

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

Cite this

Smeds, M. R., Duncan, A. A., Harlander-Locke, M. P., Lawrence, P. F., Lyden, S., Fatima, J., ... Wittgen, C. (2016). Treatment and outcomes of aortic endograft infection. Journal of Vascular Surgery, 63(2), 332-340. https://doi.org/10.1016/j.jvs.2015.08.113
Smeds, Matthew R. ; Duncan, Audra A. ; Harlander-Locke, Michael P. ; Lawrence, Peter F. ; Lyden, Sean ; Fatima, Javariah ; Eskandari, Mark K. ; Steenberge, Sean P. ; Tomita, Tadaki M. ; Morasch, Mark ; Jim, Jeffrey ; Lyons, Lewis C. ; Charlton-Ouw, Kristofer ; Mushtaq, Harith ; Leake, Samuel S. ; Motaganahalli, Raghu ; Nelson, Peter ; Parkerson, Godfrey ; Shalhub, Sherene ; Bove, Paul ; Modrall, Gregory ; Davila, Victor ; Money, Samuel ; Hedayati, Nasim ; Abou-Zamzam, Ahmed ; Abularrage, Christopher ; Wittgen, Catherine. / Treatment and outcomes of aortic endograft infection. In: Journal of Vascular Surgery. 2016 ; Vol. 63, No. 2. pp. 332-340.
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abstract = "Objective This study examined the medical and surgical management and outcomes of patients with aortic endograft infection after abdominal endovascular aortic repair (EVAR) or thoracic endovascular aortic repair (TEVAR). Methods Patients diagnosed with infected aortic endografts after EVAR/TEVAR between January 1, 2004, and January 1, 2014, were reviewed using a standardized, multi-institutional database. Demographic, comorbidity, medical management, surgical, and outcomes data were included. Results An aortic endograft infection was diagnosed in 206 patients (EVAR, n = 180; TEVAR, n = 26) at a mean 22 months after implant. Clinical findings at presentation included pain (66{\%}), fever/chills (66{\%}), and aortic fistula (27{\%}). Ultimately, 197 patients underwent surgical management after a mean of 153 days. In situ aortic replacement was performed in 186 patients (90{\%}) using cryopreserved allograft in 54, neoaortoiliac system in 21, prosthetic in 111 (83{\%} soaked in antibiotic), and 11 patients underwent axillary-(bi)femoral bypass. Graft cultures were primarily polymicrobial (35{\%}) and gram-positive (22{\%}). Mean hospital length of stay was 23 days, with perioperative 30-day morbidity of 35{\%} and mortality of 11{\%}. Of the nine patients managed only medically, four of five TEVAR patients died after mean of 56 days and two of four EVAR patients died; both deaths were graft-related (mean follow-up, 4 months). Nineteen replacement grafts were explanted after a mean of 540 days and were most commonly associated with prosthetic graft material not soaked in antibiotic and extra-anatomic bypass. Mean follow-up was 21 months, with life-table survival of 70{\%}, 65{\%}, 61{\%}, 56{\%}, and 51{\%} at 1, 2, 3, 4, and 5 years, respectively. Conclusions Aortic endograft infection can be eradicated by excision and in situ or extra-anatomic replacement but is often associated with early postoperative morbidity and mortality and occasionally with a need for late removal for reinfection. Prosthetic graft replacement after explanation is associated with higher reinfection and graft-related complications and decreased survival compared with autogenous reconstruction.",
author = "Smeds, {Matthew R.} and Duncan, {Audra A.} and Harlander-Locke, {Michael P.} and Lawrence, {Peter F.} and Sean Lyden and Javariah Fatima and Eskandari, {Mark K.} and Steenberge, {Sean P.} and Tomita, {Tadaki M.} and Mark Morasch and Jeffrey Jim and Lyons, {Lewis C.} and Kristofer Charlton-Ouw and Harith Mushtaq and Leake, {Samuel S.} and Raghu Motaganahalli and Peter Nelson and Godfrey Parkerson and Sherene Shalhub and Paul Bove and Gregory Modrall and Victor Davila and Samuel Money and Nasim Hedayati and Ahmed Abou-Zamzam and Christopher Abularrage and Catherine Wittgen",
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Smeds, MR, Duncan, AA, Harlander-Locke, MP, Lawrence, PF, Lyden, S, Fatima, J, Eskandari, MK, Steenberge, SP, Tomita, TM, Morasch, M, Jim, J, Lyons, LC, Charlton-Ouw, K, Mushtaq, H, Leake, SS, Motaganahalli, R, Nelson, P, Parkerson, G, Shalhub, S, Bove, P, Modrall, G, Davila, V, Money, S, Hedayati, N, Abou-Zamzam, A, Abularrage, C & Wittgen, C 2016, 'Treatment and outcomes of aortic endograft infection', Journal of Vascular Surgery, vol. 63, no. 2, pp. 332-340. https://doi.org/10.1016/j.jvs.2015.08.113

Treatment and outcomes of aortic endograft infection. / Smeds, Matthew R.; Duncan, Audra A.; Harlander-Locke, Michael P.; Lawrence, Peter F.; Lyden, Sean; Fatima, Javariah; Eskandari, Mark K.; Steenberge, Sean P.; Tomita, Tadaki M.; Morasch, Mark; Jim, Jeffrey; Lyons, Lewis C.; Charlton-Ouw, Kristofer; Mushtaq, Harith; Leake, Samuel S.; Motaganahalli, Raghu; Nelson, Peter; Parkerson, Godfrey; Shalhub, Sherene; Bove, Paul; Modrall, Gregory; Davila, Victor; Money, Samuel; Hedayati, Nasim; Abou-Zamzam, Ahmed; Abularrage, Christopher; Wittgen, Catherine.

In: Journal of Vascular Surgery, Vol. 63, No. 2, 01.02.2016, p. 332-340.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Treatment and outcomes of aortic endograft infection

AU - Smeds, Matthew R.

AU - Duncan, Audra A.

AU - Harlander-Locke, Michael P.

AU - Lawrence, Peter F.

AU - Lyden, Sean

AU - Fatima, Javariah

AU - Eskandari, Mark K.

AU - Steenberge, Sean P.

AU - Tomita, Tadaki M.

AU - Morasch, Mark

AU - Jim, Jeffrey

AU - Lyons, Lewis C.

AU - Charlton-Ouw, Kristofer

AU - Mushtaq, Harith

AU - Leake, Samuel S.

AU - Motaganahalli, Raghu

AU - Nelson, Peter

AU - Parkerson, Godfrey

AU - Shalhub, Sherene

AU - Bove, Paul

AU - Modrall, Gregory

AU - Davila, Victor

AU - Money, Samuel

AU - Hedayati, Nasim

AU - Abou-Zamzam, Ahmed

AU - Abularrage, Christopher

AU - Wittgen, Catherine

PY - 2016/2/1

Y1 - 2016/2/1

N2 - Objective This study examined the medical and surgical management and outcomes of patients with aortic endograft infection after abdominal endovascular aortic repair (EVAR) or thoracic endovascular aortic repair (TEVAR). Methods Patients diagnosed with infected aortic endografts after EVAR/TEVAR between January 1, 2004, and January 1, 2014, were reviewed using a standardized, multi-institutional database. Demographic, comorbidity, medical management, surgical, and outcomes data were included. Results An aortic endograft infection was diagnosed in 206 patients (EVAR, n = 180; TEVAR, n = 26) at a mean 22 months after implant. Clinical findings at presentation included pain (66%), fever/chills (66%), and aortic fistula (27%). Ultimately, 197 patients underwent surgical management after a mean of 153 days. In situ aortic replacement was performed in 186 patients (90%) using cryopreserved allograft in 54, neoaortoiliac system in 21, prosthetic in 111 (83% soaked in antibiotic), and 11 patients underwent axillary-(bi)femoral bypass. Graft cultures were primarily polymicrobial (35%) and gram-positive (22%). Mean hospital length of stay was 23 days, with perioperative 30-day morbidity of 35% and mortality of 11%. Of the nine patients managed only medically, four of five TEVAR patients died after mean of 56 days and two of four EVAR patients died; both deaths were graft-related (mean follow-up, 4 months). Nineteen replacement grafts were explanted after a mean of 540 days and were most commonly associated with prosthetic graft material not soaked in antibiotic and extra-anatomic bypass. Mean follow-up was 21 months, with life-table survival of 70%, 65%, 61%, 56%, and 51% at 1, 2, 3, 4, and 5 years, respectively. Conclusions Aortic endograft infection can be eradicated by excision and in situ or extra-anatomic replacement but is often associated with early postoperative morbidity and mortality and occasionally with a need for late removal for reinfection. Prosthetic graft replacement after explanation is associated with higher reinfection and graft-related complications and decreased survival compared with autogenous reconstruction.

AB - Objective This study examined the medical and surgical management and outcomes of patients with aortic endograft infection after abdominal endovascular aortic repair (EVAR) or thoracic endovascular aortic repair (TEVAR). Methods Patients diagnosed with infected aortic endografts after EVAR/TEVAR between January 1, 2004, and January 1, 2014, were reviewed using a standardized, multi-institutional database. Demographic, comorbidity, medical management, surgical, and outcomes data were included. Results An aortic endograft infection was diagnosed in 206 patients (EVAR, n = 180; TEVAR, n = 26) at a mean 22 months after implant. Clinical findings at presentation included pain (66%), fever/chills (66%), and aortic fistula (27%). Ultimately, 197 patients underwent surgical management after a mean of 153 days. In situ aortic replacement was performed in 186 patients (90%) using cryopreserved allograft in 54, neoaortoiliac system in 21, prosthetic in 111 (83% soaked in antibiotic), and 11 patients underwent axillary-(bi)femoral bypass. Graft cultures were primarily polymicrobial (35%) and gram-positive (22%). Mean hospital length of stay was 23 days, with perioperative 30-day morbidity of 35% and mortality of 11%. Of the nine patients managed only medically, four of five TEVAR patients died after mean of 56 days and two of four EVAR patients died; both deaths were graft-related (mean follow-up, 4 months). Nineteen replacement grafts were explanted after a mean of 540 days and were most commonly associated with prosthetic graft material not soaked in antibiotic and extra-anatomic bypass. Mean follow-up was 21 months, with life-table survival of 70%, 65%, 61%, 56%, and 51% at 1, 2, 3, 4, and 5 years, respectively. Conclusions Aortic endograft infection can be eradicated by excision and in situ or extra-anatomic replacement but is often associated with early postoperative morbidity and mortality and occasionally with a need for late removal for reinfection. Prosthetic graft replacement after explanation is associated with higher reinfection and graft-related complications and decreased survival compared with autogenous reconstruction.

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Smeds MR, Duncan AA, Harlander-Locke MP, Lawrence PF, Lyden S, Fatima J et al. Treatment and outcomes of aortic endograft infection. Journal of Vascular Surgery. 2016 Feb 1;63(2):332-340. https://doi.org/10.1016/j.jvs.2015.08.113