Outcomes Following in Situ Reconstruction for Aortic Infection with the Neo-Aortoiliac System and Aortic Homograft.

Autor:	Voit A; Division of Vascular and Endovascular Surgery, Duke University Medical Center, Durham, NC. Electronic address: antanina.voit@duke.edu., Commander SJ; Division of Vascular and Endovascular Surgery, Duke University Medical Center, Durham, NC., Anjorin AC; Division of Vascular and Endovascular Surgery, Duke University Medical Center, Durham, NC., Williams Z; Division of Vascular and Endovascular Surgery, Duke University Medical Center, Durham, NC.
Jazyk:	angličtina
Zdroj:	Annals of vascular surgery [Ann Vasc Surg] 2023 Mar; Vol. 90, pp. 93-99. Date of Electronic Publication: 2022 Oct 27.
DOI:	10.1016/j.avsg.2022.10.006
Abstrakt:	Background: In situ reconstruction is one of the primary surgical options for primary aortic and graft and endograft infections. One institution's outcomes following aortic reconstruction with femoro-popliteal vein (i.e., the neo-aortoiliac system) and cryopreserved aortic allografts are described. Methods: A retrospective review was performed of any patient who underwent aortic reconstruction with femoropopliteal vein or cryopreserved aortic allograft from 2013-2022 at a single tertiary-care institution. Results: Twenty four patients underwent in situ reconstruction with the neo-aortoiliac system or with cadaveric allograft for primary or secondary aortic infection from 2013-2022. Short-term (30-day) mortality remains low (3/24 or 12.5%) despite the high incidence of major postoperative complications that necessitated reintervention in 11/24 or 45.8% of the cohort, most often for recurrent intracavitary infection. Gram-negative and drug-resistant pathogens were the most commonly implicated organisms in recurrent intra-abdominal infection. Management of early allograft degeneration is also described with extra-anatomic bypass grafting, conduit/graft embolization, which is then followed by allograft explantation and wide surgical debridement. Despite low short-term (30-day) mortality, all-cause 1-year mortality remains elevated at 38.1% (8/21) in those with an adequate follow-up interval. Conclusions: In situ reconstruction for primary or secondary aortic infections results in excellent short-term patient outcomes but is characterized by a high incidence of reintervention and an elevated all-cause 1-year mortality. (Copyright © 2022 Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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