Contemporary Outcomes After Partial Resection of Infected Aortic Grafts

Página do item simplificado
dc.contributor.authorJanko, Matthew
dc.contributor.authorHubbard, Grant
dc.contributor.authorWoo, Karen
dc.contributor.authorKashyap, Vikram S.
dc.contributor.authorMitchell, Megan
dc.contributor.authorMurugesan, Arun
dc.contributor.authorChen, Lin
dc.contributor.authorGardner, Rachel
dc.contributor.authorBaril, Donald
dc.contributor.authorHacker, Robert I.
dc.contributor.authorSzeberin, Zoltan
dc.contributor.authorElSayed, Ramsey
dc.contributor.authorMagee, Gregory A.
dc.contributor.authorMotta, Fernando
dc.contributor.authorZhou, Wei
dc.contributor.authorLemmon, Gary
dc.contributor.authorColeman, Dawn
dc.contributor.authorBehrendt, Christian-Alexander
dc.contributor.authorAziz, Faisal
dc.contributor.authorBlack, James H.
dc.contributor.authorTran, Kimberly
dc.contributor.authorDao, Allen
dc.contributor.authorShutze, William
dc.contributor.authorGarrett, H. Edward
dc.contributor.authorDe Caridi, Giovanni
dc.contributor.authorPatel, Rhusheet
dc.contributor.authorLiapis, Christos D.
dc.contributor.authorGeroulakos, George
dc.contributor.authorKakisis, John
dc.contributor.authorMoulakakis, Konstantinos
dc.contributor.authorKakkos, Starvos K.
dc.contributor.authorObara, Hideaki
dc.contributor.authorWang, Grace
dc.contributor.authorStoecker, Jordan
dc.contributor.authorRhéaume, Pascal
dc.contributor.authorDavila, Victor
dc.contributor.authorRavin, Reid
dc.contributor.authorDeMartino, Randall
dc.contributor.authorMilner, Ross
dc.contributor.authorShalhub, Sherene
dc.contributor.authorJim, Jeffrey
dc.contributor.authorLee, Jason
dc.contributor.authorDubuis, Celine
dc.contributor.authorRicco, Jean-Baptiste
dc.contributor.authorCoselli, Joseph
dc.contributor.authorLemaire, Scott
dc.contributor.authorFatima, Javairiah
dc.contributor.authorSanford, Jennifer
dc.contributor.authorYoshida, Winston [UNESP]
dc.contributor.authorSchermerhorn, Marc L
dc.contributor.authorMenard, Matthew
dc.contributor.authorBelkin, Michael
dc.contributor.authorBlackwood, Stuart
dc.contributor.authorConrad, Mark
dc.contributor.authorWang, Linda
dc.contributor.authorCrofts, Sara
dc.contributor.authorNixon, Thomas
dc.contributor.authorWu, Timothy
dc.contributor.authorChiesa, Roberto
dc.contributor.authorBose, Saideep
dc.contributor.authorTurner, Jason
dc.contributor.authorMoore, Ryan
dc.contributor.authorSmith, Justin
dc.contributor.authorIrshad, Ali
dc.contributor.authorHsu, Jeffrey
dc.contributor.authorCzerny, Martin
dc.contributor.authorCullen, Jonathan
dc.contributor.authorKahlberg, Andrea
dc.contributor.authorSetacci, Carlo
dc.contributor.authorJoh, Jin Hyun
dc.contributor.authorSenneville, Eric
dc.contributor.authorGarrido, Pedro
dc.contributor.authorSarac, Timur P.
dc.contributor.authorRizzo, Anthony
dc.contributor.authorGo, Michael R.
dc.contributor.authorBjorck, Martin
dc.contributor.authorGavali, Hamid
dc.contributor.authorWanhainen, Anders
dc.contributor.authorD'Oria, Mario
dc.contributor.authorLepidi, Sandro
dc.contributor.authorMastrorilli, Davide
dc.contributor.authorVeraldi, Gianfranco
dc.contributor.authorPiazza, Michele
dc.contributor.authorSquizzato, Francesco
dc.contributor.authorBeck, Adam
dc.contributor.authorSt. John, Rebecca
dc.contributor.authorWishy, Andrew
dc.contributor.authorHumphries, Misty
dc.contributor.authorShah, Samir K.
dc.contributor.authorBack, Martin
dc.contributor.authorChung, Jayer
dc.contributor.authorLawrence, Peter F
dc.contributor.authorBath, Jonathan
dc.contributor.authorSmeds, Matthew R.
dc.contributor.institutionCase Western Reserve University School of Medicine
dc.contributor.institutionUniversity of California Los Angeles
dc.contributor.institutionSSM Healthcare
dc.contributor.institutionSemmelweis University
dc.contributor.institutionUniversity of Southern California
dc.contributor.institutionUniversity of North Carolina School of Medicine
dc.contributor.institutionUniversity of Arizona
dc.contributor.institutionthe Indiana University Health Physicians Vascular Surgery
dc.contributor.institutionUniversity of Michigan
dc.contributor.institutionUniversity Medical Center Hamburg-Eppendorf
dc.contributor.institutionMilton S. Hershey Medical Center
dc.contributor.institutionJohns Hopkins Hospital
dc.contributor.institutionThe Heart Hospital Baylor Plano
dc.contributor.institutionthe Cardiovascular Surgery Clinic
dc.contributor.institutionUniversity of Messina
dc.contributor.institutionNational & Kapodistrian University of Athens
dc.contributor.institutionUniversity of Patras
dc.contributor.institutionKeio University
dc.contributor.institutionUniversity of Pennsylvania
dc.contributor.institutionVancouver General Hospital & University of British Columbia
dc.contributor.institutionMayo Clinic
dc.contributor.institutionChristiana Health System
dc.contributor.institutionUniversity of Chicago
dc.contributor.institutionUniversity of Washington
dc.contributor.institutionWashington University
dc.contributor.institutionStanford University
dc.contributor.institutionCHU de Poitiers
dc.contributor.institutionBaylor College of Medicine
dc.contributor.institutionMedStar Georgetown University Hospital
dc.contributor.institutionSSM Health St. Louis University
dc.contributor.institutionUniversidade Estadual Paulista (UNESP)
dc.contributor.institutionBeth Israel Deaconness Medical Center
dc.contributor.institutionBrigham and Women's Hospital
dc.contributor.institutionSt. Joseph's Hospital
dc.contributor.institutionMassachusetts General Hospital
dc.contributor.institutionRutgers University
dc.contributor.institutionSan Raffaele Scientific Institute
dc.contributor.institutionKaiser Permanente
dc.contributor.institutionUniversity Heart Center Freiburg-Bad Krozingen Freiburg
dc.contributor.institutionUniversity of Virginia Medical Center
dc.contributor.institutionUniversity of Siena
dc.contributor.institutionKyung Hee University
dc.contributor.institutionGustave Dron Hospital
dc.contributor.institutionCentro Hospitalar de Lisboa Norte
dc.contributor.institutionOhio State University
dc.contributor.institutionUppsala University
dc.contributor.institutionUniversity Hospital of Trieste
dc.contributor.institutionUniversity Hospital of Verona
dc.contributor.institutionUniversity Hospital of Padova
dc.contributor.institutionUniversity of Alabama
dc.contributor.institutionUniversity of California Davis
dc.contributor.institutionUniversity of Florida
dc.contributor.institutionUniversity of Missouri
dc.date.accessioned2022-04-28T19:47:00Z
dc.date.available2022-04-28T19:47:00Z
dc.date.issued2021-10-01
dc.description.abstractIntroduction: Aortic graft infection remains a considerable clinical challenge, and it is unclear which variables are associated with adverse outcomes among patients undergoing partial resection. Methods: A retrospective, multi-institutional study of patients who underwent partial resection of infected aortic grafts from 2002 to 2014 was performed using a standard database. Baseline demographics, comorbidities, operative, and postoperative variables were recorded. The primary outcome was mortality. Descriptive statistics, Kaplan-Meier (KM) survival analysis, and Cox regression analysis were performed. Results: One hundred fourteen patients at 22 medical centers in 6 countries underwent partial resection of an infected aortic graft. Seventy percent were men with median age 70 years. Ninety-seven percent had a history of open aortic bypass graft: 88 (77%) patients had infected aortobifemoral bypass, 18 (16%) had infected aortobiiliac bypass, and 1 (0.8%) had an infected thoracic graft. Infection was diagnosed at a median 4.3 years post-implant. All patients underwent partial resection followed by either extra-anatomic (47%) or in situ (53%) vascular reconstruction. Median follow-up period was 17 months (IQR 1, 50 months). Thirty-day mortality was 17.5%. The KM-estimated median survival from time of partial resection was 3.6 years. There was no significant survival difference between those undergoing in situ reconstruction or extra-anatomic bypass (P = 0.6). During follow up, 72% of repairs remained patent and 11% of patients underwent major amputation. On univariate Cox regression analysis, Candida infection was associated with increased risk of mortality (HR 2.4; P = 0.01) as well as aortoenteric fistula (HR 1.9, P = 0.03). Resection of a single graft limb only to resection of abdominal (graft main body) infection was associated with decreased risk of mortality (HR 0.57, P = 0.04), as well as those with American Society of Anesthesiologists classification less than 3 (HR 0.35, P = 0.04). Multivariate analysis did not reveal any factors significantly associated with mortality. Persistent early infection was noted in 26% of patients within 30 days postoperatively, and 39% of patients were found to have any post-repair infection during the follow-up period. Two patients (1.8%) were found to have a late reinfection without early persistent postoperative infection. Patients with any post-repair infection were older (67 vs. 60 years, P = 0.01) and less likely to have patent repairs during follow up (59% vs. 32%, P = 0.01). Patients with aortoenteric fistula had a higher rate of any post-repair infection (63% vs. 29%, P < 0.01) Conclusion: This large multi-center study suggests that patients who have undergone partial resection of infected aortic grafts may be at high risk of death or post-repair infection, especially older patients with abdominal infection not isolated to a single graft limb, or with Candida infection or aortoenteric fistula. Late reinfection correlated strongly with early persistent postoperative infection, raising concern for occult retained infected graft material.en
dc.description.affiliationUniversity Hospitals Cleveland Medical Center Case Western Reserve University School of Medicine
dc.description.affiliationthe Ronald Reagan UCLA Medical Center University of California Los Angeles
dc.description.affiliationSSM Healthcare
dc.description.affiliationSemmelweis University
dc.description.affiliationKeck School of Medicine University of Southern California
dc.description.affiliationUniversity of North Carolina School of Medicine
dc.description.affiliationUniversity of Arizona
dc.description.affiliationthe Indiana University Health Physicians Vascular Surgery
dc.description.affiliationMichigan Medicine University of Michigan
dc.description.affiliationUniversity Heart Center Hamburg University Medical Center Hamburg-Eppendorf
dc.description.affiliationPenn State Heart and Vascular Institute Milton S. Hershey Medical Center
dc.description.affiliationJohns Hopkins Hospital
dc.description.affiliationThe Heart Hospital Baylor Plano
dc.description.affiliationthe Cardiovascular Surgery Clinic
dc.description.affiliationUniversity of Messina
dc.description.affiliationNational & Kapodistrian University of Athens
dc.description.affiliationUniversity of Patras
dc.description.affiliationKeio University
dc.description.affiliationUniversity of Pennsylvania
dc.description.affiliationVancouver General Hospital & University of British Columbia
dc.description.affiliationMayo Clinic
dc.description.affiliationChristiana Health System
dc.description.affiliationUniversity of Chicago
dc.description.affiliationHarborview Medical Center University of Washington
dc.description.affiliationWashington University
dc.description.affiliationStanford University
dc.description.affiliationCHU de Poitiers
dc.description.affiliationBaylor College of Medicine
dc.description.affiliationMedStar Georgetown University Hospital
dc.description.affiliationSSM Health St. Louis University
dc.description.affiliationFaculdade de Medicina de Botucatu-Unesp
dc.description.affiliationBeth Israel Deaconness Medical Center
dc.description.affiliationBrigham and Women's Hospital
dc.description.affiliationSt. Joseph's Hospital
dc.description.affiliationMassachusetts General Hospital
dc.description.affiliationRobert Wood Johnson Medical School Rutgers University
dc.description.affiliationVita-Salute University School of Medicine San Raffaele Scientific Institute
dc.description.affiliationKaiser Permanente
dc.description.affiliationUniversity Heart Center Freiburg-Bad Krozingen Freiburg
dc.description.affiliationUniversity of Virginia Medical Center
dc.description.affiliationUniversity of Siena
dc.description.affiliationKyung Hee University
dc.description.affiliationGustave Dron Hospital
dc.description.affiliationCentro Hospitalar de Lisboa Norte
dc.description.affiliationWexner Medical Center Ohio State University
dc.description.affiliationUppsala University
dc.description.affiliationUniversity Hospital of Trieste
dc.description.affiliationUniversity Hospital of Verona
dc.description.affiliationUniversity Hospital of Padova
dc.description.affiliationUniversity of Alabama
dc.description.affiliationUniversity of California Davis
dc.description.affiliationUniversity of Florida
dc.description.affiliationMichael E. DeBakey Department of Surgery Baylor College of Medicine
dc.description.affiliationUniversity Hospital University of Missouri
dc.description.affiliationUnespFaculdade de Medicina de Botucatu-Unesp
dc.format.extent202-210
dc.identifierhttp://dx.doi.org/10.1016/j.avsg.2021.07.002
dc.identifier.citationAnnals of Vascular Surgery, v. 76, p. 202-210.
dc.identifier.doi10.1016/j.avsg.2021.07.002
dc.identifier.issn1615-5947
dc.identifier.issn0890-5096
dc.identifier.scopus2-s2.0-85118700372
dc.identifier.urihttp://hdl.handle.net/11449/222821
dc.language.isoeng
dc.relation.ispartofAnnals of Vascular Surgery
dc.sourceScopus
dc.titleContemporary Outcomes After Partial Resection of Infected Aortic Graftsen
dc.typeArtigo
unesp.author.orcid0000-0002-3201-0348[2]
unesp.author.orcid0000-0003-1780-979X[4]
unesp.author.orcid0000-0002-4918-7617[6]
unesp.author.orcid0000-0003-3957-4100[12]
unesp.author.orcid0000-0001-9008-6642[13]
unesp.author.orcid0000-0002-5590-1602[16]
unesp.author.orcid0000-0003-0406-3319[18]
unesp.author.orcid0000-0002-1195-9108[27]
unesp.author.orcid0000-0002-6914-2440[29]
unesp.author.orcid0000-0002-2269-5937[30]
unesp.author.orcid0000-0002-7516-4873[31]
unesp.author.orcid0000-0002-1599-0890[34]
unesp.author.orcid0000-0003-2053-7553[38]
unesp.author.orcid0000-0003-1912-900X[44]
unesp.author.orcid0000-0003-2176-5988[45]
unesp.author.orcid0000-0002-8736-4266[46]
unesp.author.orcid0000-0003-3963-4302[65]
unesp.author.orcid0000-0003-1546-7159[68]
unesp.author.orcid0000-0001-6561-9734[76]
unesp.author.orcid0000-0002-7156-7827[79]
unesp.author.orcid0000-0001-6474-1455[89]
unesp.author.orcid0000-0003-3143-5181[93]

Arquivos

Coleções

Artigos