Aortic Graft Infection Treatments Compared in 20-Year Study

Outcomes of patients treated for aortic graft infections with in situ prosthetic reconstruction (ISR) as well as a non-concurrent comparison of a group of patients who had the same conditions, but were treated with axillofemoral reconstruction (AXFR) appears in the June 2006 Journal of Vascular Surgery.

According to Thomas Bower, MD, from the division of vascular surgery at the Mayo Clinic in Rochester, Minn., the primary aims of this report were to determine the incidence of early and late procedure-related death, primary graft patency and limb loss with in situ prosthetic reconstruction. Secondary outcomes were operative morbidity, patient survival and graft reinfection rates.

“The primary analysis consisted of 52 ISR patients treated with ISR during a 20-year period.  Of the patients, 35 had total graft excisions and 17 had partial graft excisions. “Forty-three patients had Rifampini-soaked grafts and 39 had omental flaps. Four patients died for an operative mortality of eight percent. Postoperative complications occurred in 23 ISR patients and there were no late procedure-related deaths after a median follow up of 3.4 years. Primary patency and limb salvage rates at five years were 89 percent and 100 percent respectively, and graft reinfection occurred in six patients (11.5 percent).

The secondary, nonconcurrent comparative analysis of patients with similar extent of infection treated with either ISR or AXFR, primary graft patency and limb salvage rates were significantly better for ISR. Primary graft patency was 89 percent for ISR, compared to 48 percent AXFR; limb salvage was 100 percent for ISR compared to 88 percent for AXFR. The reinfection rate was similar for both groups10 percent for ISR and 16 percent for AXFR. There were three procedure-related deaths in the ISR group in comparison to 10 in the AXFR group. The authors attribute this difference to four aortic-stump blowouts in the AXFR group. 

“There are a number of effective treatments for aortic graft infection,” said Dr. Bower. “We believe ISR is a safe and effective alternative in the treatment of select patients with aortic graft infection. In our study graft patency and limb salvage rates were excellent, and reinfection occurred in 11.5 percent of the patients.”