Michael P. Harlander-Locke1, Peter F. Lawrence1, Gustavo S. Oderich2, Liv Harmon1, Robert A. McCready3, Mark D. Morasch4, Robert J. Feezor5, Wei Zhou6, Jean Bismuth7, William C. Pevec8, Mateus P. Correa2, Jeffrey Jim9, Joseph S. Ladowski10, Panagiotis Kougias11, Paul G. Bove12, Catherine M. Wittgen13, John V. White14
1Vascular Surgery, University of California Los Angeles, Los Angeles, CA; 2Mayo Clinic, Rochester, MN; 3Indiana University, Indianapolis, IN; 4St. Vincent Heart and Vascular, Billings, MT; 5University of Florida, Gainesville, FL; 6Stanford University, Stanford, CA; 7Methodist Hospital, Houston, TX; 8University of California Davis, Davis, CA; 9Washington University, St. Louis, MO; 10Indiana Ohio Heart, Indianapolis, IN; 11Baylor University, Houston, TX; 12William Beaumont Hospital, Royal Oak, MI; 13Saint Louis University, St. Louis, MO; 14Advocate Lutheran General Hospital, Niles, IL.
OBJECTIVES: Aortic infections, even with treatment, have a high mortality and risk of recurrent infection and limb loss. CAA has been proposed for in-line reconstruction to improve outcomes in this high-risk population.
METHODS: A multicenter study using a standardized database was performed at 14 of the highest volume institutions who used CAA for aortic infection.
RESULTS: Two hundred and twenty patients (mean age=65; M:F=1.6/1) were treated since 2000 with 283 CAAs for prosthetic graft infection (59%), primary aortic infection (17%), enteric fistula/erosion (16%), mycotic aneurysm (4%) and other (4%). Intra-op cultures indicated infection in 66%, most frequently polymicrobial. Distal anastomosis was to the femoral artery, iliac, then distal aorta. Thirty-day mortality was 9%, and procedure-related major complications occurred in 24%, including persistent sepsis (n=17), graft thrombosis (n=9), graft/stump rupture (n=8), recurrent CAA/aortic infection (n=8), pseudoaneurysm (n=6), recurrence of AE fistula (n=4) and compartment syndrome (n=1). Hospital LOS was 24 days. Ten (5%) required allograft explant; 2 developed CAA aneurysm requiring resection at 23 and 40 months. Primary graft patency and freedom from limb loss were 93% and 97%, respectively, at 5 years. Patient survival was 75% at 1 year and 51% at 5 years.
CONCLUSIONS: This largest study indicates that CAA allows in-line reconstruction of aortic infection with lower early and long-term morbidity and mortality than other previously reported treatment options. Repair with CAA is associated with low rates of aneurysm formation, recurrent infection, and limb loss.
AUTHOR DISCLOSURES: J. Bismuth: Nothing to disclose; P. G. Bove: Nothing to disclose; M. P. Correa: Nothing to disclose; R. J. Feezor: Nothing to disclose; M. P. Harlander-Locke: CryoLife, Research grants; L. Harmon: Nothing to disclose; J. Jim: CryoLife, Research grants; P. Kougias: Nothing to disclose; J. S. Ladowski: Nothing to disclose; P. F. Lawrence: CryoLife, Research grants; R. A. McCready: Nothing to disclose; M. D. Morasch: Nothing to disclose; G. S. Oderich: Nothing to disclose; W. C. Pevec: Nothing to disclose; J. V. White: Nothing to disclose; C. M. Wittgen: Nothing to disclose; W. Zhou: Nothing to disclose.
Posted April 2013