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Open Repair of Mycotic Abdominal Aortic Aneurysms With Biological Grafts: An International Multicenter Study
Univ Helsinki, Dept Vasc Surg, Helsinki, Finland;Helsinki Univ Hosp, Helsinki, Finland.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
Univ Bern, Bern Univ Hosp, Inselspital, Dept Cardiovasc Surg, Bern, Switzerland.ORCID iD: 0000-0002-9679-4938
Aarhus Univ Hosp, Dept Cardiothorac & Vasc Surg, Aarhus, Denmark.ORCID iD: 0000-0002-7980-5295
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2018 (English)In: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, ISSN 2047-9980, E-ISSN 2047-9980, Vol. 7, no 12, article id e008104Article in journal (Refereed) Published
Abstract [en]

Background-The treatment of mycotic abdominal aortic aneurysm requires surgery and antimicrobial therapy. Since prosthetic reconstructions carry a considerable risk of reinfection, biological grafts are noteworthy alternatives. The current study evaluated the durability, infection resistance, and midterm outcome of biological grafts in treatment of mycotic abdominal aortic aneurysm. Methods and Results-All patients treated with biological graft in 6 countries between 2006 and 2016 were included. Primary outcome measures were 30- and 90-day survival, treatment-related mortality, and reinfection rate. Secondary outcome measures were overall mortality and graft patency. Fifty-six patients (46 males) with median age of 69 years (range 35-85) were included. Sixteen patients were immunocompromised (29%), 24 (43%) had concomitant infection, and 12 (21%) presented with rupture. Bacterial culture was isolated from 43 (77%). In-situ aortic reconstruction was performed using autologous femoral veins in 30 patients (54%), xenopericardial tube-grafts in 12 (21%), cryopreserved arterial/venous allografts in 9 (16%), and fresh arterial allografts in 5 (9%) patients. During a median follow-up of 26 months (range 3 weeks-172 months) there were no reinfections and only 3 patients (5%) required assistance with graft patency. Thirty-day survival was 95% (n=53) and 90-day survival was 91% (n=51). Treatment-related mortality was 9% (n=5). Kaplan-Meier estimation of survival at 1 year was 83% (95% confidence interval, 73%-94%) and at 5 years was 71% (52%-89%). Conclusions-Mycotic abdominal aortic aneurysm repair with biological grafts is a durable option for patients fit for surgery presenting an excellent infection resistance and good overall survival.

Place, publisher, year, edition, pages
WILEY , 2018. Vol. 7, no 12, article id e008104
Keywords [en]
allograft, aneurysm, aorta, autologous vein, femoral vein, graft, in situ reconstruction, infection, vein
National Category
Cardiac and Cardiovascular Systems Surgery
Identifiers
URN: urn:nbn:se:uu:diva-372905DOI: 10.1161/JAHA.117.008104ISI: 000452696000008PubMedID: 29886419OAI: oai:DiVA.org:uu-372905DiVA, id: diva2:1277960
Available from: 2019-01-11 Created: 2019-01-11 Last updated: 2019-01-11Bibliographically approved

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