A 14-year Experience with Aortic Endograft Infection: Management and Results

Abstract

Objective: We report the uptake, length of stay and vascular readmission rates of carotid endarterectomy (CEA) and CAS among patients with symptomatic or asymptomatic carotid artery disease in the English National Health Service (NHS).Methods: Retrospective cohort study based on routinely collected Hospital Episode Statistics (HES) inpatient data. We identified individual admissions for CEA (n = 15996) or CAS (n = 632) between 2006 and 2009. Summary data were used to describe procedure volumes between 2009 and 2012. We analysed trends in procedure use over time and used ordinary least squares regression to evaluate patient, clinical and organisational characteristics associated with longer length of stay for revascularisation.Results: CAS made up less than 5% of carotid revascularisation procedures; there was no trend for increasing use between 2006 and 2012. Patients treated with CAS were on average younger, lived in areas of higher deprivation and were more likely to have amaurosis fugax or a comorbidity of heart disease. CAS patients had a 19% (95% CI 14-24) shorter stay in hospital than CEA patients.Conclusion: Despite the early promise of CAS and numerous randomised controlled trials evaluating efficacy, it has not been rapidly adopted in England. Cautious adoption may be appropriate given the higher periprocedural risk of stroke or death after CAS, particularly in recently symptomatic patients.

Diagnosis of Aortic Graft Infection: A Case Definition by the Management of Aortic Graft Infection Collaboration (MAGIC)

“…6e10 Conversely, and often despite prolonged antimicrobial treatment, mortality within 2 years can approach 100% if an infected endograft is left in situ. 6,11 The diagnosis and management of AGI is highly complex, clinical manifestations are protean, and there is no "goldstandard" diagnostic test. 3,5 In the existing literature, radiological data are mostly descriptive, microbiology details are brief or incomplete, and there have been no well designed trials of the optimum antimicrobial agent(s), route of administration, and treatment duration.…”

Outcomes of Surgical Explantation of Infected Aortic Grafts After Endovascular and Open Abdominal Aneurysm Repair

“…Overall mortality rates are similar to the reports of the current literature, with post-operative mortality (23.1% overall, 37.5% for iEVAR, and 0% for iOAR) after aortic graft infection. 2,9,16 The study showed that explantation of an infected conventional graft was related to significant lower 30 day mortality rates and peri-operative complications than the iEVAR group. The clinical presentation probably plays a crucial role on the outcome; of note in the series gastrointestinal bleeding was the dominant presentation in the iOAR group; however, contained rupture and abdominal pain were the dominating clinical symptoms in the iEVAR cohort.…”

“…In particular endograft (iEVAR) or conventional aortic graft infection (iOAR) represents one of the most serious complications after aortic aneurysm treatment. 1,2 Reported rates of iEVAR ranges from 0.2% to 0.7% and up to 2% for conventional grafts. 3,4 A cumulative incidence of aortic graft infection of 0.44% has been reported in population based studies.…”

Management of aortic graft infections – the present strategy and future perspectives

“…Contact of suture line, vascular prosthesis or endovascular anchors with bowel (usually duodenum), and endograft migration or its severe angulation can lead in the longer postoperative period to the development of aorto-enteric fi stula (AEF). At the time of vascular reconstruction, almost 90% of patients have one or more factors predisposing to graft infection (5,6).…”