VESS26. An Alternative Treatment of Vascular Graft Infections With Antibiotic Polymethyl Methacrylate Beads: Our Five-Year Experience

Abstract

Endovascular aneurysm repair (EVAR) has reduced perioperative mortality for patients undergoing abdominal aortic aneurysm (AAA) repair despite the increase in elective aneurysm repair for the elderly. However, Medicare will not cover screening for beneficiaries older than 75 years, and AAA treatment in this population depends on incidental detection. Thus, we risk stratified elderly patients undergoing elective AAA repair to identify a subset of elderly patients who would potentially benefit from an expanded screening policy.Methods: We reviewed all patients undergoing elective EVAR in the Vascular Quality Initiative between 2003 and 2017. We used the beta coefficients from Cox regression models to construct a risk model for 5-year survival in patients >75 years old.Results: We identified 26,967 patients undergoing elective EVAR, 11,351 (42%) of whom were >75 years old. Perioperative mortality for the entire cohort was 0.9% (75 years, 0.6%; >75 years, 1.4%; P < .01). Although perioperative mortality varied directly with age, it was only 2.1% in the oldest group of patients (>85 years old). Factors included in our risk model for 5year survival in the elderly included age, aortic diameter, smoking status, white race, body mass index, renal function, diabetes, congestive heart failure, statin use, anemia (hemoglobin level <10 mg/dL), chronic obstructive pulmonary disease, prior aortic surgery, and beta blocker use. Total point values were 0 to 21 and classified patients into four risk categories. The lowest risk group (0-4 points) included 21% of the patients older than 75 years, whose 5-year survival was 89%, equivalent to that of patients younger than 75 years. Less than 1% of patients older than 75 years fell into the highest risk category (15+ points), who experienced 50% 5-year survival (Fig) . Five-year survival in the four risk categories was statistically significantly different (P < .001), with a Harrell C statistic of 0.71.Conclusions: Elective EVAR in the elderly is associated with acceptable perioperative mortality. Our risk score can be used to define optimal patients for expanded screening based on expected postoperative 5-year survival to justify removing this Medicare coverage restriction.

Infecciones de injertos vasculares por gramnegativos: rompiendo un paradigma en la literatura

“…En la fase aguda está indicada la terapia antimicrobiana intensiva con antibióticos de amplio espectro. En la elección de la terapia antimicrobiana, se debe considerar el material del injerto que puede estar cubierto con una biopelícula y también la epidemiología local de los patrones de resistencia antimicrobiana 15 . No hay consenso sobre la duración óptima de la terapia antimicrobiana.…”