Is In-Situ Reconstruction of the Aorta a Better Alternative to Extra-Anatomic Bypass in Patients with Aortic Infections?
Khalil Masabni, MD, Loay Kabbani, MD, Praveen Balraj, MD, Ziad Al-Adas, MD, Jordan Huang, BS, Liang Liang, BS, Alexander D. Shepard, MD, Timothy J. Nypaver, MD, Mitchell R. Weaver, MD
Henry Ford Hospital, Detroit, MI, USA.
OBJECTIVES: Management of patients with infected aortic aneurysms and prosthetic aortic grafts is associated with significant morbidity and mortality. We describe a single center experience with the use of cryopreserved human allografts, rifampin-soaked grafts and extra-anatomic bypass in the management of aortic infections.
METHODS: We retrospectively reviewed all patients who had surgical intervention for aortic infections at our tertiary care center from August 2007 to August 2017. Patients who had in-situ aortic reconstruction with either cryopreserved grafts or rifampin-soaked grafts were compared to patients who had extra-anatomic bypass. Demographic data, pre-operative work-up, procedural details and outcomes were collected.
RESULTS: Thirty-two patients had surgical intervention for aortic infections. 27 patients had in-situ aortic reconstruction with either cryopreserved allografts or rifampin-soaked grafts (14 had infected prosthetic graft and 13 had primary aortic infection), and 5 had extra-anatomic bypass (3 had infected prosthetic graft and 2 had primary aortic infection). Of the patients who had in-situ reconstruction, 1 had involvement of the thoracic aorta, 2 of the thoracoabdominal aorta, 11 of the paravisceral aorta, and 13 of the infrarenal abdominal aorta. Of the patients with extra-anatomic bypass, 1 had involvement of the paravisceral aorta, and 4 of the infrarenal abdominal aorta. Mean follow-up was 23.5 months. Among patients who had in-situ reconstruction, one (3.7%) died intraoperatively and one (3.7%) died within 30 days. Postoperative complications included graft thrombosis in one (3.7%), and reoperation for bleeding in one (3.7%). During follow up, two (7.4%) developed graft stenosis requiring angioplasty, one (3.7%) had graft rupture requiring stent placement, and one (3.7%) had limb loss. At 1 month, 6 months, 1 year, and 3 years, estimated survival was 92%, 80%, 74%, and 74% respectively. Among patients who had extra-anatomic bypass, two (40%) died postoperatively after a prolonged hospitalization. During follow-up, no patient had graft related complications and no patient suffered limb loss. At 1 month, 6 months, 1 year, and 3 years, estimated survival was 100%, 60%, 60%, and 60% respectively. No patient had recurrent aortic infection.
CONCLUSIONS: In-situ reconstruction of the aorta with cryopreserved or rifampin-soaked grafts has low morbidity and mortality, and thus is a good alternative to extra-anatomic bypass in the setting of infection.
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