Abstract：
Aortic and iliac graft infections remain complex clinical problems with high mortality and morbidity. Cryopreserved arterial allografts (CAAs) and rifampin-soaked Dacron (RSD) are options for in situ reconstruction. This study aimed to compare the safety and effectiveness of CAA vs RSD in this setting.
Data from patients with aortic and iliac graft infections undergoing in situ reconstruction with either CAA or RSD from January 2002 through August 2022 were retrospectively analyzed. Our primary outcomes were freedom from graft-related reintervention and freedom from reinfection. Secondary outcomes included comparing trends in the use of CAA and RSD at our institution, overall survival, perioperative mortality, and major morbidity.
A total of 149 patients (80 RSD, 69 CAA) with a mean age of 68.9 and 69.1 years, respectively, were included. Endovascular stent grafts were infected in 60 patients (41 CAA group and 19 RSD group; P ≤ .01). Graft-enteric fistulas were more common in the RSD group (48.8% RSD vs 29.0% CAA; P ≤ .01). Management included complete resection of the infected graft (85.5% CAA vs 57.5% RSD; P ≤ .01) and aortic reconstructions were covered in omentum in 57 (87.7%) and 63 (84.0%) patients in the CAA and RSD group, respectively (P = .55). Thirty-day/in-hospital mortality was similar between the groups (7.5% RSD vs 7.2% CAA; P = 1.00). One early graft-related death occurred on postoperative day 4 due to CAA rupture and hemorrhagic shock. Median follow-up was 20.5 and 21.5 months in the CAA and RSD groups, respectively. Overall post-discharge survival at 5 years was similar, at 59.2% in the RSD group and 59.0% in the CAA group (P = .80). Freedom from graft-related reintervention at 1 and 5 years was 81.3% and 66.2% (CAA) vs 95.6% and 92.5% (RSD; P = .02). Indications for reintervention in the CAA group included stenosis (n = 5), pseudoaneurysm (n = 2), reinfection (n = 2), occlusion (n = 2), rupture (n = 1), and graft-limb kinking (n = 1). In the RSD group, indications included reinfection (n = 3), occlusion (n = 1), endoleak (n = 1), omental coverage (n = 1), and rupture (n = 1). Freedom from reinfection at 1 and 5 years was 98.3% and 94.9% (CAA) vs 92.5% and 87.2% (RSD; P = .11). Two (2.9%) and three patients (3.8%) in the CAA and RSD group, respectively, required graft explantation due to reinfection.
Aorto-iliac graft infections can be managed safely with either CAA or RSD in selected patients for in situ reconstruction. However, reintervention was more common with CAA use. Freedom from reinfection rates in the RSD group was lower, but this was not statistically significant. Conduit choice is associated with long-term surveillance needs and reinterventions.
Data from patients with aortic and iliac graft infections undergoing in situ reconstruction with either CAA or RSD from January 2002 through August 2022 were retrospectively analyzed. Our primary outcomes were freedom from graft-related reintervention and freedom from reinfection. Secondary outcomes included comparing trends in the use of CAA and RSD at our institution, overall survival, perioperative mortality, and major morbidity.
A total of 149 patients (80 RSD, 69 CAA) with a mean age of 68.9 and 69.1 years, respectively, were included. Endovascular stent grafts were infected in 60 patients (41 CAA group and 19 RSD group; P ≤ .01). Graft-enteric fistulas were more common in the RSD group (48.8% RSD vs 29.0% CAA; P ≤ .01). Management included complete resection of the infected graft (85.5% CAA vs 57.5% RSD; P ≤ .01) and aortic reconstructions were covered in omentum in 57 (87.7%) and 63 (84.0%) patients in the CAA and RSD group, respectively (P = .55). Thirty-day/in-hospital mortality was similar between the groups (7.5% RSD vs 7.2% CAA; P = 1.00). One early graft-related death occurred on postoperative day 4 due to CAA rupture and hemorrhagic shock. Median follow-up was 20.5 and 21.5 months in the CAA and RSD groups, respectively. Overall post-discharge survival at 5 years was similar, at 59.2% in the RSD group and 59.0% in the CAA group (P = .80). Freedom from graft-related reintervention at 1 and 5 years was 81.3% and 66.2% (CAA) vs 95.6% and 92.5% (RSD; P = .02). Indications for reintervention in the CAA group included stenosis (n = 5), pseudoaneurysm (n = 2), reinfection (n = 2), occlusion (n = 2), rupture (n = 1), and graft-limb kinking (n = 1). In the RSD group, indications included reinfection (n = 3), occlusion (n = 1), endoleak (n = 1), omental coverage (n = 1), and rupture (n = 1). Freedom from reinfection at 1 and 5 years was 98.3% and 94.9% (CAA) vs 92.5% and 87.2% (RSD; P = .11). Two (2.9%) and three patients (3.8%) in the CAA and RSD group, respectively, required graft explantation due to reinfection.
Aorto-iliac graft infections can be managed safely with either CAA or RSD in selected patients for in situ reconstruction. However, reintervention was more common with CAA use. Freedom from reinfection rates in the RSD group was lower, but this was not statistically significant. Conduit choice is associated with long-term surveillance needs and reinterventions.
摘要：
目的：主动脉和髂移植物感染仍然是复杂的临床问题，死亡率和发病率高。冷冻保存的同种异体动脉移植物（CAA）和利福平浸泡的涤纶（RSD）是原位重建的选择。本研究旨在比较CAA和RSD在这种情况下的安全性和有效性。
方法：回顾性分析2002年1月至2022年8月接受CAA或RSD原位重建的主动脉和髂骨移植物感染患者的数据。我们的主要结果是免于移植物相关的再干预和免于再感染。次要结果包括比较我们机构使用CAA和RSD的趋势，总生存率,围手术期死亡率，和主要发病率。
结果：共149例患者（80RSD，69CAA)，平均年龄为68.9岁和69.1岁，分别,包括在内。60例患者发生血管内支架感染（CAA组41例，RSD组19例；P≤0.01）。移植物肠瘘在RSD组中更为常见（48.8％RSDvs29.0％CAA；P≤0.01）。治疗包括完全切除受感染的移植物（85.5％CAAvs57.5％RSD;P≤0.01），CAA和RSD组中57例（87.7％）和63例（84.0％）患者的网膜覆盖了主动脉重建。分别（P=0.55）。两组之间30天/住院死亡率相似（RSD为7.5％，CAA为7.2％；P=1.00）。由于CAA破裂和失血性休克，在术后第4天发生了一例早期移植物相关死亡。CAA和RSD组的中位随访时间分别为20.5和21.5个月，分别。出院后5年总生存率相似，RSD组为59.2%，CAA组为59.0%（P=0.80）。1年和5年的移植物相关再干预的自由度分别为81.3%和66.2%(CAA)，而非95.6%和92.5%(RSD;P=.02)。CAA组的再干预指征包括狭窄(n=5)，假性动脉瘤（n=2），再感染（n=2），闭塞（n=2），破裂（n=1），和移植肢体扭结（n=1）。在RSD组中，适应症包括再感染（n=3），遮挡（n=1），内漏(n=1)，网膜覆盖率(n=1)，和破裂（n=1）。1年和5年的再感染发生率分别为98.3%和94.9%（CAA），而非92.5%和87.2%（RSD；P=.11）。CAA和RSD组2例(2.9%)和3例(3.8%),分别,由于再感染需要移植。
结论：在选定的原位重建患者中，可以使用CAA或RSD安全地管理主动脉移植物感染。然而,再干预在CAA使用中更为常见。RSD组的再感染率较低，但这没有统计学意义。导管选择与长期监测需求和再干预有关。
方法：回顾性分析2002年1月至2022年8月接受CAA或RSD原位重建的主动脉和髂骨移植物感染患者的数据。我们的主要结果是免于移植物相关的再干预和免于再感染。次要结果包括比较我们机构使用CAA和RSD的趋势，总生存率,围手术期死亡率，和主要发病率。
结果：共149例患者（80RSD，69CAA)，平均年龄为68.9岁和69.1岁，分别,包括在内。60例患者发生血管内支架感染（CAA组41例，RSD组19例；P≤0.01）。移植物肠瘘在RSD组中更为常见（48.8％RSDvs29.0％CAA；P≤0.01）。治疗包括完全切除受感染的移植物（85.5％CAAvs57.5％RSD;P≤0.01），CAA和RSD组中57例（87.7％）和63例（84.0％）患者的网膜覆盖了主动脉重建。分别（P=0.55）。两组之间30天/住院死亡率相似（RSD为7.5％，CAA为7.2％；P=1.00）。由于CAA破裂和失血性休克，在术后第4天发生了一例早期移植物相关死亡。CAA和RSD组的中位随访时间分别为20.5和21.5个月，分别。出院后5年总生存率相似，RSD组为59.2%，CAA组为59.0%（P=0.80）。1年和5年的移植物相关再干预的自由度分别为81.3%和66.2%(CAA)，而非95.6%和92.5%(RSD;P=.02)。CAA组的再干预指征包括狭窄(n=5)，假性动脉瘤（n=2），再感染（n=2），闭塞（n=2），破裂（n=1），和移植肢体扭结（n=1）。在RSD组中，适应症包括再感染（n=3），遮挡（n=1），内漏(n=1)，网膜覆盖率(n=1)，和破裂（n=1）。1年和5年的再感染发生率分别为98.3%和94.9%（CAA），而非92.5%和87.2%（RSD；P=.11）。CAA和RSD组2例(2.9%)和3例(3.8%),分别,由于再感染需要移植。
结论：在选定的原位重建患者中，可以使用CAA或RSD安全地管理主动脉移植物感染。然而,再干预在CAA使用中更为常见。RSD组的再感染率较低，但这没有统计学意义。导管选择与长期监测需求和再干预有关。
