Aortic Vascular Graft and Endograft Infection–Patient Outcome Cannot Be Determined Based on Pre-Operative Characteristics

Author:

Puttini Ilaria1,Kapalla Marvin2ORCID,Braune Anja3,Michler Enrico3,Kröger Joselyn2,Lutz Brigitta2,Sakhalihasan Natzi4ORCID,Trenner Matthias5ORCID,Biro Gabor1,Weber Wolfgang6,Rössel Thomas7,Reeps Christian2,Eckstein Hans-Henning1,Wolk Steffen2,Knappich Christoph1ORCID,Notohamiprodjo Susan6,Busch Albert12ORCID

Affiliation:

1. Department for Vascular and Endovascular Surgery, Klinikum Rechts der Isar, Technical University of Munich, 80333 Munich, Germany

2. Division of Vascular and Endovascular Surgery, Department for Visceral, Thoracic and Vascular Surgery, Medical Faculty Carl Gustav Carus, University Hospital, Technical University of Dresden, 01307 Dresden, Germany

3. Nuclear Medicine Department, University Hospital Carl Gustav Carus, Technical University of Dresden, 01307 Dresden, Germany

4. Department of Cardiovascular and Thoracic Surgery, University of Liège, 4000 Liège, Belgium

5. Division of Vascular Medicine, St. Josefs-Hospital Wiesbaden, 65189 Wiesbaden, Germany

6. Department of Nuclear Medicine, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany

7. Department of Anaesthesiology and Critical Care Medicine, University Hospital Carl Gustav Carus Dresden, Technical University of Dresden, 01307 Dresden, Germany

Abstract

Vascular graft/endograft infection (VGEI) is a serious complication after aortic surgery. This study investigates VGEI and patient characteristics, PET/CT quantification before surgical or conservative management of VGEI and post-intervention outcomes in order to identify patients who might benefit from such a procedure. PET standard uptake values (SUV) were quantitatively assessed and compared to a non-VGEI cohort. The primary endpoints were in-hospital mortality and aortic reintervention-free survival at six months. Ninety-three patients (75% male, 65 ± 10 years, 82% operated) were included. The initial operation was mainly for aneurysm (67.7%: 31% EVAR, 12% TEVAR, 57% open aortic repair). Thirty-two patients presented with fistulae. PET SUVTLR (target-to-liver ratio) showed 94% sensitivity and 89% specificity. Replacement included silver-coated Dacron (21.3%), pericardium (61.3%) and femoral vein (17.3%), yet the material did not influence the overall survival (p = 0.745). In-hospital mortality did not differ between operative and conservative treatment (19.7% vs. 17.6%, p = 0.84). At six months, 50% of the operated cohort survived without aortic reintervention. Short- and midterm morbidity and mortality remained high after aortic graft removal. Neither preoperative characteristics nor the material used for reconstruction influenced the overall survival, and, with limitations, both the in-hospital and midterm survival were similar between the surgically and conservatively managed patients.

Publisher

MDPI AG

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