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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY
A Journal on Vascular and Endovascular Surgery
Giornale Italiano di Chirurgia Vascolare 2002 December;9(4):309-21
language: English, Italian
Management of patients with infected aortic prosthesis. Analysis of 164 patients from the Italian Registry of Graft Infection (IRGI)
Speziale F. 1, Rizzo L. 1, Schioppa A. 1, Brizzi V. 1, Fiorani P. 1 , Cao P. 2, Zannetti S. 2, Parlani G. 2
1 I Department of Vascular Surgery University «La Sapienza», Rome, Italy
2 Unit of Vascular Surgery, Policlinico Monteluce, Perugia, Italy
Background. To evaluate outcome in patients with infected aortic graft in order to identify the profile of those at higher risk of complications after the treatment.
Methods. Multi-center study conducted in 42 Italian Vascular Surgery Centers on a total of 164 patients (54 patients with aorto-enteric fistula, 23 patients with groin infection, 56 patients with clear clinical evidence of graft infection and 31 patients with infection based on non specific clinical findings).
Results. Thirty-day mortality occurred in 34 patients (20.7%) and 7 amputations were performed in the same period. Statistical analysis showed that emergency surgery (p=0.01) and aorto-enteric fistula (p=0.03) are positive predictors of 30-day mortality. Gastrointestinal bleeding (p<0.0001) and fever (p=0.01) are positive predictors of aorto-enteric fistula. Actuarial survival, amputation-free interval and re-infection-free interval at 4 years were 70%, 90% and 96%, respectively.
Conclusions. Aorto-enteric fistula and emergent surgery represent the conditions at higher risk of postoperative mortality. Aorto-enteric fistula in this series was associated with gastrointestinal bleeding only in half of the cases. In these cases, the presence of fever and the absence of palpable masses in the setting of a clinical situation suggestive of prosthesis infection, may lead the surgeon to a quick diagnosis and to prompt intervention.