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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY

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Official Journal of the Italian Society of Vascular and Endovascular Surgery
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Giornale Italiano di Chirurgia Vascolare 2002 December;9(4):309-21

Copyright © 2003 EDIZIONI MINERVA MEDICA

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


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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.

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