REVIEW  VASCULAR SECTION 

The Journal of Cardiovascular Surgery 2020 April;61(2):171-82

DOI: 10.23736/S0021-9509.19.10669-6

Copyright © 2019 EDIZIONI MINERVA MEDICA

lingua: Inglese

A meta-analysis of outcomes of in-situ reconstruction after total or partial removal of infected abdominal aortic graft

Michel BATT ¹ ✉, Fabrice CAMOU ², Amandine COFFY ³, Patrick FEUGIER ⁴, Eric SENNEVILLE ⁵, Jocelyne CAILLON ⁶, Brigitte CALVET ⁷, Christian CHIDIAC ^{8, 9}, Frederic LAURENT ¹⁰, Matthieu REVEST ¹¹, Jean Pierre DAURES ³, on behalf of the Research Group for Vascular Graft Infection

¹ Department of Vascular Surgery, University Nice-Sophia Antipolis, Nice, France; ² Intensive Care Unit, Saint-Andre University Hospital, Bordeaux, France; ³ Laboratory of Biostatistics and Epidemiology, University Institute for Clinical Research, Montpellier, France; ⁴ Department of Vascular Surgery, University Claude Bernard Lyon 1, Hospices Civils de Lyon, Lyon, France; ⁵ Infectious Diseases Department, Gustave Dron Hospital, Lille 2 University, Tourcoing, France; ⁶ Bacteriology Department, University Hospital, Nantes, France; ⁷ Anesthosiology Department, Béziers Hospital, Béziers, France; ⁸ Infectious Deseases Department, Hospices Civils de Lyon and International Center for Infectiology Research (CIRI), INSERM U1111, Lyon 1 University, Lyon, France; ⁹ Bacteriology Department, International Center for Infectiology Research (CIRI), INSERM U1111, Lyon 1 University, Lyon, France; ¹⁰ Infectious Diseases, and Intensive Care Unit, Pontchaillou University Hospital, CIC-INSERM 1414, Rennes 1 University, France

INTRODUCTION: There is currently a lack of evidence for the relative effectiveness of partial resection (PR) and total resection (TR) before managing abdominal aortic graft infection (AGI). Most authorities agree that TR is mandatory for intracavitary AGI in patients with favorable conditions but there is an increasing number of patients with severe comorbidities for whom this approach is not suitable, resulting in a prohibitive mortality rate. The purpose of this study was to determine the most appropriate indication for TR or PR.
EVIDENCE ACQUISITION: A meta-analysis was conducted on the rates of early/late mortality, amputations and reinfection. A meta-regression was performed with eight variables: patient age, male prevalence, presence of virulent or nonvirulent organisms, urgency, omentoplasty and follow-up.
EVIDENCE SYNTHESIS: Twenty-one studies and 1052 patients were included. For TR and PR, the rates of early mortality and reinfection were 16.8% and 10.5%, 11% and 27%, respectively. For TR urgency and male gender were associated with increased rate of early mortality and male gender, PDF and virulent organisms were associated with increased risk of reinfection. For PR no statistical correlation was analyzable except for PDF with increased risk of reinfection.
CONCLUSIONS: Early mortality rates are higher for TR and reinfection rates are higher for PR. For TR early mortality increases in urgent cases and it is suggested that alternative option must be discussed, reinfection decreases in the presence of nonvirulent organisms and TR seems optimal. For TR and PR reinfection increases in presence of PDF and alternative technique may be more appropriate.

KEY WORDS: Meta-analysis; Reconstructive surgical procedures; Infection; Vascular grafting