Commentary on ‘Outcomes of Infected Abdominal Grafts Managed with Antimicrobial Therapy and Graft Retention in an Unselected Cohort’

Abstract

In this paper, Maze et al. report a series of 18 patients treated for aortic graft infection over a period of 11 years. Only one of them, presenting with an aortoduodenal fistula, was treated surgically as a first intention, while the other 17 were treated conservatively, despite the fact that 11/18 (61%) showed signs of systemic infection. The only patient initially treated surgically with complete graft removal remained alive 128 months after treatment. Of the 17 patients treated with antimicrobial therapy and graft retention, there was a recurrence of infection in almost 60% (10/17). A quarter of these patients died as a result of the first relapse episode. Surgery was performed in 35% (6/17) of patients initially treated conservatively. Of note also is that for patients treated by non-operative management the overall survival rate was 1/9. Although this article aimed to investigate the assumption that conservative management may be an alternative to graft removal with or without revascularization, there are several issues to be considered before reaching a conclusion from the data presented.