Impact of a Multidisciplinary Management on the Outcome of Aortic (Endo)Graft Infections: A Retrospective, Single-Centre Experience

Abstract

Introduction: Aortic (endo)graft infection is a rare (up to 5%) but devastating complication in vascular surgery, burdened by high mortality and reinfection rates. Aim of this study was to evaluate the impact of a multidisciplinary management on the outcome of the treatment of this complication in terms of morbidity and mortality. Methods: Since April 2011 a monthly meeting dedicated to infection of vascular substitutes was organised in our unit. Nuclear medicine physicians, infectious disease physicians, microbiologists, anesthesists and vascular surgeons discuss about the perioperative management of each patientin order to propose a tailored treatment strategy. Patients treated in our unit for aortic (endo)graft infection from January 2004 to July 2018 were retrospectively reviewed and divided in two groups: P1 (from 2004 to April 2011) and P2 (from April 2011 to 2018). Mortality and reinfection rates were the primary outcomes and were calculated using Kaplan-Meier curves, Log-Rank test was used to compare the two groups. Results: A total of 92 patients (87 males, mean age: 64 years old) have been included in the study: 31 in P1 and 61 in P2. Demographic and baseline disease characteristics were comparable between groups. Mean delay between index surgery and (endo)graft infection surgical treatment was 6 years. For each group, 21% of patients underwent an emergent surgical treatment. A conservative treatment was realised in 4 cases of P2. More total extractions (48% vs 51,7%) and reconstructions using cryopreserved allograft (0 vs 19%) were performed in P2. Mean follow-up was 4.9 and 1.2 years for P1 and P2 respectively. In-hospital mortality rate was 32.3% and 21.3% for P1 and P2 respectively. Median reinfection delay was 7.5 months. The reinfection rate was significantly reduced in P2 (47.6% vs 12.5%, log rank p=0.02). The 2-years survival rate was 54,6% and 69% for P1 and P2 respectively. Conclusion: A multidisciplinary management seems to provide better results in the management of aortic (endo)graft infections reducing in-hospital mortality and reinfection rates. Disclosure: Nothing to disclose