Preliminary Results from a National Enquiry of Infection in Abdominal Aortic Endovascular Repair (Registry of Infection in EVAR - R.I.EVAR)

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• 作者：Laura Capoccia¹ ; ^{laura.capoccia@uniroma1.it" class="auth_mail" title="E-mail the corresponding author} ; Francesco Speziale¹ ; Danilo Menna¹ ; Andrea Esposito¹ ; Pasqualino Sirignano¹ ; Anna Rita Rizzo¹ ; Wassim Mansour¹ ; Nunzio Montelione¹ ; Enrico Sbarigia¹ ; Carlo Setacci² ; On behalf of Collaborators^a
• 刊名：Annals of Vascular Surgery
• 出版年：2016
• 出版时间：January 2016
• 年：2016
• 卷：30
• 期：Complete
• 页码：198-204
• 全文大小：685 K

文摘

To preliminary report on epidemiology, risk factors, diagnosis, treatments, and outcomes in a multicenter series of patients treated for endovascular aortic repair (EVAR) infection and detected by an Italian National enquiry.

Methods

From June 2012, 26 cases of abdominal aortic endograft infection were collected by a National Enquiry and recorded in the Italian National Registry of Infection in EVAR. Cases collected were available for patients submitted to EVAR implantation from January 2004 to June 2013.

Results

Mean time from EVAR treatment to infection diagnosis was 20.5 ± 20.3 months (range, 1–72). In 6 cases (23.1%), an aortoenteric fistula (AEF) was detected. Positive microbiologic cultures were found in 20 patients (76.9%). More than 1 infectious agent was found in 6 cases (19.2%). EVAR infection treatment was conservative in 4 cases, endovascular in 2. Endograft excision was performed in 10 cases by conventional treatment (aortic stump + extra-anatomic bypass) and in 10 cases by in situ reconstruction (cryopreserved allograft or rifampin-soaked silver Dacron graft). A 30-day mortality was 38.4% (10 of 26 cases), 3 patients died from 2 to 24 months after infection treatment, accounting for a mean time from infection treatment to death of 1.25 ± 0.62 months. Mortality rates were 50% in all treatment groups. In those survived (13 of 26 cases) recurrence-free follow-up after infection treatment was 27.9 ± 22.4 months (range, 2–74). Four patients with AEF died in the first month after treatment (66.6%). Suprarenal endografts required supraceliac aortic cross-clamping for removal. Supraceliac cross-clamping was burdened by higher mortality rates than infrarenal cross-clamping (71.4% vs. 30.7%).

Conclusions

EVAR infection diagnosis is burdened by extremely high mortality rates. Prospective registries could help monitoring outcomes in EVAR infection patients and, possibly, developing new surveillance protocols in patients at high risk of recurrence.