Ann Surg Treat Res.  2023 Oct;105(4):207-218. 10.4174/astr.2023.105.4.207.

Clinical outcome of graft removal versus preservation in abdominal aortic graft infection: a systematic review and meta-analysis

• Kim H
• Choi HZ
• Kwon Y
• Labropoulos N

• KMID: 2546783
• DOI: http://doi.org/10.4174/astr.2023.105.4.207

Abstract

Purpose
The purpose of this study was to compare the clinical outcomes of abdominal aortic graft infection (AGI) treated with removal of the graft vs. graft preservation.
Methods
The electronic databases PubMed, Embase, and Cochrane Library for studies that reported on AGI were searched. Observational studies and case series of at least 10 cases that reporting on the prevalence, microbiology, and outcomes of AGI were included.
Results
Our search identified 23 studies that met our inclusion criteria, reporting on a total of 873 patients who underwent open surgical repair (OSR) or endovascular aneurysm repair (EVAR). Of these patients, 833 received graft removal, and 40 received graft preservation. The prevalence of AGI was reported to be 1.0% (95% confidence interval [CI], 0.5%–1.8%) after OSR and 0.4% (95% CI, 0%–1.1%) after EVAR. The pooled estimates of 1-year, 2-year, and 5-year mortality were 28.7% (95% CI, 19.4%–38.8%), 36.6% (95% CI, 24.6%–49.5%), and 51.8% (95% CI, 38.4%–65.1%) in the graft removal group and 16.1% (95% CI, 4.1%–32.2%), 18.5% (95% CI, 5.7%–35.1%), and 50.0% (95% CI, 31.6%–68.4%) in the graft preservation group. The 30-day mortality rate’s risk ratio (RR) for graft removal vs. preservation was 0.98 (95% CI, 0.40–2.38), while the 1-year mortality rate’s RR was 3.44 (95% CI, 1.60–7.42).
Conclusion
The 30-day mortality rate of AGI treatment was found to be high, whether using graft removal or preservation. In selected patients, implementing antibiotics with graft preservation as an initial management may be helpful in reducing the mortality rate.

Keyword

Prosthesis-related infection; Aortic aneurysm; Device removal; Treatment outcome

Figure

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  Fig. 1 Flow chart of the literature search for studies that reported mortality of treatment of aortic graft infection.

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  Fig. 2 Risk of bias graph (A) and summary (B) of included studies.

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  Fig. 3 Pooled estimate of prevalence of aortic graft infection after open surgical repair (OSR) or endovascular aneurysm repair (EVAR). IV, inverse variance; CI, confidence interval; df, degree of freedom.

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  Fig. 4 Relative risk of 30-day mortality (A) and 1-year mortality (B) of graft removal (experimental) vs. graft preservation (control) in patients with aortic graft infection. RR, risk ratio, CI, confidence interval.

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