P-037 - RESULTS OF SURGICAL REMOVAL OF INFECTED AORTIC GRAFTS AND STENT-GRAFTS AFTER TREATMENT OF INFRARENAL AORTIC ANEURYSMS

TOPIC:
Vascular Infection
AUTHORS:
Michel C. (Henri Mondor University Hospital ~ Créteil ~ France) , Oubaya N. (Henri Mondor University Hospital ~ Créteil ~ France) , Moubarak H. (Henri Mondor University Hospital ~ Créteil ~ France) , Rouard H. (Henri Mondor University Hospital ~ Créteil ~ France) , Cochennec F. (Pitié Salpêtrière University Hospital ~ Paris ~ France) , Desgranges P. (Henri Mondor University Hospital ~ Créteil ~ France) , Touma J. (Henri Mondor University Hospital ~ Créteil ~ France)
Introduction:
To compare the in-hospital mortality rate of the surgical management of endovascular graft infections (iEVAR) and aortic graft infections (iOAR), in patients initially treated for infra-renal aortic abdominal aneurysm.
Methods:
A retrospective monocentric review was conducted including consecutive patients with infra-renal iEVAR or iOAR, who underwent graft explantation and revascularization from September 2006 to December 2019. The surgical method always consisted of local debridement and in situ reconstruction using a cryopreserved aortic allograft. The primary outcome was the in-hospital mortality. Secondary outcomes were 30-day mortality, overall survival, postoperative morbidity and rate of secondary rupture of the vascular substitute. Survival rates were determined by the Kaplan-Meier method. Univariate analysis attempted to identify mortality predictors. A Propensity score was performed to cope with the initial EVAR vs OAR possible indication bias, and average treatment effect was estimated.
Results:
During the study period, 41 patients underwent explantation of an aortic graft infection (20 iEVAR cases and 21 iOAR cases) with in situ reconstruction. The graft-related early mortality rate was 48,7% (55% for iEVAR group and 43% for iOAR group (p=.43). Risk factors for in-hospital mortality were : Age > 65 years (OR 5.54 CI 95% 1.01 - 30.49),the presence of aorto-enteric fistula (OR 4.25 CI 95% 1.05 - 17.20), a short delay between the operative decision and removal of infected material (OR 0.04 CI 95% 0.00-0.5), the occurrence of postoperative revision (OR CI 9.6 95% 2.32-39.95), the number of postoperative revisions (for one revision, OR 11.2 CI 95% 1.73-72.3; for 2 revisions OR 6.40 CI 95% 0.89-45.99; for >2 revisions OR 12.80 CI 95% 1.15-142.58), the occurrence of major postoperative complication (OR 17.10 CI 95% 1.89-154.84). Based on the propensity score and the calculated average treatment effect, if all the patients had received EVAR, the proportion of in-hospital deaths would be increased by 0.20 [CI 95%: -0.09; 0.48] (p=.48).
Conclusion:
The EVAR infection does not appear to add excess mortality compared to infections of conventional grafts. This specific risk does not appear to be an initial decision-making criterion. With a propensity score taking into account the initial indication bias EVAR vs OAR, we show a strong but non-significant trend towards excess iEVAR mortality.