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Predicting Infection-Related Complications after Endovascular Repair of Infective Native Aortic Aneurysms

Published:November 03, 2022DOI:https://doi.org/10.1016/j.ejvs.2022.11.003
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      Abstract

      Background

      Endovascular aortic repair (EVAR) as surgical treatment for infective native aortic aneurysm (INAA) is associated with superior survival compared with open surgery, but with risk of infection-related complication (IRC). This study aimed to assess the association between baseline clinical and CT features and the risk of postoperative IRCs in patients treated with EVAR for INAA, and develop a model to predict long-term IRC in patients with abdominal INAA treated with EVAR.

      Methods

      All initial clinical details and CT examinations of INAAs between 2005 and 2020 at a major referral hospital were retrospectively reviewed. The images were scrutinised according to aneurysm features, as well as periaortic and surrounding organ involvement. Data on postoperative IRC were found in the patient records. Cox regression model was used to derive predictors for IRC and develop a model to predict 5-year IRCs after EVAR in abdominal INAA.

      Results

      Out of 3780 patients with the diagnosis of aortic aneurysm or aortitis, 98 (3%) patients were treated with EVAR for abdominal INAAs and were thus included. The mean follow-up time was 52 months (range 0‒163). The mean transaxial diameters were 6.5 ± 2.4 cm (range 2.1‒14.7). In the enrolled patients, 38 (39%) presented with rupture. The rate of 5-year IRC in abdominal INAA was 26%. Female sex, renal insufficiency, positive blood culture, aneurysm diameter, and psoas muscle involvement were predictive for 5-year IRC in abdominal INAA after EVAR. The model had c-index of 0.76 (95%CI 0.66-0.87).

      Conclusion

      Preoperative clinical and CT features have the potential to predict IRC after endovascular aortic repair in INAA patients. These findings stress the importance of rigorous clinical, laboratory, and radiological follow-up in these patients.

      Keywords

      Abbreviations:

      INAA (infective native aortic aneurysm), IRC (infection-related complication), CT (computed tomography), MDCT (multidetector computed tomography), EVAR (endovascular aortic repair), TEVAR (thoracic endovascular aortic repair), OSR (open surgical repair), VGEI (vascular graft/endograft infection), MAGIC (management of aortic graft infection collaboration), SD (standard deviation), HR (hazard ratio), CI (confidence interval)
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