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- Title
251SURGICAL STRATEGY FOR AORTIC INFECTION.
- Authors
Yamanaka, K.; Matsumori, M.; Omura, A.; Miyahara, S.; Sakamoto, T.; Inoue, T.; Okada, K.; Okita, Y.
- Abstract
Objectives: To report our surgical experience with aortic infection.Methods: From 1999 to 2012, 69 patients underwent surgical treatment for aortic infection, including aortobronchial fistula in 12, aorto-oesophageal fistula in 13 and aortoduodenal fistula in four. The location of infection was root to aortic arch in 22, descending aorta in 28, thoracoabdominal aorta in 12, and abdominal aorta in seven. Forty-seven patients had infections of the native aorta and 22 patients had postoperative graft infections. In situ replacement (bridge thoracic endovascular aortic repair [TEVAR] to open repair; n = 1) was done in 44, endovascular aortic repair in 18, and extra-anatomical bypass (bridge TEVAR; n = 2) in seven. Omental flap installation was done in 28; pedicled muscle flap was used in seven (latissmus dorsi 6, major pectoralis 1).Results: Hospital mortality was 17.4%. Overall survival at three years was 59.6 ± 6.7%. Freedom from infection-related death of patients who had in situ replacement, endovascular repair and extra-anatomical bypass at three years was 83.2 ± 6.6%, 75.2 ± 10.9% and 16.7 ± 15.2%, respectively (P < 0.01). In situ replacement provided a better freedom from reintervention at three years compared with endovascular repair (83.4 ± 5.7% and 58.9 ± 12.2%, P = 0.03). Complete resection of all infected tissues, abscess, surrounding aneurysmal wall and oesophagus provided higher freedom from infection-related death at three years than incomplete resection (83.6 ± 5.7% vs 56.7 ± 11.8%, P < 0.05).Conclusions: Surgical treatment for aorta-related infection still has high mortality and morbidity. However, aggressive surgical strategy, including resection of all infected tissues, in situ replacement of the aorta and omental or muscle installation provided a better survival.
- Publication
Interactive Cardiovascular & Thoracic Surgery, 2013, Vol 17, Issue suppl_2, pS130
- ISSN
1569-9293
- Publication type
Article
- DOI
10.1093/icvts/ivt372.251