PMID- 38163582
OWN - NLM
STAT- MEDLINE
DCOM- 20240325
LR  - 20240325
IS  - 1615-5947 (Electronic)
IS  - 0890-5096 (Linking)
VI  - 101
DP  - 2024 Apr
TI  - A Comparison of Surgical Techniques and Outcomes for Primary Infected Abdominal 
      Aortic Aneurysms.
PG  - 209-218
LID - S0890-5096(23)00862-2 [pii]
LID - 10.1016/j.avsg.2023.11.021 [doi]
AB  - BACKGROUND: Primary infected abdominal aortic aneurysms (PIAAAs) are associated 
      with high morbidity and mortality. Three repair approaches include open in-situ 
      repair (OIR), extra-anatomic repair (EAR), and endovascular abdominal aortic 
      aneurysm repair (EVAR). This study is one of the largest single-center case 
      series comparing the outcomes of the different surgical approaches for PIAAA. 
      METHODS: This is a retrospective cohort study of all patients treated surgically 
      for PIAAA between 2000 and 2021. PIAAA diagnosis was defined as the presence of 
      an abdominal aortic aneurysm with evidence of infection on clinical presentation, 
      laboratory markers, radiology, or surgically. Patients with prior aortic surgery 
      were excluded from this study. Basic demographics were compared across the 3 
      surgical groups using standard statistical methods. Our primary outcomes included 
      mortality at 1 and 5 years. Kaplan-Meier curves were generated and compared using 
      log-rank testing. Multivariate Cox proportional hazards models were created to 
      assess determinants of mortality. RESULTS: A total of 43 patients were included 
      in the full cohort. Patients undergoing EVAR more often had diabetes, end-stage 
      renal disease, and coronary artery disease. EVAR was also more often done in 
      patients with a saccular aneurysm rather than fusiform. (93% vs. 70% in EAR and 
      42% in OIR; P = 0.015). All-cause mortality rates at 1 year were not 
      significantly different between the 3 groups. Survival at 5 years did show a 
      significant benefit of OIR over EVAR and EAR: OIR had an 8% mortality rate with 
      EAR having a 53% rate and EVAR having the highest (72%) mortality rate at 5 years 
      (P = 0.03). Multivariable Cox regression analysis showed that EVAR (aHR 12.1, 
      (95% CI 1.42 to 103.9), P = 0.02) and EAR (aHR 15.1, (95% CI 1.59 to 143.3), 
      P = 0.0.02) had an increased 5-year mortality risk when compared to OIR. 
      CONCLUSIONS: Repair of primary infected aortic aneurysm is associated with high 
      complication and mortality rates regardless of the approach. In our studied 
      sample, OIR offered an improved long-term survival without added benefits in 
      terms of complication rates. In infected AAA, EVAR should be considered bridging 
      stage between the urgent situation and eventual open repair.
CI  - Copyright (c) 2023. Published by Elsevier Inc.
FAU - Semaan, Dana B
AU  - Semaan DB
AD  - Division of Vascular Surgery, UPMC, Pittsburgh, PA.
FAU - Habib, Salim G
AU  - Habib SG
AD  - Division of Vascular Surgery, UPMC, Pittsburgh, PA.
FAU - Madigan, Michael
AU  - Madigan M
AD  - Division of Vascular Surgery, UPMC, Pittsburgh, PA.
FAU - Eid, Raymond
AU  - Eid R
AD  - Division of Vascular Surgery, UPMC, Pittsburgh, PA.
FAU - Singh, Michael J
AU  - Singh MJ
AD  - Division of Vascular Surgery, UPMC, Pittsburgh, PA.
FAU - Chaer, Rabih A
AU  - Chaer RA
AD  - Division of Vascular Surgery, UPMC, Pittsburgh, PA.
FAU - Makaroun, Michel S
AU  - Makaroun MS
AD  - Division of Vascular Surgery, UPMC, Pittsburgh, PA.
FAU - Eslami, Mohammad H
AU  - Eslami MH
AD  - Division of Vascular and Endovascular Surgery, Charleston Area Medical Center, 
      Charleston, WV. Electronic address: mohammad.eslami@vandaliahealth.org.
LA  - eng
PT  - Journal Article
DEP - 20231230
PL  - Netherlands
TA  - Ann Vasc Surg
JT  - Annals of vascular surgery
JID - 8703941
SB  - IM
MH  - Humans
MH  - Retrospective Studies
MH  - *Endovascular Procedures
MH  - Treatment Outcome
MH  - *Aortic Aneurysm, Abdominal/diagnostic imaging/surgery/etiology
MH  - Aorta/surgery
MH  - Risk Factors
MH  - *Blood Vessel Prosthesis Implantation/adverse effects
MH  - Postoperative Complications/etiology
EDAT- 2024/01/02 11:42
MHDA- 2024/03/25 06:43
CRDT- 2024/01/01 19:14
PHST- 2023/07/21 00:00 [received]
PHST- 2023/10/28 00:00 [revised]
PHST- 2023/11/05 00:00 [accepted]
PHST- 2024/03/25 06:43 [medline]
PHST- 2024/01/02 11:42 [pubmed]
PHST- 2024/01/01 19:14 [entrez]
AID - S0890-5096(23)00862-2 [pii]
AID - 10.1016/j.avsg.2023.11.021 [doi]
PST - ppublish
SO  - Ann Vasc Surg. 2024 Apr;101:209-218. doi: 10.1016/j.avsg.2023.11.021. Epub 2023 
      Dec 30.