title: Aortic Graft Infections after Emergency and Non-Emergency Reconstruction: Incidence, Treatment, and Long-Term Outcome.
abstract: BACKGROUND
  Aortic graft infections (AGI) are rare, with an incidence of 0.6%-3% among patients with aortic grafts. Most previous reports are based on single-center material with limited follow-up. Because of the paucity of these cases, the optimal treatment remains unclear. A factor possibly affecting the mortality rate of these infections is whether the index procedure was emergency or elective. The aim of this study was to investigate the incidence of AGI and assess the long-term outcome after emergency and non-emergency aortic reconstruction in a large population.
  
  
  METHODS
  A population-based, retrospective study was conducted of all patients treated with aortic reconstructive surgery at the two centers for vascular surgery in Stockholm County (population 2.2 million) during 2005-2015. Patients with AGI were identified by the in-hospital patient registry. Chart data on demographics, co-morbidity, index operation, type of infection, treatment, and outcome were analyzed.
  
  
  RESULTS
  Reconstructive aortic surgery was performed on 2,026 patients (open repair 47.7%; endovascular aortic repair 52.3%). The incidence of infection was 1.4% (29/2,026). The index operation was performed as an emergency in ten patients and non-emergency in 19. Median follow-up after the index operation was 69.2 months (interquartile range [IQR] 109.5). Patients having an emergency index procedure were older (77 vs. 69 y; p = 0.03). Time to infection was similar (30.2 ± 27.4 and 56.1 ± 51.2 mos; p = 0.21). The median time from diagnosis of AGI to surgery was 30 d (IQR 30.5 d). Infectious agents were identified in 76% of the cases. Of the conservatively treated patients, one was free of infection compared with three of the surgically treated. Conservatively treated patients had a higher graft-associated mortality rate of 57% compared with 25% of the surgically treated (p = 0.05).
  
  
  CONCLUSIONS
  This population-based study with long-term follow-up confirms the low incidence of AGI, 1.4%. The similar incidence in the emergency and non-emergency groups suggests that the index operation is not decisive in the development of AGI. The outcome of these infections generally is poor but is worse for non-surgically treated patients.
authors.affiliation: 1 Department of Molecular Medicine and Surgery, Södersjukhuset, Institution of Clinical Science and Education, Karolinska Institutet , Stockholm, Sweden .
authors.forename: Jennifer
authors.initials: J
authors.lastname: Pettersson
authors.affiliation: 1 Department of Molecular Medicine and Surgery, Södersjukhuset, Institution of Clinical Science and Education, Karolinska Institutet , Stockholm, Sweden .|2 Department of Vascular Surgery, Södersjukhuset, Institution of Clinical Science and Education, Karolinska Institutet , Stockholm, Sweden .
authors.forename: Alireza
authors.initials: A
authors.lastname: Daryapeyma
authors.affiliation: 1 Department of Molecular Medicine and Surgery, Södersjukhuset, Institution of Clinical Science and Education, Karolinska Institutet , Stockholm, Sweden .|3 Department of Section of Vascular Surgery, Department of Surgery, Södersjukhuset, Institution of Clinical Science and Education, Karolinska Institutet , Stockholm, Sweden .
authors.forename: Peter
authors.initials: P
authors.lastname: Gillgren
authors.affiliation: 1 Department of Molecular Medicine and Surgery, Södersjukhuset, Institution of Clinical Science and Education, Karolinska Institutet , Stockholm, Sweden .|2 Department of Vascular Surgery, Södersjukhuset, Institution of Clinical Science and Education, Karolinska Institutet , Stockholm, Sweden .
authors.forename: Rebecka
authors.initials: R
authors.lastname: Hultgren
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001018:Aortic Diseases / Q000601:surgery*; D004635:Emergency Medicine / Q000379:methods*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000453:epidemiology*; D016896:Treatment Outcome
keywords: abdominal aortic aneurysm; aortoiliac occlusive disease; graft infection