Primary Aortic Endograft Infections Have Worse Outcomes Compared to Infections Involving Aortic Surgical Grafts or Primary Mycotic Aortic Infections

Aortic infection is associated with high morbidity and mortality, but the outcomes of prosthetic (surgical or endovascular) grafts compared to primary aortic infections are poorly defined. This large single-center retrospective study aims compare graft infections. Patients diagnosed infected between January 2000 December 2022 were included. group based on type (primary, surgical endograft). Baseline demographics, symptoms, imaging, interventions, evaluated. Primary included overall reintervention-free survival. Kaplan-Meier survival Cox proportional hazards analysis performed. A total 145 patients presented during period native aorta (34.5%) (65.5%). characteristics treatments summarized in Table. In-hospital mortality (36.7% vs 15.4% 10%; P = .01) 30-day complication rates (67% 40% 38%; .03) highest among endografts, followed by grafts, lowest respectively. had 30-day, 1-year, 5-year endograft (Figure). Reintervention-free was also at 1 5 years (log-rank < .001), while no difference found 30 days. On multivariate analysis, endografts a significantly higher (hazard ratio [HR], 9.18; .015 HR 7.58; .02, respectively). Visceral artery involvement isolated groin did not influence any timepoint nor treatment (in situ repair extra-anatomical endovascular), gram-positive tissue cultures 1-year (HR, 17.6; .01 4.14; .004, respectively) when who growth cultures. There duration intravenous antibiotic groups (42 45 44 days; .84). Infected have lower short long-term independent as well rate intervention-free Gram positive intraoperative increased mortality. Predictors need be determined minimize complications careful consideration necessary before employing endovascular interventions if there concern an underlying mycotic process.TableBaseline presenting treatmentsPrimary infections, n 50 (34.5%)Surgical 65 (44.8%)Endografts, (20.7%)P valuePrior pathology Aneurysmal disease26 (40%)27 (90%)<.001 Occlusive disease8 (12%)1 (3%) Other (dissection)5 (8%)1 Unknown26 (40%)1 (3%)Visceral involvement8 (16.3%)5 (7.8%)3 (9.7).35Infected location Groin4 (6.3%)0 (0%).01 Abdomen38 (59.4%)28 (93.4%) Abdomen + groin15 (23.4%)1 (3.3%) Chest7 (10.9%)1 (3.3%)Age, mean (SD)64.9 (9.1)67.8 (10.9)73.1 (10.5).003Gender Male34 (68%)42 (65%)26 (87%).078 Female16 (32%)23 (35%)4 (13%)Race Non-Hispanic White44 (88%)61 (94%)24 (80%).059 Black5 (10%)1 (2%)2 (7%) Other1 (2%)3 (5%)4 (13%)History peripheral disease2 (4%)31 (48%)9 (30%)<.001Diabetes15 (30%)9 (14%)3 (10%).046End-stage renal disease4 (10%).13Hypertension36 (72%)48 (74%)19 (63%).56Coronary disease15 (30%)19 (29%)16 (53%).060Recent (3 weeks)24 (48%)15 (23%)6 (20%).007Recent surgery weeks)1 (2%)8 (12%)3 (10%).11Antibiotics presentation2 (4%)17 (26%)9 (30%).001Abdominal pain30 (60%)21 (32%)11 (37%).010Back pain26 (52%)6 (9%)10 (33%)<.001Groin symptoms0 (0%)15 (23%)2 (7%)<.001Fever2 (4%)8 (12%)10 (33%).002Rupture computed tomography26 (53%)3 (6%)3 (11%)<.001Surgical/tissue culture results Fungal0 (0%)2 (5%)1 (4%).015 negative4 (13%)9 (21%)1 (4%) positive10 (32%)7 (17%)9 (36%) Mixed0 (0%)7 (17%)6 (24%) No growth17 (55%)17 (40%)8 (32%)Blood (0%)1 (2%)0 (0%).017 (9%)2 (4%)2 positive15 (34%)5 (9%)6 (22%) growth25 (57%)47 (85%)19 (70%)Antibiotics given21 (42%)64 (98%)30 (100%)<.001Antibiotic duration, median (IQR), days42 (9, 96)45 (30, 61)44 (29, 52).84Intraoperative purulence noted0 (0%)27 (55%)25 (100%)<.00130-day complications19 (38%)26 (40%)20 (67%).02830-Day readmission12 (27%)11 (19%)3 (11%).29Treatment Open repair18 (36%)13 (20%)7 (23%).007 Extra-anatomical bypass15 (30%)31 (48%)16 (53%) Endovascular16 (32%)8 (13%)1 Medical0 (0%)5 (8%)3 (10%) Palliative0 (3%)1 (debridement)1 (2%)5 (8%)2 (8%)Recurrent infections3 (33.3%)6 (27.3%)1 (14.3%).6830-Day survival44 (89.8%)52 (89%)21 (66.7%).041-Year survival35 (73.3%)41 (69.1%)10 (36.7%)<.0015-Year survival20 (58.8%)22 (42.8%)10 (36.7%).0230-Day survival41 (83.7%)45 (61.4%)19 (62.7%).121-Year survival31 (65.1%)31 (52.3%)5 (20.7%)<.0015-Year survival16 (48.3%)15 (27.1%)2 (16.5%)<.001 table new tab