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Article ; Online: Expanding superior mesenteric artery pseudoaneurysm.

Cirillo-Penn, Nolan C / Colglazier, Jill J

2023 Volume 78, Issue 1, Page(s) 230

MeSH term(s)	Humans ; Mesenteric Artery, Superior/diagnostic imaging ; Mesenteric Artery, Superior/surgery ; Aneurysm, False/diagnostic imaging ; Aneurysm, False/surgery ; Abdomen ; Stents
Language	English
Publishing date	2023-06-20
Publishing country	United States
Document type	Journal Article
ZDB-ID	605700-7
ISSN	1097-6809 ; 0741-5214
ISSN (online)	1097-6809
ISSN	0741-5214
DOI	10.1016/j.jvs.2022.10.004
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Article: Thirty-three-year-old man with circumflex aorta and 4-cm right subclavian artery aneurysm.

Colglazier, Jill J / Kenyon, Bianca / Danduch, Eduardo / Pochettino, Alberto

Journal of vascular surgery cases and innovative techniques

2022 Volume 8, Issue 4, Page(s) 569

Language	English
Publishing date	2022-08-23
Publishing country	United States
Document type	Journal Article
ISSN	2468-4287
ISSN	2468-4287
DOI	10.1016/j.jvscit.2022.08.005
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Article: Open repair of symptomatic superior mesenteric artery dissection.

Cirillo-Penn, Nolan C / Lima, Guilherme B B / Colglazier, Jill J / Mendes, Bernardo C

Journal of vascular surgery cases and innovative techniques

2023 Volume 9, Issue 3, Page(s) 101255

Language	English
Publishing date	2023-07-04
Publishing country	United States
Document type	Journal Article
ISSN	2468-4287
ISSN	2468-4287
DOI	10.1016/j.jvscit.2023.101255
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Article ; Online: Incidence, reintervention, and survival associated with type II endoleak at hospital discharge after elective endovascular aneurysm repair in the Vascular Quality Initiative.

DeMartino, Randall R / Breite, Matthew D / Neal, Dan / Mendes, Bernardo C / Colglazier, Jill J / Stone, David H / Scali, Salvatore T

Journal of vascular surgery

2023 Volume 78, Issue 3, Page(s) 679–686.e1

Abstract: Background: The longitudinal clinical significance of type II endoleaks (T2ELs) remains controversial. Specifically, the real-world incidence, need for reintervention, and associated mortality referable to T2ELs remain unknown. Moreover, current ... ...

Abstract	Background: The longitudinal clinical significance of type II endoleaks (T2ELs) remains controversial. Specifically, the real-world incidence, need for reintervention, and associated mortality referable to T2ELs remain unknown. Moreover, current professional society clinical practice guidelines recommend differing aneurysm sac growth thresholds to prompt intervention. Therefore, the purpose of this analysis was to better quantify the prevalence of early T2ELs after infrarenal endovascular aortic aneurysm repair (EVAR) and determine its association with reintervention and survival. Methods: All elective EVARs from the Vascular Quality Initiative (2010-2020) were examined to identify patients with isolated T2ELs vs no endoleak (NONE) at discharge. Procedures with a type I or III endoleak were excluded. A subgroup analysis was performed on patients surviving beyond the first postoperative year with follow-up data available on endoleaks. The primary outcome was overall survival. Secondary outcomes included perioperative mortality and reinterventions. Outcomes were assessed by multivariable logistic and Cox proportional hazards regression to adjust for covariates. Results: We identified 53,697 patients who underwent EVAR. The overall incidence of isolated T2ELs at discharge was 16%. In-hospital mortality was lower for those with isolated T2ELs vs NONE (0.8% vs 1.9%, odds ratio: 0.6, 95% confidence interval: 0.5-0.8, P < .0001). Unadjusted overall survival was marginally higher at 5 years for patients with T2ELs vs NONE (84% vs 82%); however, after risk adjustment, survival was similar (hazard ratio: 0.95, 95% confidence interval: 0.9-1.0). Among 44,345 patients with 1-year follow-up, 66% had data on endoleak status for assessment. Survival was similar regardless of endoleak status (NONE, at discharge only, at follow-up only, or at both time points). Among patients with documented T2ELs during follow-up, 6.1% and 2.5% had abdominal aortic aneurysm sac diameter growth ≥5 mm and ≥10 mm, respectively. Reinterventions occurred in 12%. Rupture (1%) and any open reintervention (4%) were rare among patients with 1-year follow-up. For patients with T2ELs, 5-year survival was similar between those with and without reintervention by 1 year (89% vs 91%, log-rank P = .06). Conclusions: T2ELs remain common after EVAR within the Vascular Quality Initiative and are not associated with long-term mortality. Reinterventions for T2ELs were not associated with improved overall survival among patients with T2ELs. Although additional data surrounding the appropriate role of reintervention for T2ELs remain necessary, it appears that the natural history of T2ELs is benign.
MeSH term(s)	Humans ; Aortic Aneurysm, Abdominal/diagnostic imaging ; Aortic Aneurysm, Abdominal/surgery ; Aortic Aneurysm, Abdominal/complications ; Endovascular Aneurysm Repair ; Incidence ; Patient Discharge ; Treatment Outcome ; Blood Vessel Prosthesis Implantation ; Risk Factors ; Endovascular Procedures ; Endoleak/diagnostic imaging ; Endoleak/epidemiology ; Endoleak/etiology ; Hospitals ; Retrospective Studies
Language	English
Publishing date	2023-05-29
Publishing country	United States
Document type	Journal Article
ZDB-ID	605700-7
ISSN	1097-6809 ; 0741-5214
ISSN (online)	1097-6809
ISSN	0741-5214
DOI	10.1016/j.jvs.2023.05.041
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Article ; Online: Characterization and surgical management of aberrant subclavian arteries.

Tallarita, Tiziano / Rogers, Richard T / Bower, Thomas C / Stone, William / Farres, Houssam / Money, Samuel R / Colglazier, Jill J

Journal of vascular surgery

2022 Volume 77, Issue 4, Page(s) 1006–1015

Abstract: Objective: Aberrant subclavian arteries (aSCAs), with or without aortic pathology, are uncommon. The purpose of the present study was to review our experience with the surgical management of aSCA.: Methods: We performed a retrospective review of ... ...

Abstract	Objective: Aberrant subclavian arteries (aSCAs), with or without aortic pathology, are uncommon. The purpose of the present study was to review our experience with the surgical management of aSCA. Methods: We performed a retrospective review of patients who had undergone surgery for an aSCA between 1996 and 2020. Symptomatic and asymptomatic patients were included. The primary end points were ≤30-day and late mortality. The secondary end points were ≤30-day complications, graft patency, and reinterventions. Results: A total of 46 symptomatic and 3 asymptomatic patients with aSCA had undergone surgery (31 females [62%]; median age, 45 years). An aberrant right subclavian artery was present in 38 (78%) and an aberrant left subclavian artery in 11 patients (22%). Of the 49 patients, 41 (84%) had had a Kommerell diverticulum (KD) and 11 (22%) had had a concomitant distal arch or proximal descending thoracic aortic aneurysm. Symptoms included dysphagia (56%), dyspnea (27%), odynophagia (20%), and upper extremity exertional fatigue (16%). Five patients (10%) had required emergency surgery. The aSCA had been treated by transposition in 32, a carotid to subclavian bypass in 11, and an ascending aorta to subclavian bypass in 6. The KD was treated by resection and oversewing in 19 patients (39%). Fifteen patients (31%) had required distal arch or proximal descending thoracic aortic replacement for concomitant aortic disease and/or KD treatment. Thoracic endovascular aortic repair was used to exclude the KD in six patients (12%). Seven patients (14%) had undergone only bypass or transposition. The 30-day complications included one death from pulseless electrical activity arrest secondary to massive pulmonary embolism. The 30-day major complications (14%) included acute respiratory failure in three, early mortality in one, stroke in one, non-ST-elevation myocardial infarction in one, and temporary dialysis in one patient. The other complications included chylothorax/lymphocele (n = 5; 10%), acute kidney injury (n = 2; 4%), pneumonia (n = 2; 4%), wound infection (n = 2; 4%), atrial fibrillation (n = 2; 4%), Horner syndrome (n = 2; 4%), lower extremity acute limb ischemia (n = 1; 2%), and left recurrent laryngeal nerve injury (n = 1; 2%). At a median follow-up of 53 months (range, 1-230 months), 40 patients (82%) had had complete symptom relief and 9 (18%) had experienced improvement. Six patients had died at a median of 157 months; the deaths were not procedure or aortic related. The primary patency was 98%. Reintervention at ≤30 days had been required for two patients (4%) for ligation of lymphatic vessels and bilateral lower extremity fasciotomy after proximal descending thoracic aorta replacement. One patient had required late explantation of an infected and occluded carotid to subclavian bypass graft, which was treated by cryopreserved allograft replacement. Conclusions: Surgical treatment of the aSCA can be accomplished with low major morbidity and mortality with excellent primary patency and symptom relief.
MeSH term(s)	Female ; Humans ; Middle Aged ; Aorta/surgery ; Aorta, Thoracic/surgery ; Aortic Aneurysm, Thoracic/surgery ; Aortic Diseases/diagnostic imaging ; Aortic Diseases/surgery ; Aortic Diseases/complications ; Blood Vessel Prosthesis Implantation/adverse effects ; Cardiovascular Abnormalities/complications ; Cardiovascular Abnormalities/diagnostic imaging ; Cardiovascular Abnormalities/surgery ; Endovascular Procedures/adverse effects ; Retrospective Studies ; Subclavian Artery/diagnostic imaging ; Subclavian Artery/surgery ; Treatment Outcome
Language	English
Publishing date	2022-12-21
Publishing country	United States
Document type	Journal Article
ZDB-ID	605700-7
ISSN	1097-6809 ; 0741-5214
ISSN (online)	1097-6809
ISSN	0741-5214
DOI	10.1016/j.jvs.2022.12.018
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Implications and Late Outcomes of Type II Endoleaks After Endovascular Aneurysm Repair.

Cifuentes, Sebastian / Tabiei, Armin / Mendes, Bernardo C / Cirillo-Penn, Nolan C / Rodrigues, Diego V S / Colglazier, Jill J / Rasmussen, Todd E / Shuja, Fahad / Kalra, Manju / Schaller, Melinda S / Morrison, Jonathan J / Vierkant, Robert A / DeMartino, Randall R

Journal of vascular surgery

2024

Abstract: Objective: Type II endoleaks (T2EL) are the most common cause of reintervention after endovascular aneurysm repair (EVAR). While most resolve spontaneously, the long-term implications of T2EL remain elusive. We aim to evaluate the impact of persistent ... ...

Abstract	Objective: Type II endoleaks (T2EL) are the most common cause of reintervention after endovascular aneurysm repair (EVAR). While most resolve spontaneously, the long-term implications of T2EL remain elusive. We aim to evaluate the impact of persistent and late T2EL on clinical outcomes after EVAR. Methods: Single institution retrospective review of patients who underwent EVAR for degenerative infrarenal abdominal aortic aneurysm between January 2010 and June 2022 with no Type I (T1EL) or III (T3EL) endoleak seen at EVAR completion. Patients were categorized based on T2EL status. Group 1 included patients with never detected or transient T2EL (detected at EVAR completion but not after). Group 2 encompassed persistent T2EL (seen at EVAR completion and again during follow-up) and late T2EL (detected for the first time at any point during follow-up). Time-to-event analysis was conducted using a time-dependent approach to T2EL status. Primary outcomes included freedom from sac enlargement (SE), aneurysm-related reinterventions, and overall survival. Results: 803 patients met inclusion criteria. Group 1 included 418 patients (52%), of which 85% had no T2EL and 15% had transient T2EL. Group 2 had 385 patients; 23% had persistent T2EL, and 77% developed a new T2EL. Patients in group 1 had a higher prevalence of smoking (88% vs. 83%; p<0.001), COPD (33% vs. 25%; p=0.008), chronic kidney disease (13% vs. 8%; p=0.021) and a higher mean SVS score (7 vs. 6 points; p=0.049). No differences were found in aneurysm diameter or morphology. Mean follow-up was 5 years for the entire cohort. In Group 2, 58 patients (15%) underwent T2EL treatment, most commonly transarterial embolization. At 10 years after EVAR, Group 2 was associated with lower freedom from SE (p<0.001) and AAA-related reinterventions (p<0.001) and comparable overall survival (p=0.42). More T1EL were detected during follow-up in Group 2 (6 [1%] vs. 20 [5%]; p=0.004), with 15 (75%) of these detected at a median of 3 years after the T2EL. No difference between groups was observed in explant (0.7% vs. 2.1%; p=0.130) or aneurysm rupture (0.5% vs. 1.3%; p=0.269) rates. Conclusion: One-half of patients treated with infrarenal EVAR developed persistent/late T2ELs, which are associated with a higher risk of sac enlargement and reinterventions. No difference in overall survival or aneurysm rupture risk was seen at 10 years, based on T2EL status or T2EL intervention. A conservative approach to T2EL may be appropriate for most patients with absent T1EL or T3EL.
Language	English
Publishing date	2024-04-23
Publishing country	United States
Document type	Journal Article
ZDB-ID	605700-7
ISSN	1097-6809 ; 0741-5214
ISSN (online)	1097-6809
ISSN	0741-5214
DOI	10.1016/j.jvs.2024.03.457
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Article ; Online: Cryopreserved Arterial Allografts Versus Rifampin-Soaked Dacron for the Treatment of Infected Aortic and Iliac Aneurysms.

Tabiei, Armin / Cifuentes, Sebastian / Kalra, Manju / Colglazier, Jill J / Mendes, Bernardo C / Schaller, Melinda S / Shuja, Fahad / Rasmussen, Todd E / DeMartino, Randall R

Annals of vascular surgery

2023 Volume 97, Page(s) 49–58

Abstract: Background: Infected aortic and iliac artery aneurysms are challenging to treat. Cryopreserved arterial allografts (CAAs) or rifampin-soaked Dacron (RSD) are standard options for in situ reconstruction. Our aim was to compare the safety and ... ...

Abstract	Background: Infected aortic and iliac artery aneurysms are challenging to treat. Cryopreserved arterial allografts (CAAs) or rifampin-soaked Dacron (RSD) are standard options for in situ reconstruction. Our aim was to compare the safety and effectiveness of CAA versus RSD for these complex pathologies. Methods: This is a retrospective review of infected iliac, abdominal, and thoracoabdominal aortic aneurysms treated with either CAAs or RSD between 2002 and 2022 at our institution. The diagnosis was confirmed by intraoperative, radiologic, or microbiological evidence of aortic infection. Perioperative events, 30-day and long-term mortality, reinfection, and reintervention were analyzed. Results: Thirty patients (17 CAA, 13 RSD) with a mean age of 61 and 68 years, respectively, were identified. The infected aneurysm was most commonly suprarenal or infrarenal. Culture-negative infections were present in 47% of the CAA group and 54% in the RSD group. Early major morbidity was 57% and 54% for the CAA and RSD, respectively. Thirty-day mortality was similar between groups (18% vs. 23% CAA vs. RSD, P ≥ 0.99). Median follow-up was longer in the RSD group (14.5 months vs. 13 months). Overall survival at 1 and 5 years was 80.8% and 64.8% in the CAA group and 69.2% and 57.7% in the RSD group. Reinterventions only occurred with CAA repairs and indications included graft occlusion (2), multiple pseudoaneurysms and reinfection (1), and hemorrhagic shock caused by graft rupture (1). Freedom from reintervention at 1 and 3 years was 87.5% and 79.5% (CAA group) versus 100% and 100% (RSD, P = 0.06). Freedom from reinfection at 1 year was 100% in both groups, while at 3 years it was 90.9% for the CAA group and 100% for the RSD group (P = 0.39). Conclusions: Infected aortic and iliac aneurysms have high early morbidity and mortality. CAA and RSD had similar outcomes in our series; CAA trended toward higher reintervention rates. Both remain viable options for complex scenarios but require close surveillance.
MeSH term(s)	Humans ; Middle Aged ; Aged ; Rifampin/adverse effects ; Iliac Aneurysm/diagnostic imaging ; Iliac Aneurysm/surgery ; Polyethylene Terephthalates ; Blood Vessel Prosthesis ; Blood Vessel Prosthesis Implantation/adverse effects ; Reinfection ; Treatment Outcome ; Risk Factors ; Allografts/surgery ; Retrospective Studies ; Aortic Aneurysm, Abdominal/surgery
Chemical Substances	Rifampin (VJT6J7R4TR) ; Polyethylene Terephthalates
Language	English
Publishing date	2023-04-29
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	1027366-9
ISSN	1615-5947 ; 0890-5096
ISSN (online)	1615-5947
ISSN	0890-5096
DOI	10.1016/j.avsg.2023.04.015
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Zs.A 2882: Show issues

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Article ; Online: The USMLE® STEP 1 Pass or Fail Era of the Vascular Surgery Residency Application Process: Implications for Structural Bias and Recommendations.

Alnahhal, Khaled I / Lyden, Sean P / Caputo, Francis J / Sorour, Ahmed A / Rowe, Vincent L / Colglazier, Jill J / Smith, Brigitte K / Shames, Murray L / Kirksey, Lee

Annals of vascular surgery

2023 Volume 94, Page(s) 195–204

Abstract: United States Medical Licensing Examination® (USMLE®) STEP 1 score reporting has been changed to a binary pass/fail format since January 26, 2022. The motives behind this change were (1) the questionable validity of using USMLE STEP 1 as a screening tool ...

Abstract	United States Medical Licensing Examination® (USMLE®) STEP 1 score reporting has been changed to a binary pass/fail format since January 26, 2022. The motives behind this change were (1) the questionable validity of using USMLE STEP 1 as a screening tool during the candidate selection process and (2) the negative impact of using standardized examination scores as an initial gatekeeping threshold for the underrepresented in medicine (URiM) candidates applying to graduate medical education programs, given their generally lower mean standardized exams scores compared to non-URiM students. The USMLE administrators justified this change as a tactic to enhance the overall educational experience for all students and to increase the representation of URiM groups. Moreover, they advised the program directors (PDs) to give more attention to other important qualities and components such as the applicant's personality traits, leadership roles and other extracurricular accomplishments, as part of a holistic evaluation strategy. At this early stage, it is unclear how this change will impact Vascular Surgery Integrated residency (VSIR) programs. Several questions are outstanding, most importantly, how VSIR PDs will evaluate applicants absent the variable which heretofore was the primary screening tool. Our previously published survey showed that VSIR PDs will move their attention to other measures such as USMLE STEP 2 Clinical Knowledge (CK) and letters of recommendation during the VSIR selection process. Furthermore, more emphasis on subjective measures such as the applicant's medical school rank and extracurricular student activities is expected. Given the expected higher weight of USMLE STEP 2CK in the selection process than ever, many anticipate that medical students will dedicate more of their limited time to its preparation at the expense of both clinical and nonclinical activities. Potentially leaving less time to explore specialty pathways and to determine whether Vascular Surgeons is the appropriate career for them. The critical juncture in the VSIR candidate evaluation paradigm presents an opportunity to thoughtfully transform the process via current (Standardized Letter of Recommendation, USMLE STEP 2CK, and clinical research) and future (Emotional Intelligence, Structure Interview and Personality Assessment) measures which constitute a framework to follow in the USMLE STEP 1 pass/fail era.
MeSH term(s)	Humans ; United States ; Internship and Residency ; Treatment Outcome ; Educational Measurement ; Students, Medical ; Vascular Surgical Procedures
Language	English
Publishing date	2023-04-28
Publishing country	Netherlands
Document type	Journal Article ; Review
ZDB-ID	1027366-9
ISSN	1615-5947 ; 0890-5096
ISSN (online)	1615-5947
ISSN	0890-5096
DOI	10.1016/j.avsg.2023.04.018
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Article ; Online: Outcomes of lower extremity arterial bypass using the Human Acellular Vessel in patients with chronic limb-threatening ischemia.

Cifuentes, Sebastian / Sen, Indrani / Shuja, Fahad / Mendes, Bernardo C / Colglazier, Jill J / Schaller, Melinda S / Kalra, Manju / Morrison, Jonathan J / DeMartino, Randall R / Rasmussen, Todd E

Journal of vascular surgery

2023 Volume 79, Issue 2, Page(s) 348–357.e2

Abstract: Objective: Patients with chronic limb-threatening ischemia (CLTI) and no great saphenous vein to use as a conduit for arterial bypass have a high risk for amputation despite advances in medical and endovascular therapies. This report presents findings ... ...

Abstract	Objective: Patients with chronic limb-threatening ischemia (CLTI) and no great saphenous vein to use as a conduit for arterial bypass have a high risk for amputation despite advances in medical and endovascular therapies. This report presents findings from a U.S. Food and Drug Administration (FDA) supported study of the Human Acellular Vessel (HAV) (Humacyte Inc.) used as a conduit for arterial bypass in patients with CLTI and inadequate or absent autologous conduit. Methods: The HAV is a 6-mm, 40-cm vessel created from human vascular smooth muscle cells seeded onto a polyglycolic acid scaffold pulsed in a bioreactor for 8 weeks as cells proliferate and the scaffold dissolves. The resultant vessel is decellularized, creating a nonimmunogenic conduit composed of collagen, elastin, and extracellular matrix. The FDA issued an Investigational New Drug for an intermediate-sized, single-center study of the HAV under the agency's Expanded Access Program in patients with advanced CLTI and inadequate or absent autologous conduit. Technical results and clinical outcomes were analyzed and reported. Results: Between March 2021 and July 2023, 29 patients (20 males; mean age, 71 ± 11 years) underwent limb salvage operation using the HAV as a bypass conduit. Most patients had advanced CLTI (Rutherford class 5/6 in 72%; wound, ischemia, and foot infection stage 3/4 in 83%), and 97% had previously failed revascularization(s) of the extremity. Two HAVs were sewn together to attain the needed bypass length in 24 patients (83%). Bypasses were to tibial arteries in 23 patients (79%) and to the popliteal artery in 6 (21%). Technical success was 100%, and the 30-day mortality rate was 7% (2 patients). With 100% follow-up (median, 9.3 months), the limb salvage rate was 86% (25/29 patients). There were 16 reinterventions to restore secondary patency, of which 15 (94%) were successful. Primary and secondary patency of the HAV at 9 months were 59% and 71%, respectively. Conclusions: The HAV has demonstrated short- to intermediate-term safety and efficacy as an arterial bypass conduit in a complex cohort of patients with limb-threatening ischemia and no autologous options. This experience using the FDA's Expanded Access Program provides real-world data to inform regulatory deliberations and future trials of the HAV, including the study of the vessel as a first-line bypass conduit in less severe cases of chronic limb ischemia.
MeSH term(s)	Male ; Humans ; Middle Aged ; Aged ; Aged, 80 and over ; Chronic Limb-Threatening Ischemia ; Blood Vessel Prosthesis Implantation/adverse effects ; Vascular Patency ; Treatment Outcome ; Peripheral Arterial Disease/diagnostic imaging ; Peripheral Arterial Disease/surgery ; Risk Factors ; Lower Extremity/blood supply ; Ischemia/diagnostic imaging ; Ischemia/surgery ; Limb Salvage/methods ; Retrospective Studies
Language	English
Publishing date	2023-10-26
Publishing country	United States
Document type	Journal Article
ZDB-ID	605700-7
ISSN	1097-6809 ; 0741-5214
ISSN (online)	1097-6809
ISSN	0741-5214
DOI	10.1016/j.jvs.2023.10.040
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Article ; Online: Cryopreserved arterial allografts vs rifampin-soaked Dacron for the treatment of infected aortic and iliac grafts.

Tabiei, Armin / Cifuentes, Sebastian / Glasgow, Amy E / Colglazier, Jill J / Kalra, Manju / Mendes, Bernardo C / Rasmussen, Todd E / Shuja, Fahad / DeMartino, Randall R

Journal of vascular surgery

2023 Volume 78, Issue 4, Page(s) 1064–1073.e1

Abstract: Objective: Aortic and iliac graft infections remain complex clinical problems with high mortality and morbidity. Cryopreserved arterial allografts (CAAs) and rifampin-soaked Dacron (RSD) are options for in situ reconstruction. This study aimed to ... ...

Abstract	Objective: Aortic and iliac graft infections remain complex clinical problems with high mortality and morbidity. Cryopreserved arterial allografts (CAAs) and rifampin-soaked Dacron (RSD) are options for in situ reconstruction. This study aimed to compare the safety and effectiveness of CAA vs RSD in this setting. Methods: Data from patients with aortic and iliac graft infections undergoing in situ reconstruction with either CAA or RSD from January 2002 through August 2022 were retrospectively analyzed. Our primary outcomes were freedom from graft-related reintervention and freedom from reinfection. Secondary outcomes included comparing trends in the use of CAA and RSD at our institution, overall survival, perioperative mortality, and major morbidity. Results: A total of 149 patients (80 RSD, 69 CAA) with a mean age of 68.9 and 69.1 years, respectively, were included. Endovascular stent grafts were infected in 60 patients (41 CAA group and 19 RSD group; P ≤ .01). Graft-enteric fistulas were more common in the RSD group (48.8% RSD vs 29.0% CAA; P ≤ .01). Management included complete resection of the infected graft (85.5% CAA vs 57.5% RSD; P ≤ .01) and aortic reconstructions were covered in omentum in 57 (87.7%) and 63 (84.0%) patients in the CAA and RSD group, respectively (P = .55). Thirty-day/in-hospital mortality was similar between the groups (7.5% RSD vs 7.2% CAA; P = 1.00). One early graft-related death occurred on postoperative day 4 due to CAA rupture and hemorrhagic shock. Median follow-up was 20.5 and 21.5 months in the CAA and RSD groups, respectively. Overall post-discharge survival at 5 years was similar, at 59.2% in the RSD group and 59.0% in the CAA group (P = .80). Freedom from graft-related reintervention at 1 and 5 years was 81.3% and 66.2% (CAA) vs 95.6% and 92.5% (RSD; P = .02). Indications for reintervention in the CAA group included stenosis (n = 5), pseudoaneurysm (n = 2), reinfection (n = 2), occlusion (n = 2), rupture (n = 1), and graft-limb kinking (n = 1). In the RSD group, indications included reinfection (n = 3), occlusion (n = 1), endoleak (n = 1), omental coverage (n = 1), and rupture (n = 1). Freedom from reinfection at 1 and 5 years was 98.3% and 94.9% (CAA) vs 92.5% and 87.2% (RSD; P = .11). Two (2.9%) and three patients (3.8%) in the CAA and RSD group, respectively, required graft explantation due to reinfection. Conclusions: Aorto-iliac graft infections can be managed safely with either CAA or RSD in selected patients for in situ reconstruction. However, reintervention was more common with CAA use. Freedom from reinfection rates in the RSD group was lower, but this was not statistically significant. Conduit choice is associated with long-term surveillance needs and reinterventions.
MeSH term(s)	Humans ; Aged ; Rifampin/adverse effects ; Polyethylene Terephthalates ; Blood Vessel Prosthesis/adverse effects ; Blood Vessel Prosthesis Implantation/adverse effects ; Reinfection ; Retrospective Studies ; Aftercare ; Prosthesis-Related Infections/diagnosis ; Prosthesis-Related Infections/surgery ; Treatment Outcome ; Patient Discharge ; Risk Factors ; Allografts/surgery
Chemical Substances	Rifampin (VJT6J7R4TR) ; Polyethylene Terephthalates
Language	English
Publishing date	2023-06-17
Publishing country	United States
Document type	Journal Article
ZDB-ID	605700-7
ISSN	1097-6809 ; 0741-5214
ISSN (online)	1097-6809
ISSN	0741-5214
DOI	10.1016/j.jvs.2023.05.048
Database	MEDical Literature Analysis and Retrieval System OnLINE

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