Clinical research study
A systematic review and meta-analysis of treatments for aortic graft infection

https://doi.org/10.1016/j.jvs.2006.02.053Get rights and content
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Objective

We compared pooled estimates of event rates for amputations, conduit failures, reinfections, early mortalities, and late mortalities in patients with aortic graft infection who were treated by extra-anatomic bypass, rifampicin-bonded prostheses, cryopreserved allografts, or autogenous veins.

Methods

A systematic review was conducted of English language reports in MEDLINE back to 1985 and a meta-analysis was performed on the results. Studies were selected on the basis of medical subject headings aortic, graft, and infection, and also by a standardized and independent quality rating. Inclusion and exclusion criteria were met by 37 clinical studies. Pooled estimates of mean event rates for amputations, conduit failures, reinfections, early (≤30 day) mortalities, and late (>30 days) mortalities were determined for each treatment modality. Tests of heterogeneity and sensitivity analyses were performed.

Results

Fixed effect analyses, derived after tests of heterogeneity, yielded overall pooled estimates of mean event rates for all outcomes combined of 0.16 for extra-anatomic bypass, 0.07 for rifampicin-bonded prostheses, 0.09 for cryopreserved allografts, and 0.10 for autogenous vein; a lower value signifies fewer overall events associated with the treatment modality. Overall, the robustness of our meta-analysis was demonstrated by the reasonable heterogeneity of pooled data from individual studies (Q statistic <25; P >.1 for all treatment outcomes across all modalities) and the limited variability of outcomes after sensitivity analyses.

Conclusion

Although limited by the design of individual published studies whose data were pooled together in this meta-analysis, our results lead to questions concerning whether extra-anatomic bypass should remain the gold standard for treatment of aortic graft infection.

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Competition of interest: Dr O’Connor is a former employee of InterVascular, a Datascope company, and is now employed by Cameron Health, San Clemente, Calif. Dr Batt has been paid a consulting fee by Datascope for lectures, and Dr Bequemin has been paid a consulting fee by Datascope for lectures and has also received a research grant for studies other than this one.

Additional material for this article may be found online at www.mosby.com/jvs

Additional material for this article may be found online at www.jvascsurg.org

CME article