Paolo Perini, Marjan Wouthuyzen-Bakker, Oliver T Lyons, Ivika Heinola, Alexandra Catasta, Anne Lejay
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Fifty four were case reports and case series (215 patients) describing SAT infections following surgery. Among these, 11 studies with 149 patients who initially underwent carotid endarterectomy (CEA) with patch closure were included in the meta-analysis. The estimated infection rate after CEA with patch closure was 0.7% (95% confidence interval [CI] 0.4 - 0.9%). Surgical treatment was mostly based on complete removal of the infected material and in situ arterial reconstruction (82.2%, 95% CI 71.4 - 92.9%). Post-operative complications occurred in 25.9% (95% CI 16 - 35.9%). Cranial nerve injury occurred in 12.5% (95% CI 5.7 - 19.4%), with 28.4% (95% CI 5.2 - 57.4%) of these being permanent. Re-infections during a mean follow up of 37.7 months occurred in 3.4% of patients. Seventeen studies were case reports documenting SAT infections in 21 patients following endovascular treatment. Stent explantation was performed in 18 of 21 cases. A reconstruction to restore SAT flow was performed in 11 of 18 cases. GRADE analysis determined the certainty of evidence for all outcomes to be very low.</p><p><strong>Conclusion: </strong>Vascular graft and stent infections in the SAT are uncommon. The preferred treatment was removal of the infected graft and autologous reconstruction. Alternatives included drainage, stent relining, and antibiotics. Cranial nerve injuries were common, with one third resulting in permanent damage.</p>","PeriodicalId":55160,"journal":{"name":"European Journal of Vascular and Endovascular Surgery","volume":" ","pages":""},"PeriodicalIF":5.7000,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Systematic Review and Meta-analysis of Occurrence Rate, Treatments, and Outcomes of Vascular Graft and Stent Infections in the Supra-aortic Trunks.\",\"authors\":\"Paolo Perini, Marjan Wouthuyzen-Bakker, Oliver T Lyons, Ivika Heinola, Alexandra Catasta, Anne Lejay\",\"doi\":\"10.1016/j.ejvs.2025.05.006\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>This study aimed to systematically review and synthesise the available evidence on the management of vascular graft and stent infections in the supra-aortic trunks (SATs).</p><p><strong>Data sources: </strong>MEDLINE, Scopus, Cochrane databases, and citation searching.</p><p><strong>Review methods: </strong>All study designs (case reports and series, cohort studies, and trials) addressing treatments for post-operative infections of prosthetic vascular grafts and stents in the SAT were included. GRADE methodology was used to assess the certainty of evidence.</p><p><strong>Results: </strong>Seventy one studies were included in this systematic review. Fifty four were case reports and case series (215 patients) describing SAT infections following surgery. Among these, 11 studies with 149 patients who initially underwent carotid endarterectomy (CEA) with patch closure were included in the meta-analysis. The estimated infection rate after CEA with patch closure was 0.7% (95% confidence interval [CI] 0.4 - 0.9%). Surgical treatment was mostly based on complete removal of the infected material and in situ arterial reconstruction (82.2%, 95% CI 71.4 - 92.9%). Post-operative complications occurred in 25.9% (95% CI 16 - 35.9%). Cranial nerve injury occurred in 12.5% (95% CI 5.7 - 19.4%), with 28.4% (95% CI 5.2 - 57.4%) of these being permanent. Re-infections during a mean follow up of 37.7 months occurred in 3.4% of patients. 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引用次数: 0
摘要
目的：本研究旨在系统回顾和综合有关主动脉上干（SATs）血管移植和支架感染处理的现有证据。数据来源：MEDLINE， Scopus， Cochrane数据库，引文检索。回顾方法：所有的研究设计（病例报告和系列，队列研究和试验）都包括在SAT中处理假血管移植物和支架术后感染的方法。采用GRADE方法评估证据的确定性。结果：本系统综述纳入了71项研究。54例病例报告和病例系列（215例患者）描述手术后SAT感染。其中，11项研究纳入了149例最初接受颈动脉内膜切除术（CEA）贴片闭合的患者。CEA贴片闭合后的估计感染率为0.7%（95%可信区间[CI] 0.4 - 0.9%）。手术治疗主要基于完全去除感染材料和原位动脉重建（82.2%,95% CI 71.4 - 92.9%）。术后并发症发生率为25.9% （95% CI 16 - 35.9%）。脑神经损伤发生率为12.5% (95% CI 5.7 - 19.4%)，其中28.4% （95% CI 5.2 - 57.4%）为永久性损伤。在平均37.7个月的随访期间，3.4%的患者再次感染。17项研究记录了21例血管内治疗后的SAT感染病例。21例患者中18例行支架植入术。18例中有11例进行了重建以恢复SAT血流。GRADE分析确定所有结果的证据确定性都很低。结论：血管移植和支架感染在SAT是罕见的。首选的治疗方法是去除感染的移植物和自体重建。其他选择包括引流、支架内衬和抗生素。脑神经损伤是常见的，三分之一导致永久性损伤。
Systematic Review and Meta-analysis of Occurrence Rate, Treatments, and Outcomes of Vascular Graft and Stent Infections in the Supra-aortic Trunks.
Objective: This study aimed to systematically review and synthesise the available evidence on the management of vascular graft and stent infections in the supra-aortic trunks (SATs).
Data sources: MEDLINE, Scopus, Cochrane databases, and citation searching.
Review methods: All study designs (case reports and series, cohort studies, and trials) addressing treatments for post-operative infections of prosthetic vascular grafts and stents in the SAT were included. GRADE methodology was used to assess the certainty of evidence.
Results: Seventy one studies were included in this systematic review. Fifty four were case reports and case series (215 patients) describing SAT infections following surgery. Among these, 11 studies with 149 patients who initially underwent carotid endarterectomy (CEA) with patch closure were included in the meta-analysis. The estimated infection rate after CEA with patch closure was 0.7% (95% confidence interval [CI] 0.4 - 0.9%). Surgical treatment was mostly based on complete removal of the infected material and in situ arterial reconstruction (82.2%, 95% CI 71.4 - 92.9%). Post-operative complications occurred in 25.9% (95% CI 16 - 35.9%). Cranial nerve injury occurred in 12.5% (95% CI 5.7 - 19.4%), with 28.4% (95% CI 5.2 - 57.4%) of these being permanent. Re-infections during a mean follow up of 37.7 months occurred in 3.4% of patients. Seventeen studies were case reports documenting SAT infections in 21 patients following endovascular treatment. Stent explantation was performed in 18 of 21 cases. A reconstruction to restore SAT flow was performed in 11 of 18 cases. GRADE analysis determined the certainty of evidence for all outcomes to be very low.
Conclusion: Vascular graft and stent infections in the SAT are uncommon. The preferred treatment was removal of the infected graft and autologous reconstruction. Alternatives included drainage, stent relining, and antibiotics. Cranial nerve injuries were common, with one third resulting in permanent damage.
期刊介绍：
The European Journal of Vascular and Endovascular Surgery is aimed primarily at vascular surgeons dealing with patients with arterial, venous and lymphatic diseases. Contributions are included on the diagnosis, investigation and management of these vascular disorders. Papers that consider the technical aspects of vascular surgery are encouraged, and the journal includes invited state-of-the-art articles.
Reflecting the increasing importance of endovascular techniques in the management of vascular diseases and the value of closer collaboration between the vascular surgeon and the vascular radiologist, the journal has now extended its scope to encompass the growing number of contributions from this exciting field. Articles describing endovascular method and their critical evaluation are included, as well as reports on the emerging technology associated with this field.
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