Long-term outcomes of neoaortoiliac system for treatment of aortic graft infection
Bibliographic record
Abstract
Objective The aim of this study was to evaluate this center's experience with treatment of aortic graft infection using neoaortoiliac system (NAIS) in situ reconstruction with a focus on long-term outcomes to better understand the optimal management of this devastating complication and add to limited existing research. Methods A retrospective chart review over 10 years (2012-2022) of patients who underwent graft explant with simultaneous NAIS for aortic graft infection. Short- and long-term outcomes were collected within 30 days and 5 years of the operation, respectively. Outcomes were compared based on operative microbiology results. Results Twenty-three patients were included, with an average age of 63.1 years (standard deviation, 12.3 years). The most common index operation was aortobifemoral bypass (n = 11; 48%), followed by endovascular aneurysm repair (n = 9; 39%), tube graft (n = 2; 8.6%), and aortobifemoral-iliac bypass (n = 1; 3%). The average time to graft infection was 4.42 years. Sepsis was the most prevalent presenting complaint (n = 9; 39.1%), and almost three-quarters of the patients had positive preoperative blood cultures (n = 17; 73.9%). Operative cultures were positive in 74% and polymicrobial in 47.8%. There were zero intraoperative deaths, with a 30-day mortality of 21.7% (n = 5). Gram-negative or polymicrobial operative microbiology was associated with a significant increase in the composite short-term outcome of mortality, reoperation, and major adverse cardiac events with an odds ratio of 8.75 (95% confidence interval, 1.24-61.7). Average follow-up was 41.7 months, with a 5-year survival of 60.1% and reintervention rate of 41.1%. Primary and primary assisted patencies were 82.4% and 88.2%, respectively. There was no difference in survival found between patients with gram-negative or polymicrobial infections and those without. Conclusions The high perioperative mortality and low 5-year survival of the cohort are in keeping with prior literature. Patients with polymicrobial or gram-negative operative cultures had worse short-term outcomes, but long-term outcomes did not differ based on identified pathogen. Further research is needed to create a larger cohort of this rare procedure and to compare it with other reconstructive options for aortic graft infection.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".