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Master Thesis

Évaluation de la morbi-mortalité des infections prothétiques vasculaires aortiques : impact de la prise en charge pluridisciplinaire

Abstract : Introduction: Aortic Graft Infections (AGI) are a rare and serious complication of vascular surgery. The aim of our study was to evaluate the consequences of changes in care management on morbidity, mortality and reinfection, and to identify an adapted surgical strategy for each patient. Material and methods: Patients with AGI sent to Bordeaux University Hospital from January 2004 to April 2011 ("P1" period) and from May 2011 to August 2014 ("P2" period) were included retrospectively. The measures enforced were: seniorisation of the interventions, multidisciplinary meetings, an empiric antibiotic therapy protocol and the use of sonication. Results: 66 patients (64 men, mean age 64 years) were included: 31 in P1 and 35 in P2. Patients were comparable in terms of comorbidities. During P2, there have been more total explantation (68.6% vs 51.7%) and allograft revascularization (0 vs 36.3%). Comparing P1 and P2, in-hospital mortality rates were 32 3% vs 31.4%, re-infection rates were 47.6% with a follow up of 3.6 years vs 8.3% with a follow-up of 1.1 years (median delay to reinfection was 10.5 months during P1), 2-years-survival rates were 80.7% vs 86.1%. Early-mortality rates were 38.4% in total explantation and 22.7% for partial removals. The reinfection rates were 33.3% for prosthetic revascularization vs 12.6% for revascularization and vein allografts. Conclusion: Processing AGI was improved by a multidisciplinary management. The partial removal and prosthetic replacement seem suitable for fragile patients, total explantation and non-prosthetic replacement are more suitable for younger patients. The future of AGI surgery will be strongly influenced by the development of aortic stents and only a multidisciplinary management will meet this surgical challenge.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-01212317
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Submitted on : Tuesday, October 6, 2015 - 2:23:40 PM
Last modification on : Friday, October 23, 2020 - 5:02:45 PM
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Aurélie Cluzeaud. Évaluation de la morbi-mortalité des infections prothétiques vasculaires aortiques : impact de la prise en charge pluridisciplinaire. Médecine humaine et pathologie. 2014. ⟨dumas-01212317⟩

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