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

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 (Qstatistic < 25; P >. I 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.