A Decade of the GSTT Aortic Infection Programme: A Description of a Clinical Management Algorithm by a Multidisciplinary Team

TL;DR

This paper describes a 10-year multidisciplinary approach to managing rare aortic infections, showing improved patient outcomes through a standardized algorithm.

Contribution

The paper introduces a comprehensive, standardized management algorithm for mycotic aortic aneurysm and aortic graft infection.

Findings

A multidisciplinary approach with a standardized algorithm improves decision-making and patient outcomes.

The service's growth and experience have led to consistent and timely management of complex aortic infections.

The algorithm provides a unified strategy for two distinct but related aortic pathologies.

Abstract

Background/Objectives: The management of mycotic aortic aneurysm and aortic graft infection is complex, and the pathology is rare. Over the past decade, we have developed a high-volume multidisciplinary service and comprehensive management algorithm. We intend to report on our experience and management strategy. Methods: We have examined the different aspects of the service, how it was developed, the standardisation of management, and its impact on consistent decision-making. Discussion: Low-volume, high-complexity pathologies are challenging and infrequently reported in the literature. The growth of our service and experience has improved outcomes and allowed for timely and consistent decision-making. We believe a central, multidisciplinary, standardised approach allows for prospective data collection and analysis. Although mycotic aortic aneurysm and aortic graft infection are discrete pathologies, our management algorithm and dedicated aortic infection service provides a comprehensive management strategy for both conditions. Conclusions: A comprehensive management algorithm has not previously been described by a tertiary centre. We have demonstrated that a unique multidisciplinary clinical approach and dedicated specialist service following a standardised management algorithm delivers superior patient outcomes. Whilst our basic management algorithm has remained largely intact over the years, we anticipate change in the future based upon emerging high-quality evidence and our own experience.

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