Endografts for the treatment of aortic infection

Abstract

Aortic infection is an uncommon but life-threatening condition. Conservative medical treatment is insufficient in many cases because of the high risk of persistent infection, aortic rupture, and death. Conventional open surgical treatment consists of extensive tissue debridement, complete removal of the infected prosthetic material, and arterial reconstruction with anatomical or extra-anatomical bypass. This treatment is associated with significant morbidity and mortality; in order to avoid these, minimally invasive options with endovascular aneurysm repair have been attempted. Endovascular repair is minimally invasive and provides rapid aneurysm exclusion and prompt control of bleeding in the face of hemodynamic instability. Despite this, a major concern is the risk associated with endograft placement in an infected bed, leading to controversy about the wisdom of using endovascular aneurysm repair in this setting for mid- and long-term periods. The rate of recurrent infection is unclear because the majority of information exists in exceptional single cases or short-term series, while unsuccessful results with this approach are less likely to be reported. This review aims to assess the role of endovascular therapy for aortic infections, including its applicability as definitive or bridge repair in mycotic aneurysm, aortobronchial, aortoesophageal, and aortoenteric fistulas, in terms of both primary and secondary outcomes (ie, after previous open or endovascular aneurysm repair).