Outcome after preservation of infected abdominal aortic endografts

Abstract

Purpose: To review the published outcomes of aortic endograft infection treated with preservation of the stent-graft.

Methods: An extensive electronic health database search was undertaken to identify all articles published up to May 2013 that reported endograft infection after endovascular aneurysm repair (EVAR) in which treatment included preservation of the stent-graft. The search found 17 articles with 29 patients (27 men; mean age 73.1±7.6 years) fulfilling the inclusion criteria.

Results: In 2 (7%) cases, the endograft infection was diagnosed within 30 days of the initial procedure; 4 (14%) were identified within 3 months and the remaining 23 (79%) within 12 months. Staphylococcus species, Streptococcus species, and Escherichia coli were the most common isolated microorganisms. Seven (24%) had a secondary aortoenteric fistula after EVAR. Twelve (41%) patients received only antibiotic therapy, while the remaining had an additional procedure (drainage, surgical debridement, sac irrigation, and/or omentoplasty). The in-hospital mortality was 21% (n=6). During a mean follow-up of 11.4±3.1 months, 7 more patients died (overall mortality 45%). None of the 7 patients with fistula survived. Half (50%) of the 12 patients who received only antibiotic therapy died, while 7 (41%) of the 17 patients who underwent an additional procedure died during follow-up.

Conclusion: Among patients treated for endograft infection without explantation, those with aortoenteric fistula had the worst outcome. There is evidence for lower mortality in patients who underwent an additional procedure, such as drainage, surgical debridement, and sac irrigation. Larger studies are needed to examine the efficacy of this approach compared to surgical conversion with endograft excision and in situ reconstruction or extra-anatomical bypass.

Keywords: ancillary procedures; antibiotics; aortoenteric fistula; endograft; endovascular aneurysm repair; infection; mortality; stent-graft; surgical conversion.