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Objectives: EVAR failure requiring total device explant or complete relining are more morbid than routine endovascular interventions. We review our experience with the treatment of persistent endoleaks and EVAR infection requiring complete graft relining or open aortic intervention.
Methods: We conducted a retrospective review of all patients with the diagnostic code endoleak or infected endograft for the time period between January 2008-May 2015. All procedures as well as entire hospital courses and any documented follow up were captured and analyzed.
Results: Sixty-four patients had a persistent endoleak or infection that required one of the following procedures: open aortic repair(n = 21), endograft explant(n = 30), AUI stent-grafting with a cross femoral-femoral bypass(n = 20), or complete endovascular graft relining(n = 2). Average age of patients at presentation was 77.3 years with an average time to diagnosis of 5.12 years. When documented, the original type of endograft significantly affected both the time to presentation (P = < .0001) and diagnosis (P = .0005). AneuRx stent grafts accounted for 54% of all proximal migration diagnoses, while 36% of grafts treated for infection where Gore Excluder endografts. Ninety percent of the cohort had any kind of endoleak at presentation with (30% having greater than 1 endoleak source), 17% presented with an infection involving the endograft, and 9% had both an endoleak and infection at presentation. The average length of stay (LOS) for open aortic exposure versus EVAR relining was 16.8 and 7.8 days respectively. The mean follow time was 1.5 years, and there was a 57% complication rate (69% for open aortic patients and 31% for relining patients). There were 9 deaths, 79% occurring in the open aortic patients versus 22% in relining patients. LOS was significantly affected by the patient’s primary diagnosis (P = .0289) and primary procedure performed (P = .0357), with significantly increased LOS for those with infection and open aortic exposure (24.5 and 16.8 days respectively versus aggregate average of 14.2 days; P = .0019).
Conclusions: Salvage procedures for persistent endoleaks or EVAR infection can be performed albeit with a high complication rate. A high level of scrutiny should be employed in the management of these cases, with aggressive endovascular approaches utilized for endoleaks. Infected endografts continue to remain a morbid complication.