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Aortic Graft Infection After Fenestrated-branched Endovascular Aortic Aneurysm Repair
Andres V. Figueroa, Mira Tanenbaum, MD, Jose Eduardo Costa-Filho, MD, Marilisa Soto-Gonzalez, MD, Mirza Baig, MD, Carlos Timaran;
UT Southwestern, Dallas, TX, USA
OBJECTIVES: Fenestrated-branched endovascular aortic aneurysm repair (FBEVAR) is a treatment option for complex aortic aneurysms. Aortic graft infection (AGI) is a rare complication after endovascular repair. Endograft explantation is the definitive treatment, but it may be a formidable procedure after FBEVAR. The aim of this study was to assess the management and outcomes of AGI after FBEVAR.
METHODS: A retrospective study was performed of consecutive patients undergoing FBEVAR between 2015 and 2023 as part of a physician-sponsored investigational device exemption study. Primary endpoints were the occurrence of AGI, patient survival and adverse events.
RESULTS: A total of 406 patients underwent FBEVAR; mean follow-up period was 16.5±11.5 months. Six (1.5%) patients had AGI (84% female; mean age 71±7 years). Mean aortic aneurysm diameter was 63.7±23 mm. Custom-made and off-the-shelf endografts were used in 2 (33%) and 4 (67%) patients, respectively. Staged thoracic endovascular repair was performed in three (50%) patients. The average time interval between FBEVAR and AGI diagnosis was 11.2±10 months. Recurrent urinary tract infections were reported by 3 (50%) patients,
Salmonella bacteremia by 2 (30%) and Q fever by one (16%). Endograft explantation was performed in one patient (16%), who died on postoperative day 1 (Fig). Five (84%) patients were considered unfit for expantation and underwent conservative management with antibiotics. 30-day mortality after AGI diagnosis was 30%. Aortic sac enlargement and rupture after AGI occurred in two (30%) patients. Freedom from target vessel instability was 50%, and endoleaks occurred in 4 (66%) patients. Five (83%) patients died after the diagnosis of AGI. Mean survival time was 6±9 months. Aortic graft infection-related death occurred in 3 (60%) patients (Table 1).
CONCLUSIONS: Aortic graft infection is a rare and devastating complication after FBEVAR. Endograft explantation is a challenging repair with a high mortality after FBEVAR. Conservative management with lifetime antibiotics is the only treatment for unfit patients, but sac enlargement and rupture may limit its effectiveness.
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