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- Title
Infrarenal Aortic Endograft Infection: A Single-Center Experience.
- Authors
Fernandez Prendes, Carlota; Riedemann Wistuba, Mariel; Zanabili Al-Sibbai, Ahmad Amer; Del Castro Madrazo, Jose Antonio; Santervas, Lino Antonio Camblor; Perez, Manuel Alonso
- Abstract
Purpose: Endograft infection is an infrequent but one of the most serious and challenging complications after endovascular aortic repair. The aim of this study was to assess the management of this complication in a tertiary center. Case Series: A retrospective analysis of a prospective database was performed including all patients who underwent elective endovascular abdominal aortic repair (EVAR) from 2003 to 2016 in a tertiary center. Seven cases of endograft infection were identified during the follow-up period from a total of 473 (1.48%) EVAR. Most frequent symptoms at presentation were fever (71.4%) and lumbar pain (57.1%). One case developed an early infection, while 6 cases were diagnosed as late infections. Mean time from endograft placement to symptom presentation was 28.3 months (2-91.5 months). Gram-positive cocci were the microorganisms most commonly isolated in blood cultures (66%). Two cases were managed with endograft removal and aortic reconstruction with a cryopreserved allograft, 2 cases with surgical drainage, and 2 cases exclusively with antibiotic therapy. In 1 case, the diagnosis was performed postoperatively based on intraoperative findings associated with positive graft cultures; and graft explantation was performed with "in situ" reconstruction using a Dacron graft. Perioperative mortality was 42.9%. One-year mortality was 57.1%. Mean follow-up was 21.5 months. Conclusion: Endograft explantation is the gold standard of treatment; however, given the overall high morbi–mortality rates of this pathology, a tailored approach should always be offered depending on the patient's overall condition. Conservative management can be an acceptable option in those patients with short life expectancy and high surgical risk.
- Subjects
ANTIBIOTICS; MORTALITY risk factors; ABDOMINAL aortic aneurysms; AGE factors in disease; BACKACHE; BLOOD; BLOOD vessel prosthesis; ENDOVASCULAR surgery; CELL culture; CRYOPRESERVATION of organs, tissues, etc.; FEVER; GRAFT rejection; GRAM-positive bacteria; HOMOGRAFTS; PATIENT aftercare; INFECTION; LONGITUDINAL method; COMPLICATIONS of prosthesis; ELECTIVE surgery; SURGICAL therapeutics; RETROSPECTIVE studies; MEDICAL drainage; TERTIARY care; DELAYED onset of disease; DIAGNOSIS
- Publication
Vascular & Endovascular Surgery, 2019, Vol 53, Issue 2, p132
- ISSN
1538-5744
- Publication type
Article
- DOI
10.1177/1538574418813606