Endovascular Graft Infection: Preliminary Results of an International Enquiry

Abstract

Infected endovascular grafts are an urgent problem that has been heretofore underestimated and will probably increase as follow-up lengthens. New techniques should be sought to expedite the diagnosis, and an international registry should be set up to provide validated data.

Successful Management of an Infected Aortic Stent Graft in a Liver Transplanted Patient

“…It has been shown that operating rooms can provide more sterile conditions than radiologic suites. 10 Fiorani et al 9 detected that 62% of infected EVARs were placed in a radiologic suite, however, not showing to be statistically significant. Another potential reason for infection proposed by the literature was embolization of a type II endoleak via a lumbar artery by thrombin injection 14 months after primary operation.…”

“…It is widely known that the risk of an infection is apparently higher in patients who suffer from neoplastic disorders or who are receiving immunosuppressive therapy. 9 Fiorani et al 9 demonstrated an incidence of 22% of immunocompromised patients suffering from aortic graft infection in their collective. As it is mentioned previously, our patient was receiving immunosuppressive medication at the time of infection.…”

“…Fiorani et al 9 conducted an international register for infected EVARs and compared possible treatment options. They concluded that the in situ reconstruction, which includes explantation of the infected stent graft and the reconstruction with a surgical graft, is superior to other procedures in terms of patient survival.…”

“…Several treatment strategies of an infected EVAR have been described: in situ replacement with synthetic aortic grafts or autologous vascular grafts, extra-anatomic reconstruction and stent explantation, or a conservative treatment with antibiotics and abscess drainage. 9 To our knowledge, there are no current data on mortality and morbidity of infected EVARs in liver transplanted patients. We report a case of the successful management of an infected EVAR after liver transplantation.…”

“…5 In addition, previous publications have also shown that patients after liver transplantation are at major risk to develop life-threatening infections associated with high mortality. 6e8 In a large register from Fiorani et al 9 of infected EVARs in nontransplanted patients, a mean frequency of endograft infection of 0.4% and an overall patient mortality of 27.4% have been described. Several treatment strategies of an infected EVAR have been described: in situ replacement with synthetic aortic grafts or autologous vascular grafts, extra-anatomic reconstruction and stent explantation, or a conservative treatment with antibiotics and abscess drainage.…”