Management of an Aortic Graft Infection after Endovascular Aneurysm Repair

Abstract

A 77-years-old hypertensive patient who underwent EVAR for an enlarging 7-cm Abdominal Aortic Aneurysm (AAA) Using a Lombard Aorfix Graft. Protective embolization of the patient inferior mesenteric artery.The post-operative CT Angiography confirmed a successful treatment of the aneurysm without need of further intervention. The patient attends for follow up controls afterward. Twenty-one months after the EVAR, the patient admitted due to abdominal pain and elevated infection parameters for further investigations.An abdominal CT scan is done and demonstrated a remarkable contrast enhancement of the aneurysm wall and periaortic fluid collections ( Figure 1). An empirical antibiotic therapy was started with Meropenem. The following days started the patients to develop high fever. The blood cultures revealed infection with Staphauereus; accordingly the antibiotic was changed to Linezolid.For both diagnostic and potentially therapeutic purposes, CT guided drainage of the periaortic fluid collections was done ( Figure 2).Two days later we decided to operate the patient. A complete surgical excision of the infected aortic stent was done. The intraoperative findings were remarkable for inflamed aneurysmal sac with thick purulent exudates surrounding the loosely incorporated graft (Figure 3). AbstractIntroduction: Endovascular Aneurysm Repair (EVAR) is currently considered the predominant treatment for Abdominal Aortic Aneurysm (AAAs), especially in a high-risk patient, providing a low early morbidity and mortality compared with open repair. A very low number of EVAR patients suffer complications, ranging from 0.7% related to local-vascular or implant-related complications to 11% for systemic complications. Endograft infection after EVAR represents one of the most serious complications. Although the incidence of Endograft infection is rare and below 1% it is often associated with high mortality and morbidity rates.The therapeutic options are limited and should be individualized based on patient's general condition and comorbidities. The common clinical presentations are acute or chronic sepsis. The treatment options of Endograft infections classified either to remove the graft and it is considered the gold Standard approach, or bridging therapy and conservative treatment for patients which not suitable for surgery. Till now there is no evidence to prove the superiority of a treatment method over the other.The in-situ arterial reconstruction is preferred because of the low mortality and morbidity rate in comparison with extra anatomical bypass like axillo-bifemoral bypass.We report a case of infected Aortic graft after EVAR. The sequence of events in this case sheds light upon the importance of synchronization between conservative treatment, endovascular intervention and surgical intervention to achieve better results in terms of mortality and morbidity. The patient provided written informed consent to the publication Objective: The sequence of events in this case report sheds light upon the importance of synchronization b...