Management von Stentprotheseninfektionen nach EVAR und TEVAR – Fallserie und Literaturübersicht

Abstract

Endograft infection after EVAR (Endovascular aortic repair) or TEVAR (Thoracic endovascular aortic repair) is a rare but severe complication with high mortality. As the number of patients with endovascular aneurysm repair has increased over the last decade, the number of patients with endograft infection might also have increased. However, no guideline defines the treatment of endograft infection. Diagnosis is difficult and depends on clinical symptoms, radiological imaging and blood cultures. Surgery with graft excision, debridement and revascularisation should be proposed. Several techniques and graft materials are used. Additionally long term antibiotic therapy under close control of inflammation markers is always required. We conducted a retrospective analysis of all patients treated for infected aortic endografts in our hospital between January 2008 and May 2017. Study endpoints were freedom from reinfection, survival and primary patency. An extensive electronic health database search was performed to identify articles reporting endograft infection after EVAR and TEVAR. We detected aortic endograft infection in three patients (100% male, median age 77 years). In all cases, infrarenal endovascular aortic aneurysm repair had been performed. The infected stent grafts were removed and anatomical revascularisation performed. One homograft and two xenografts were used as graft material. No patient was treated conservatively. A causative organism was found in 2 of the 3 cases. The patients received antibiotics for 12 weeks. Thirty day mortality was 0%. During follow-up, one patient died from bowel perforation after 2 months and another from lung cancer after 92 months. There were no reinfections. Primary patency of the reconstructions was 100%. Publications report high mortality after conservative therapy of endograft infection. There is evidence for lower mortality in patients who underwent surgery. Removal of the infected graft, anatomical revascularisation and antibiotic therapy are important for long term survival after aortic endograft infection. Conservative therapy is only warranted in patients unsuitable for surgical treatment.

A rare case of an infected aortoiliac graft complicated with Eggerthella lenta bacteremia and septic shock

“…Publications report high mortality after conservative therapy of endograft infection. There is evidence for lower mortality in patients who underwent surgery [ 6 , 9 ]. The gold standard for aortic endograft infection includes the excision of infected endograft, debridement, and reconstruction.…”

“…Low-grade infection sometimes requires nuclear medicine imaging to make a correct diagnosis [ 8 ]. As the number of patients with endovascular aneurysm repair has increased over the last decade, the number of patients with endograft infection might also have increased [ 9 , 10 ]. However, no guideline defines the treatment of endograft infection [ 9 ].…”