Percutaneous Drainage for Aortic Graft Infection Post-aneurysm Repair: A Viable Option?

Abstract

Purpose Non-operative management of aortic graft infection is usually only considered in a palliative context. We describe the safety, efficacy, and clinical outcomes of percutaneous drainage of aortic graft infections (AGI) following either open or endovascular repair of aneurysmal disease. Methods Twelve consecutive patients (11 males, 1 female, mean age 72.7 ± 10.3 years, age range 52-88 years) between January 2010-July 2020 who underwent percutaneous drain insertion in either an infected aortic sac or periaortic abscess cavity following endovascular or open surgical graft repair were identified. Patient and procedural characteristics as well as clinical outcomes were determined. Results Of the 12 patients who underwent percutaneous drain insertion, five (41.7%) had undergone open abdominal aneurysm repair, one (8.3%) open thoracoabdominal aneurysmal repair, and six (50%) endovascular abdominal aneurysm repairs. Drain size ranged from 10-20 French. All were inserted under ultrasound (US), computed tomography (CT), and/or fluoroscopic guidance. Median duration of drain placement was 55.2 days (range 3-174). Five patients (41.7%) had the drain in place as a stabilizing bridge until or after definitive surgical explantation and aortic reconstruction. Seven patients (58.3%) were managed with drain placement and antibiotic therapy without surgical intervention. Six (50%) were alive at the most recent time of follow-up (median, 732 days, range 166-1650 days). Three patients (25%) died during follow-up with causes including erosion of aortic reconstruction into sigmoid colon, unrelated chronic obstructive pulmonary disease exacerbation, and severe clostridium difficile colitis and pseudomonal pneumonia (median 1244 days, range 992-1597 days). Three (25%) patients were lost to follow-up. No drain-related complications were noted. Conclusion Percutaneous drainage of AGI following endovascular or open aneurysm repair is a safe and viable management option either as a temporizing measure as a bridge to surgical graft explantation or as a non-surgical therapy for long term management.

Presentation and management of delayed aortic endograft infection

“…Our findings are consistent with a recently published case series of 12 patients who underwent percutaneous drain insertion for aortic graft infection 26. Median duration of drain placement was 55.2 days, and six (50%) patients were alive at most recent follow-up (median 732 days) 26.…”

“…Three patients were lost to follow-up 26. Our case supports the authors’ conclusions that percutaneous draining of aortic graft infection is a safe and viable management option 26. This is particularly true for patients at prohibitive surgical risk, as suggested by Society for Vascular Surgery guidelines 27.…”

“…Three patients died during follow-up, and only one death was aortic related. Three patients were lost to follow-up 26. Our case supports the authors’ conclusions that percutaneous draining of aortic graft infection is a safe and viable management option 26.…”