Abstract No. 42: Secondary Infection of Thoracic and Abdominal Aortic Endografts

Abstract

Thoracic and abdominal endovascular aneurysm repair (TEVAR and EVAR) have rapidly grown as less invasive alternatives to traditional open surgical repair of the diseased aorta. Secondary infections of indwelling prosthetic endografts is an infrequent occurrence, however the diagnosis and treatment of this problem can be daunting. Reviewed are several cases with respective outcomes. Single-center retrospective review of all secondary endograft infections from April 2002-September 2007. Data analysis includes chart review, procedural records, imaging, microbiology, and serologic information. From January 2000-September 2007, 389 EVARs and 105 TEVARs have been performed at the treating hospital. Among the 10 endograft infections identified (5 EVAR and 5 TEVAR), 4 were grafts placed at outside institutions and 6 were placed in-house. None were placed for a presumed pre-existing mycotic aneurysm. Mean time from index procedure to diagnosis of infection was 172.7 ± 70.9 days. Two EVAR patients presented with a contained rupture and the remaining 8 patients presented with constitutional symptoms and abscess formation on imaging studies. Microbiology cultures revealed Propionbacterium (n=2), Methicillin-resistant Staphylcoccus aureus (n=4), mixed gram-negative rods (n=1), Escheria coli (n=1), Coagulase-negative Staphylococcus aureas (n=1), Streptococcus pneumoniae (n=1). All EVAR patients underwent attempted removal of the infected endograft and reconstruction with extra-anatomic bypass (n=3), in situ homograft placement (n=1), and 1 intraoperative death. Only 1 TEVAR patient underwent removal and interposition grafting. The remaining 4 TEVAR patients were medically managed and 2 died of mycotic aneurysm rupture. Graft-related septic complications following TEVAR or EVAR are rare, but associated with significant mortality. Vigilance with regards to sterility and antibiotic prophylaxis during the index procedure is mandatory. Additionally, risk factors associated with secondary seeding of endografts are unknown. Guidelines for prophylactic antibiotics usage during subsequent invasive procedures need to be solidified.