IF04. A Multicenter Experience With Infected Abdominal Aortic Endograft Explantation

Abstract

Endovascular abdominal endografts (EVAR) are widely used with excellent results, but infectious complications can be devastating, we report here a multicenter experience with infected EVARs, symptoms, options for explantation and their outcome. A retrospective analysis of all EVAR explants for infection from 1998 to 2015 at 11 French University centers was performed. Diagnosis of infected endograft (i-endograft) was made on clinical findings, cultures, imaging studies, and intraoperative findings at explantation. Thirty-three patients with an i-endograft were identified with a median age of 69 years (range 57-87 years). In this group, at index EVAR, four patients (12%) presented with a groin infection and six patients (18%) presented a general infection with bacteriemia in relation with a central venous catheter (n = 3), prostatitis (n = 1), cholecystitis (n = 1), and pneumonia (n = 1). After index EVAR, eight patients underwent successful inferior mesenteric artery embolization for a type II endoleak, and one patient received an additional stent for a type I B endoleak. Median time from EVAR to presentation was 414 days. The most common presenting characteristics were pain and fever in 21 patients (64%) and fever alone in seven patients (21%), which were present an average of 31 days before explantation. Seven types of different endografts were explanted. Three patients (9%) were treated in emergency. All patients underwent total i-endograft explantation, with bowel resection in 13 patients (39%) with an aortoenteric fistula. Methods of reconstruction were in situ in 30 patients and extra-anatomic in three. In situ conduits were aortic cryopreserved allografts in 23, polyester silver graft (Maquet) in 5, and femoral vein in 2. Thirty-seven organisms were found in 24 patients (73%) with a positive culture. Gram-positive organisms were the most common found in 18 (55%). The average number of organisms per patient with a positive culture was 1.5. Antimicrobial therapy consisted of 16 different antibiotics; 29 patients (88%) received two or more antibiotics. Early mortality (30 days or in-hospital) was 39% (n = 13) in relation with graft blow-out (n = 3), multiple organ failure (n = 6), colon necrosis (n = 3), and peripheral embolism (n = 1). At 13-month median follow-up (range, 1-75 months), patient survival, graft-related complications, and reinfection rates were 39%, 10%, and 5%, respectively. Abdominal aortic endograft explantation for infection is high risk. Further studies are needed to understand the risk factors and the preventive measures at index EVAR and during follow-up.TableCauses of death at 30 days or in-hospital after removal of the infected endograftCauses of deathPatients, No.Time, daysNew graft rupture32, 20, 40 Allograft22, 20 Autogenous vein140Sepsis (multiple organ failure)a62, 2, 12, 15, 45, 56Colon necrosisb35, 5, 15Lower limb ischemiac130aTwo reoperations for recurrent aortic sepsis.bThree colectomies.cBilateral trash foot, patient refused major amputation. Open table in a new tab