Two-Decade Single-Center Experience with Graft Infections After Infrarenal Endovascular Aortic Repair

Area of Science:

• Vascular Surgery
• Infectious Disease Management
• Biomaterials in Reconstruction

Background:

• Endovascular Aneurysm Repair (EVAR) is a common procedure for abdominal aortic aneurysms.
• Graft infections following EVAR are a serious complication requiring effective treatment strategies.
• A single institution has utilized graft explantation and in situ biological reconstruction for 20 years.

Purpose of the Study:

• To determine the incidence of EVAR graft infections.
• To evaluate the outcomes of treating EVAR graft infections with explantation and in situ biological reconstruction.
• To compare survival and reinfection rates between different treatment modalities.

Main Methods:

• Retrospective analysis of a prospective vascular surgery database (2000-2022).
• Identification and review of post-EVAR infections.
• Comparison of outcomes including mortality, survival, freedom from reinfection, and reintervention.

Main Results:

• A cumulative EVAR graft infection rate of 1.7% was observed in 1,274 patients.
• Graft explantation and in situ biological reconstruction (n=22) showed improved 3-year survival (68.2%) compared to conservative treatment (22.2%).
• No reinfections or late graft reinterventions occurred in patients treated with biological reconstructions.

Conclusions:

• EVAR graft explantation with in situ biological reconstruction is a viable treatment for EVAR infections.
• This approach provides a durable and infection-resistant solution.
• Biological reconstruction significantly improves patient survival following EVAR infection.