Management of Endograft Infection after Thoracic Endovascular Aortic Repair

Endograft infections following thoracic endovascular treatment are rare but associated with high morbidity and mortality. This study describes our experience with the surgical management of infections involving descending thoracic and thoracoabdominal aorta. The study retrospectively reviewed patients who underwent open descending thoracic and thoracoabdominal aortic aneurysm repair between January 1991 and March 2025, including cases of stent graft infections and secondary aortobronchial or aortoenteric fistula. Perioperative characteristics, operative outcomes and overall survival were evaluated. Of 2220 patients who underwent descending thoracic and thoracoabdominal aortic aneurysm repair, 20 patients (0.9%) received surgical treatment for endograft infections: 8 with endograft infection; 7 with aortoesophageal fistula; and 5 with aortobronchial fistula. The extent of repair involved the descending thoracic aneurysm in 18 patients (90%), and thoracoabdominal aortic aneurysm in 2 patients (10%). Endograft explantation and in-situ aortic reconstruction were performed in 19 patients (95%) while flap reconstruction was utilized in 16 patients (80%). Operative mortality was 6 patients (30%). Postoperative stroke occurred in 1 patient (5%) and temporary paraparesis also occurred in 1 patient (5%). Overall survival was 43.5% at 1 year and 36.3% at 5 years. Management of endograft infection involving the descending thoracic and thoracoabdominal aortic aneurysm remains challenging. Surgical repair, including endograft explantation, in-situ reconstruction, and flap installation, yielded acceptable mortality and morbidity rates in this high-risk patient population.