Addressing Endograft Infection After EVAR

Although rare, endograft infection is a severe complication of endovascular aneurysm repair (EVAR), usually requiring open endograft explantation and aortic reconstruction. This single-center retrospective series analyzed 9 consecutive patients who underwent EVAR explantation for infection from 2004 to 2023.

EVAR infection was diagnosed a median of 10 months (IQR: 3.25-21.5 months) after EVAR implantation. Eight patients underwent in situ reconstruction with physician-made bovine pericardial grafts, and in 1 patient, a silver-impregnated prosthetic graft was used. Two patients died within 30 days. One aortic reintervention was necessary owing to bleeding. Median follow-up was 10.5 months (IQR: 5-54 months). Two patients died during follow-up, but there were no aortic-related complications except for 1 reinfection in the patient who had been treated with a silver-impregnated prosthetic graft.

Despite the relevant perioperative morbidity and mortality associated with EVAR infection, endograft explantation and in situ reconstruction with preferably bovine pericardial grafts may offer definitive treatment of infection, with promising mid- and long-term results.