Endograft Infections after Complex Endovascular Aortic Repair

Area of Science:

• Vascular Surgery
• Infectious Diseases
• Medical Device Complications

Background:

• Aortic endograft infection (AeGI) is a rare but serious complication of complex endovascular aortic repair (cEVAR).
• Existing data on AeGI incidence, risk factors, and outcomes are limited due to small case series.

Purpose of the Study:

• To determine the incidence and risk factors for AeGI following cEVAR.
• To describe treatment strategies and outcomes for AeGI in a high-volume aortic center.

Main Methods:

• Retrospective analysis of patients undergoing cEVAR with fenestrated or branched endografts (September 2010 - May 2024).
• AeGI diagnosis based on Management of Aortic Graft Infection Collaboration (MAGIC) criteria.
• Multivariable Cox regression used to identify risk factors; outcomes included incidence, microbiology, treatment, survival, and infection status.

Main Results:

• 19 cases of AeGI occurred among 527 patients (542 cEVARs); 5-year incidence was 3.87%.
• Independent risk factors for AeGI included primary infected aortic pathology (MAA) and late aortic re-interventions.
• Secondary fistula formation (32% of cases) was associated with significantly poorer survival (4.0 vs. 41.5 months).

Conclusions:

• AeGI after cEVAR is more frequent than previously reported.
• MAA and late re-interventions are significant risk factors for AeGI.
• Endograft-preserving strategies, including antimicrobial therapy and debridement, can achieve remission in selected patients without fistula, improving survival.