Surgical management of infected thoracic endografts: A single-center experience

Thoracic endovascular aortic repair is the preferred approach for treating pathology of the descending thoracic aorta. Infection after thoracic endovascular aortic repair is reported to occur in less than 1% of patients and is associated with significant mortality. The purpose of the present study is to describe the surgical management and outcomes of patients who underwent explant of infected thoracic endovascular aortic repairs at our institution.

Patients with an infected thoracic endovascular aortic repair who underwent surgical management at our institution between January 2017 and June 2024 were included. Chart review was performed to identify comorbidities and operative variables including method of reconstruction, postoperative complications, and mortality.

Nine patients were identified in the study period. There were 7 men and 2 women with an age range of 29 to 67 years. Indications for thoracic endovascular aortic repair included type B aortic dissection, pseudoaneurysm, and rupture of the descending thoracic aorta. The median time from endograft implant to diagnosis of infection was 182 days (range, 31-1826 days). The causative infectious organism was identified in 77% of cases (7/9). Five patients underwent extra-anatomic bypass and aortic ligation followed by interval thoracic endovascular aortic repair explant. Four patients underwent thoracic endovascular aortic repair explant and in situ aortic reconstruction. There were no instances of graft thrombosis. In-hospital mortality was 22% (2 patients) with 1-year mortality of 50% (4 patients). One patient was lost to follow-up.

As thoracic endovascular aortic repair volume continues to increase, the prevalence of thoracic endograft infection will continue to increase. Our experience demonstrates thoracic aortic endograft explantation with extra-anatomic or in-line aortic reconstruction is viable; however, mortality from this pathology and its management remain high.