Surgical Treatment Outcomes of Abdominal Aortic Endograft Infection: A Dual-Center Retrospective Study

Abdominal aortic endograft infection (AAEI) is a rare but life-threatening complication following endovascular aneurysm repair. This study aimed to report surgical outcomes of AAEI from 2 specialized Chinese vascular centers and analyze prognostic risk factors.

A dual-center retrospective cohort study enrolled 41 patients who underwent complete infected graft excision and revascularization for AAEI between February 2018 and September 2025. Clinical data were collected and analyzed via Kaplan-Meier survival analysis and univariate COX regression.

This cohort included 40 males and 1 female (mean age: 64.22 ± 9.12 years). Complete removal of the infected graft was performed in all cases, with revascularization achieved via extra-anatomical bypass (EAB, n = 39) or in situ reconstruction (n = 2). Median follow-up time was 12 months. All-cause mortality was 29.3%, nonfatal complication rate was 39.0% and reintervention rate was 17.1% (7/41). Elevated white blood cell (WBC) (P = 0.01, hazard ratio [HR] = 3.90) and enteric fistula (P = 0.04, HR = 3.21) worsened survival; advanced age showed a trend toward significance (P = 0.09). C-reactive protein level and renal artery stent coverage had no significant prognostic impact (P > 0.05).

EAB is a feasible and practical option for high-risk AAEI patients, particularly at centers lacking biological grafts. Enteric fistula, elevated preoperative WBC, and advanced age predict poor survival. Large prospective multicenter trials are needed to refine individualized treatments for AAEI.