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CC BY 4.0 · Aorta (Stamford) 2014; 02(06): 255-264
DOI: 10.12945/j.aorta.2014.14-036
State-of-the-Art Review
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

How To Diagnose and Manage Infected Endografts after Endovascular Aneurysm Repair

Carlo Setacci
1   Vascular and Endovascular Surgery Unit, University of Siena, Siena, Italy
,
Emiliano Chisci
2   Department of Surgery, Vascular and Endovascular Surgery Unit, “San Giovanni di Dio” Hospital, Florence, Italy
,
Francesco Setacci
3   P. Valdoni Department of Surgery, La Sapienza University, Rome, Italy
,
Leonardo Ercolini
2   Department of Surgery, Vascular and Endovascular Surgery Unit, “San Giovanni di Dio” Hospital, Florence, Italy
,
Gianmarco de Donato
1   Vascular and Endovascular Surgery Unit, University of Siena, Siena, Italy
,
Nicola Troisi
2   Department of Surgery, Vascular and Endovascular Surgery Unit, “San Giovanni di Dio” Hospital, Florence, Italy
,
Giuseppe Galzerano
1   Vascular and Endovascular Surgery Unit, University of Siena, Siena, Italy
,
Stefano Michelagnoli
2   Department of Surgery, Vascular and Endovascular Surgery Unit, “San Giovanni di Dio” Hospital, Florence, Italy
› Author Affiliations
Further Information

Publication History

16 June 2014

03 October 2014

Publication Date:
24 September 2018 (online)

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Abstract

Based on a Presentation at the 2013 VEITH Symposium, November 19–23, 2013 (New York, NY, USA)

The prevalence of endograft infections (EI) after endovascular abdominal aortic aneurysm repair is below 1%. With the growing number of patients with aortic endografts and the aging population, the number of patients with EI might also increase. The diagnosis is based on an association of clinical symptoms, imaging, and microbial cultures. Angio-computed tomography is currently the gold-standard technique for diagnosis. Low-grade infection sometimes requires nuclear medicine imaging to make a correct diagnosis. There is no good evidence to guide management so far. In the case of active gastrointestinal bleeding, pseudoaneurysm, or extensive perigraft purulence involving adjacent organs, an invasive treatment should always be attempted. In the other cases (the majority), when there is not an immediate danger to the patient's life, a conservative management is started with a proper antimicrobial therapy. Any infectious cavity can be percutaneously drained. Management depends on the patient's condition and a tailored approach should always be offered. In the case of a patient who is young, has a good life expectancy, or in whom there is absence of significant comorbidities, a surgical attempt can be proposed. Surgical techniques favor, in terms of mortality, patency, and reinfection rate, the in situ reconstruction. Choice of technique relies on the center and the operator's experience. Long-term antibiotic therapy is always required in all cases, with close monitoring of the C-reactive protein.

Key Words

Computed tomography scan - Aortic aneurysm - Epidemiology - Stent graft - Endovascular
 

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