Ann Surg Treat Res.  2023 Jun;104(6):339-347. 10.4174/astr.2023.104.6.339.

Clinical outcomes of in situ graft reconstruction in treating infected abdominal aortic stent grafts following endovascular aortic aneurysm repair: a single-center experience

• Lee SA
• Jeong SJ
• Gwon JG
• Han Y
• Cho YP
• Kwon TW

• KMID: 2542798
• DOI: http://doi.org/10.4174/astr.2023.104.6.339

Abstract

Purpose
This study aimed to review our experience with the explantation of infected endovascular aneurysm repair (EVAR) grafts.
Methods
This single-center, retrospective, observational study analyzed the data of 12 consecutive patients who underwent infected aortic stent graft explantation following EVAR between January 1, 2010 and December 31, 2019, of which 11 underwent in situ graft reconstruction following graft removal. The presentation symptoms, infection route, original pathology of abdominal aortic aneurysms (AAA), graft materials, and clinical outcomes were analyzed.
Results
Six patients underwent total explantation, whereas 5 underwent removal of only the fabric portions. For in situ reconstructions, prosthetic grafts and banked allografts were used in 8 and 3 patients, respectively. Four mechanisms of graft infection were noted in 11 patients: 4 had bacteremia from systemic infections, 3 had persistent infections following EVAR of primary infected AAA, 3 had ascending infections from adjacent abscesses, and 1 had an aneurysm sac erosion resulting in an aortoenteric fistula. No infection-related postoperative complications or reinfections occurred during the mean 65.27-month (standard deviation, ±52.51) follow-up period. One patient died postoperatively because of the rupture of the proximal aortic wall pseudoaneurysm that had occurred during forceful bare stent removal.
Conclusion
Regardless of graft material, in situ graft reconstruction is safe for interposition in treating an infected aortic stent graft following EVAR. In our experience, the residual bare stent is no longer a risk factor for reinfection. Therefore, it is important not to injure the proximal aortic wall when removing the bare stent by force.

Keyword

Abdominal aortic aneurysm; Endovascular aneurysm repair; Infected aneurysm

Figure

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  Fig. 1 (A) Surgical photo of the explanted stent graft (Gore Excluder, W. L. Gore & Associates, Inc.) of a patient who had persistent infection after endovascular aneurysm repair (EVAR) with an aortoduodenal fistula. The stent graft was removed completely. (B) Postoperative CT image of the patient who underwent in situ reconstruction after explantation of the infected EVAR graft, showing the patent Dacron graft with omental wrapping (yellow arrow).

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  Fig. 2 The Kaplan-Meier estimate of overall 5-year survival rates among 11 patients with in situ reconstruction after explantation of infected stent grafts.

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