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

Sang Ah Lee; Seon Jeong Jeong; Jun Gyo Gwon; Youngjin Han; Yong-Pil Cho; Tae-Won Kwon

doi: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

Ann Surg Treat Res. 2023 Jun;104(6):339-347. doi: 10.4174/astr.2023.104.6.339. Epub 2023 Jun 7.

Authors

Sang Ah Lee¹, Seon Jeong Jeong¹, Jun Gyo Gwon¹, Youngjin Han¹, Yong-Pil Cho¹, Tae-Won Kwon^{2

3}

Affiliations

¹ Division of Vascular Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
² Department of Acute Care Surgery, Korea University Guro Hospital, Seoul, Korea.
³ Armed Forces Trauma Center, Korean Armed Forces Capital Hospital, Seongnam, Korea.

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.

Keywords: Abdominal aortic aneurysm; Endovascular aneurysm repair; Infected aneurysm.