The management of aortic stent-graft infection: endograft removal versus conservative treatment

Ann Vasc Surg. 2010 May;24(4):554.e1-5. doi: 10.1016/j.avsg.2009.11.003. Epub 2010 Jan 25.

Abstract

Background: Aortic stent-graft infections (ASGIs) are associated with significant mortality. We report our experience of two cases of ASGI treated differently and successfully.

Methods: Two patients presented with constitutional symptoms some months after scheduled endovascular repair of aortic aneurysm (EVAR). Patient 1 had an abscess formation around the endograft in continuity with the right groin. Due to patient comorbidities, a conservative treatment was performed. Patient 2 had an abscess formation with air surrounding the stent graft. The patient was treated successfully by endograft removal.

Results: Computed tomographic scan follow-up at 6 months from surgery showed no evidence of recurrent infection.

Conclusion: Despite the recommended treatment of ASGI being surgery, conservative treatment can be performed successfully in patients with high surgical risk, avoiding aortic clamping. We present the first reported case of ASGI due to Streptococcus haemolyticus, the second case due to a fungus, and the second reported case of spondylodiscitis after EVAR.

Publication types

  • Case Reports

MeSH terms

  • Abdominal Abscess / diagnostic imaging
  • Abdominal Abscess / microbiology
  • Abdominal Abscess / therapy*
  • Aged
  • Anti-Bacterial Agents / therapeutic use*
  • Aortic Aneurysm / surgery*
  • Aortography / methods
  • Blood Vessel Prosthesis / adverse effects*
  • Blood Vessel Prosthesis Implantation / adverse effects*
  • Blood Vessel Prosthesis Implantation / instrumentation
  • Candida albicans / isolation & purification
  • Debridement*
  • Device Removal*
  • Discitis / etiology
  • Enterobacter cloacae / isolation & purification
  • Humans
  • Male
  • Propionibacterium / isolation & purification
  • Prosthesis-Related Infections / diagnostic imaging
  • Prosthesis-Related Infections / microbiology
  • Prosthesis-Related Infections / therapy*
  • Stents / adverse effects*
  • Streptococcus / isolation & purification
  • Time Factors
  • Tomography, X-Ray Computed
  • Treatment Outcome

Substances

  • Anti-Bacterial Agents