Current Status of Treatment of Aortic Endograft Infection

The widespread use of endovascular aortic aneurysm repair (EVAR) has been accompanied by an increase in need to surgically treat infectious complications of aortic stent-grafts. Although this indication remains somewhat uncommon in most centers, the incidence of stent-graft infections ranges from 1% to 3% in small retrospective series [1,2]. Graft infection can occur as a primary event from skin contamination or hematogenous seeding, or it can result from aorto-enteric erosion or fistula. Independent of the etiology, aortic stent-graft infection carries significant morbidity and mortality and represents a formidable therapeutic challenge. Aortoenteric erosion or fistula (AEF) occurs after either open surgical or endovascular repair, and remains a devastating complication, particularly if the patient presents with massive gastrointestinal bleeding and hemodynamic instability. Although this is more common after repair of a pseudo aneurysm by open technique, it can also affect patients treated by EVAR [3]. In these cases, progression of infection affects the aneurysm sac, the stent and often extends into para spinal ligaments. If this is, not interrupted by extensive antibiotic and surgical treatment, the process evolves to aneurysm rupture or disseminated sepsis [14].