A multicenter experience with infected abdominal aortic endograft explantation

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• 作者：Xavier Chaufour ; MD ; PhD^a ; Julien Gaudric ; MD^b ; Yann Goueffic ; MD ; PhD^c ; Ré ; da Hassen Khodja ; MD^d ; Patrick Feugier ; MD ; PhD^e ; Sergei Malikov ; MD^f ; Guillaume Beraud ; MD ; PhD^g ; Jean-Baptiste Ricco ; MD ; PhD^h ; ^{jeanbaptistericco@gmail.com} ; for the AURC (French University Surgeons Association) collaborators^&lowast ; ; Xavier Chaufour ; MD ; Julien Gaudric ; MD ; Yann Goueffic ; MD ; PhD ; É ; ric Steinmetz ; MD ; Ré ; da Hassen Khodja ; MD ; Dominique Midy ; MD ; PhD ; Patrick Feugier ; MD ; Sergei Malikov ; MD ; Eugé ; nio Rosset ; MD ; Alain Cardon ; MD ; Malcom Legall ; MD ; Jean-Baptiste Ricco ; MD ; PhD
• 刊名：Journal of Vascular Surgery
• 出版年：2017
• 出版时间：February 2017
• 年：2017
• 卷：65
• 期：2
• 页码：372-380
• 全文大小：896 K
• 卷排序：65

文摘

Endovascular aneurysm repair (EVAR) is widely used with excellent results, but its infectious complications can be devastating. In this paper, we report a multicenter experience with infected EVAR, symptoms, and options for explantation and their outcome.MethodsWe have reviewed all consecutive endograft explants for infection at 11 French university centers following EVAR, defined as index EVAR, from 1998 to 2015. Diagnosis of infected aortic endograft was made on the basis of clinical findings, cultures, imaging studies, and intraoperative findings.ResultsThirty-three patients with an infected aortic endograft were identified. In this group, at index EVAR, six patients (18%) presented with a groin or psoas infection and six patients (18%) presented with a general infection, including catheter-related infection (n = 3), prostatitis (n = 1), cholecystitis (n = 1), and pneumonia (n = 1). After index EVAR, eight patients underwent successful inferior mesenteric artery embolization for a type II endoleak within 6 months of index EVAR and one patient received an additional stent for a type Ib endoleak 1 week after index EVAR. Median time between the first clinical signs of infection and endograft explantation was 30 days (range, 1 day to 2.2 years). The most common presenting characteristics were pain and fever in 21 patients (64%) and fever alone in 8 patients (24%). Suprarenal fixation was present in 20 of 33 endografts (60%). All patients underwent endograft explantation, with bowel resection in 12 patients (36%) presenting with an endograft-enteric fistula. Methods of reconstruction were graft placement in situ in 30 patients and extra-anatomic bypass in 3 patients. In situ conduits were aortic cryopreserved allografts in 23, polyester silver graft in 5, and autogenous femoral vein in 2. Microbiology specimens obtained from the endograft and the aneurysm were positive in 24 patients (74%). Gram-positive organisms were the most commonly found in 18 patients (55%). Early mortality (30 days or in the hospital) was 39% (n = 13) in relation to graft blowout (n = 3), multiple organ failure (n = 6), colon necrosis (n = 3), and peripheral embolism (n = 1). At 1 year, the rates of patient survival, graft-related complications, and reinfection were 44%, 10%, and 5%, respectively.ConclusionsAbdominal aortic endograft explantation for infection is high risk and associated with graft-enteric fistula in one-third of the cases. Larger multicenter studies are needed to better understand the risk factors and to improve preventive measures at index EVAR and during follow-up.