Presentation and management of delayed aortic endograft infection

Abstract

A man in his 60s who underwent endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm 4 years ago presents with 1 week of abdominal pain, fever and leucocytosis. CT angiogram demonstrated an enlarged aneurysm sac with intraluminal gas and periaortic stranding consistent with infected EVAR. He was clinically unfit for an open surgical intervention due to his significant cardiac comorbidities, including hypertension, dyslipidaemia, type 2 diabetes, recent coronary artery bypass grafting and congestive heart failure secondary to ischaemic cardiomyopathy with an ejection fraction of 30%. Therefore, due to this significant surgical risk, he was treated with percutaneous drainage for the aortic collection and lifelong antibiotics. The patient is well 8 months following presentation with no signs of ongoing endograft infection, residual aneurysm sac enlargement, endoleak or haemodynamic instability.

Aortic Endograft Infection: Diagnosis and Management

“…Conservative treatment involves nonsurgical prolonged antimicrobial therapy with or without percutaneous drainage and antimicrobial solution irrigation of localized abscesses. Conservative treatment is sometimes the only reasonable option, especially for patients with a short life expectancy, unacceptably high surgical risk, or localized infections by organisms with low virulence and susceptibility to antibiotic therapy [ 50 - 52 ]. However, surgery remains the first-line treatment for patients suspected of having an AEF, and conservative treatment is not indicated for such cases.…”