Successful Treatment of an Infected Zenith Fenestrated Endograft Without Explantation

Abstract

Current surgical dogma for infected aortic endografts consists of complete explantation concurrent with revascularization via extra-anatomic bypass or in situ infection-resistant conduit. However, this treatment paradigm is associated with high rates of postoperative mortality and major morbidity. Therefore, patients with prohibitive operative risk are often not offered surgical intervention. In the following manuscript, we report the successful treatment of an 85-year-old gentleman with a fenestrated aortic endograft (Cook Medical, Bloomington, Indiana) infected secondary to the formation of an aortoenteric fistula with primary bowel repair, washout, and lifelong antibiotics and followed for nearly 2 years after intervention. Therefore, this nonexplantation approach can be considered for patients who may otherwise have no surgical recourse.

Nonspecific Presentation of an Infected Aorto-Iliac Artery Stent Following Endovascular Revision and Stent Insertion

“…1,3 The conservative therapy option may only be considered for patients who are poor surgical candidates. 16,17 Daptomycin and rifampin are usually administered given their ability to diffuse through the stent biofilm and potentiate their bactericidal effect. 18 In our case, the decision to opt for an ascending aortic to bilateral femoral artery bypass over alternative methods such as axillary bifemoral artery bypass or a descending thoracic to bifemoral artery bypass was deemed more suitable due to factors including the patient's anatomy, the extent of the vascular involvement, the surgeon's expertise, and the urgency of the situation.…”

“…1,3 The conservative therapy option may only be considered for patients who are poor surgical candidates. 16,17 Daptomycin and rifampin are usually administered given their ability to diffuse through the stent biofilm and potentiate their bactericidal effect. 18…”

A rare case of an infected aortoiliac graft complicated with Eggerthella lenta bacteremia and septic shock

“…Expert opinion previously suggested removal of the infected graft, anatomical revascularization, and antibiotic therapy are important for long term survival after aortic endograft infection [19]. Conservative therapy is only warranted in patients unsuitable for surgical treatment [12,20,21].…”

Endovascular management and the risk of late failure in the treatment of ureteroarterial fistulas

“…Pelvic angiography remains the diagnostic method of choice, offering an immediate treatment strategy 13, 14, 15. In cases of uncontrollable hematuria with hemodynamic compromise, endovascular therapy is a lifesaving measure 14, 16…”

“…It is important to consider the patient's medical condition and ability to undergo a high-risk procedure. In a case report by Wang et al, 16 the patient described with an infected aortic endograft underwent washout, was prescribed lifelong antibiotics, and was observed for nearly 2 years after intervention. In another case report by Gharacholou et al, 17 the authors explained that although long-term suppressive antimicrobial therapy for infected endovascular stents has been used, patients with persistent bacteremia or complications from the infected stent may require explantation, and this is currently the standard of care for infected endografts.…”