Outcomes of Surgical Explantation of Infected Aortic Grafts After Endovascular and Open Abdominal Aneurysm Repair

Infection of the vascular graft represents one of the most threatening complications after aortic repair. It is rare and associated with high morbidity and mortality rates. The aim of this study was to present short-term outcomes after surgical treatment of infected aortic grafts after endovascular and open repair of abdominal aortic aneurysms (AAAs). Data of all patients affected by aortic graft infection after aneurysm repair who underwent an explantation of a conventional or endovascular aortic graft between January 2008 and December 2016 were retrospectively reviewed. All patients underwent in situ reconstruction using a rifampicin soaked synthetic graft. The primary endpoint of this study was 30 day mortality; secondary endpoints were major post-operative complications. Twenty-six patients were included in the cohort, 16 with an infected endograft (iEVAR) and 10 patients with an infected conventional graft (iOAR). Thirty-day mortality was 23.1% overall, 37.5% for iEVAR and 0% (p = .027) for iOAR. Post-operative major complications occurred in eight (50%) patients from the iEVAR group and in four (40%) patients from the iOAR group (p = .619). The supravisceral clamping rate was higher in patients with infected iEVAR (93.8 vs. 20%, p = .001), furthermore a greater incidence of post-operative acute kidney injury was observed (50 vs. 0%, p = .009). Explantation of the graft and in situ reconstruction for aortic graft infection is accepted as the therapy of choice. However, re-operation for iEVAR is related to significantly higher mortality and morbidity rates. The need for suprarenal aortic clamping seems to be a possible explanation for worse outcomes in iEVAR.