Management of Complex Aortic Endograft Infection by a Multidisciplinary Team

BACKGROUND: This study aimed to evaluate the outcomes of a multidisciplinary team approach managing infections of complex aortic endografts, focusing on conservative treatment as an alternative to surgical explantation in selected cases. This was a retrospective, monocentric study conducted at Bordeaux University Hospital.

METHODS: From January 2018 to July 2024, we reviewed cases of complex aortic endografts (chimney endovascular aortic repair [ChEVAR], fenestrated endovascular aortic repair [BEVAR], and fenestrated endovascular aortic repair [FEVAR]) infections, managed by our multidisciplinary vascular infection team (MDVIT). The primary end points were in-hospital mortality and overall survival. Secondary end points included complications during hospitalization and follow-up.

RESULTS: All 11 cases of complex endografts infections managed by our MDVIT were scrutinized, infected FEVARS n = 10 and infected ChEVAR n = 1. The mean age was 72 years. The patients were divided into 2 groups: group A (7 patients) managed with conservative treatment with antimicrobial therapy ± percutaneous drainage, and group B (4 patients) undergoing surgical treatment due to complications. Group A demonstrated infection remission in 6/7 patients (86%) with antimicrobial therapy. One patient from group A required emergent surgery due to sepsis and was reassigned to group B. All patients in group B presented with complications such as aorto-duodenal fistulas n = 3 and pseudoaneurysms n = 1; 3 underwent graft explantations, and one underwent sacotomy and duodenal fistula repair without graft removal. The overall in-hospital mortality was 9%, and the mean follow-up was 15 months (range 3-37). The overall survival was 82% at 1 year. Long-term vascular complications were limited, and suppressive antimicrobial therapy was effective with high rate of remission of infection.

CONCLUSIONS: Multidisciplinary team management enables a tailored approach to complex aortic endograft infections. Conservative treatment was first-line treatment, but for cases complicated by fistula or pseudoaneurysm surgical explantation was performed. Antimicrobial grafts and visceral debranching played a pivotal role in the surgical cases. This study highlights the importance of multidisciplinary decision-making and follow-up to optimize patient outcomes and inform future multicenter research.