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The emergency medicine approach to abdominal vascular graft complications

A graft infection is often the inciting factor for endoleaks, fistulas, and graft migration. The diagnosis of this condition can be difficult because of nonspecific symptoms including malaise, back pain, fever, GI bleeding, or ischemia from a clotted graft. What is most relevant to the emergency physician is that these may also present asymptomatically or atypically, thus emergency physicians must consider this condition with a patient presenting with graft and the symptoms listed.

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 Current Status of Treatment of Aortic Endograft Infection

The widespread use of endovascular aortic aneurysm repair (EVAR) has been accompanied by an increase in need to surgically treat infectious complications of aortic stent-grafts. Although this indication remains somewhat uncommon in most centers, the incidence of stent-graft infections ranges from 1% to 3% in small retrospective series. Currently there is not a consensus on which is the best treatment option in patients with aortic graft infection.

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Abdominal aortic endograft infection. A decade of experience and literature review

Aortic endograft infection is an infrequent but life-threatening complication after endovascular abdominal aortic repair (EVAR). There is no consensus on management of endograft infection...

Aortic Endograft Infection: Diagnosis and Management

Aortic endograft infection (AEI) is a rare but life-threatening complication of endovascular aneurysm repair (EVAR). The clinical features of AEI range from generalized weakness and mild fever to fatal aortic rupture or sepsis. The diagnosis of AEI usually depends on clinical manifestations, laboratory tests, and imaging studies. Management of Aortic Graft Infection Collaboration (MAGIC) criteria are often used to diagnose AEI. Surgical removal of the infected endograft, restoration of aortic blood flow, and antimicrobial therapy are the main components of AEI treatment.

Current Management of Aortic Endograft Infection: Prepare Your Team for This New Challenge

While the reported aortic endograft infection (EGI) rate is lower than 1%, the number of more challenging infected patients will increase due to the widespread use of aortic endografts (EGs). The lessons learned from the management of aortic vascular graft infections (VGIs) are not fully transposable to EGI.

Diagnosis and treatment of vascular graft and endograft infections: a structured clinical approach

A vascular graft or endograft infection (VGEI) is a severe infectious disease and is accompanied by high morbidity and mortality rates. Diagnosis can be challenging due to the often difficult-to-reach anatomical sites for microbiologic diagnosis and the possibility of false-positive imaging.

Endograft Infection After Endovascular Abdominal Aortic Aneurysm Repair: A Systematic Review and Meta-analysis

Aortic endograft infection is a rare complication after EVAR. Surgical treatment with complete explantation of the infected endograft seems to be the optimal management in selected patients. Supportive medical treatment without surgical intervention has a significant associated mortality.

Endograft Infection After EVAR

An uncommon complication leads interventionists to opt for graft removal. Graft infection and aortoenteric fistula after endovascular aneurysm repair (EVAR) is an underrecognized and underreported event. Although rare, it may have devastating consequences. Traditional treatment with extra-anatomic bypass and either simultaneous or subsequent graft removal has been challenged by in situ reconstructions with autologous femoral/popliteal veins, cadaveric homograft, or rifampin-impregnated synthetic grafts.

Managing Infected Thoracic Endografts

A review of presentation and diagnosis, medical and surgical management and explantation, and outcomes after explantation.

Tackling the Infected Aortic Endograft: A Feared Complication with a Multidisciplinary Solution

Although the chances of infection of the stentgraft are only about 1%, patients whose grafts become infected are at a very high risk of death from infection (50-100% mortality). Treatment of the patient with an infected endograft often requires careful planning and the involvement of multiple medical and surgical specialties to provide salvage and rehabilitation from a life-threatening disease.

Talking Tall Rounds: Abdominal Aortic Graft Infection - Emphasizing a Team Approach to Patient Care Coordination

The current recommendations from the guidelines state that if the prosthetic material and tissue is removed two weeks of IV antibiotics, and up to four weeks of an oral antibiotic are appropriate. If the infected material is replaced with a new vascular graft at that same surgery, a longer time course is necessary with four to six weeks of IV therapy followed by even up to 12 months of an oral tail.

The relevance of aortic endograft prosthetic infection

The incidence of endograft infection is below 1%, with a mortality rate of 25%. Although consensus is that infected graft material should always be removed, this study shows no significant difference in mortality between the conservatively- and the surgically-managed group, possibly related to the small sample size. There may be a role for conservative treatment in selected cases of patients with an infected endograft.