Aortic endograft infection: A report of 2 cases

Introduction: Endograft infection has received less attention than other complication, so that little is known about the general features, risk factors, and treatment. The purpose of this short series is to examine our experience of infective complications after EVAR. Material and methods: Between November 2000 and December 2008, 247 patients underwent endograft repair for abdominal aortic aneurysm. Follow-up protocol included clinical visit and computed-tomography angiography 1, 4 and 12 months after the intervention, and yearly thereafter. No duplex control was performed on a regular basis. Results: Median follow-up was 16 months (range, 3-92); two patients (2/244, 0.8%) developed an endograft infection, 12 and 36-months after the intervention respectively. On admission, both patients complained septic-like fever and abdominal discomfort; leukocytes-labelled scans did not reveal pathologic traits whereas spiral computed-tomography confirmed the suspicious of endograft infection. They underwent endograft removal and extra-anatomic axillo-bifemoral by-pass; both survived and are still alive 12 and 6-months after the intervention. Isolated micro-organisms were Candida albicans and Escherichia coli in one patient, and Haemophilus aphrophilus in the other. Conclusion: Endograft infection is an uncommon occurrence, Spiral computed-tomography seems to be an essential diagnostic tool. Graft removal was successful in our high-risk patients. A multicenter registry should be started to define guidelines.