Endovascular graft infection: preliminary results of an international enquiry.
OBJECTIVE
To investigate the frequency of aortoiliac endovascular graft infections and seek the main factors influencing their development.


METHODS
To augment personal experience (1 case), a questionnaire was sent to 40 international centers of vascular and endovascular surgery. The literature was also reviewed to collect data on infections developing in endovascular grafts.


RESULTS
The survey (85% response rate) and literature review identified 62 cases of infected endovascular grafts (0.4% frequency of endograft infection). In 22 (35%) patients, the infection manifested initially with vague symptoms only, but 41 (65%) patients eventually presented with abdominal abscess, groin fistula, and septic embolization. Common bacteria, such as Staphylococcus aureus, were identified as the cause of most infections (54.5%). The majority (49, 79%) of the 62 patients were treated surgically; 11 (17.7%) patients received conservative therapy (no therapeutic data in 2 patients). Overall mortality was 27.4% (17/62), and operative mortality was 16.3% (8/49). Conservative treatment led to a mortality rate of 36.4% (4/11). The mean follow-up for all patients was 47.8 weeks. Possible factors influencing the development of an infection were secondary adjunctive procedures, immunosuppression, treatment of false aneurysms, and infected central lines.


CONCLUSIONS
Infected endovascular grafts are an urgent problem that has been heretofore underestimated and will probably increase as follow-up lengthens. New techniques should be sought to expedite the diagnosis, and an international registry should be set up to provide validated data.
Fiorani
Paolo
P
Department of Vascular Surgery, Policlinico Umberto I, Rome, Italy.
Speziale
Francesco
F
Calisti
Annalisa
A
Misuraca
Maria
M
Zaccagnini
Davide
D
Rizzo
Luigi
L
Giannoni
Maria Fabrizia
MF
D001012:Aorta, Abdominal / Q000601:surgery*; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D005500:Follow-Up Studies; D006801:Humans; D007083:Iliac Artery / Q000601:surgery*; D016459:Prosthesis-Related Infections / Q000453:epidemiology* / Q000382:microbiology; D015607:Stents / Q000009:adverse effects*; D011795:Surveys and Questionnaires