title: Outcome after preservation of infected abdominal aortic endografts.
abstract: OBJECTIVE
  To review the published outcomes of aortic endograft infection treated with preservation of the stent-graft.
  
  
  METHODS
  An extensive electronic health database search was undertaken to identify all articles published up to May 2013 that reported endograft infection after endovascular aneurysm repair (EVAR) in which treatment included preservation of the stent-graft. The search found 17 articles with 29 patients (27 men; mean age 73.1±7.6 years) fulfilling the inclusion criteria.
  
  
  RESULTS
  In 2 (7%) cases, the endograft infection was diagnosed within 30 days of the initial procedure; 4 (14%) were identified within 3 months and the remaining 23 (79%) within 12 months. Staphylococcus species, Streptococcus species, and Escherichia coli were the most common isolated microorganisms. Seven (24%) had a secondary aortoenteric fistula after EVAR. Twelve (41%) patients received only antibiotic therapy, while the remaining had an additional procedure (drainage, surgical debridement, sac irrigation, and/or omentoplasty). The in-hospital mortality was 21% (n=6). During a mean follow-up of 11.4±3.1 months, 7 more patients died (overall mortality 45%). None of the 7 patients with fistula survived. Half (50%) of the 12 patients who received only antibiotic therapy died, while 7 (41%) of the 17 patients who underwent an additional procedure died during follow-up.
  
  
  CONCLUSIONS
  Among patients treated for endograft infection without explantation, those with aortoenteric fistula had the worst outcome. There is evidence for lower mortality in patients who underwent an additional procedure, such as drainage, surgical debridement, and sac irrigation. Larger studies are needed to examine the efficacy of this approach compared to surgical conversion with endograft excision and in situ reconstruction or extra-anatomical bypass.
authors.affiliation: Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece.
authors.forename: Konstantinos G
authors.initials: KG
authors.lastname: Moulakakis
authors.forename: George S
authors.initials: GS
authors.lastname: Sfyroeras
authors.forename: Spyridon N
authors.initials: SN
authors.lastname: Mylonas
authors.forename: George
authors.initials: G
authors.lastname: Mantas
authors.forename: Anastasios
authors.initials: A
authors.lastname: Papapetrou
authors.forename: Constantine N
authors.initials: CN
authors.lastname: Antonopoulos
authors.forename: John D
authors.initials: JD
authors.lastname: Kakisis
authors.forename: Christos D
authors.initials: CD
authors.lastname: Liapis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001012:Aorta, Abdominal / Q000382:microbiology / Q000601:surgery*; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation / Q000401:mortality; D003646:Debridement; D057510:Endovascular Procedures / Q000009:adverse effects* / Q000295:instrumentation / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009852:Omentum / Q000601:surgery*; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000382:microbiology / Q000401:mortality / Q000628:therapy*; D012086:Reoperation; D012307:Risk Factors; D015607:Stents / Q000009:adverse effects*; D007507:Therapeutic Irrigation; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: ancillary procedures; antibiotics; aortoenteric fistula; endograft; endovascular aneurysm repair; infection; mortality; stent-graft; surgical conversion