title: How To Diagnose and Manage Infected Endografts after Endovascular Aneurysm Repair.
abstract: The prevalence of endograft infections (EI) after endovascular abdominal aortic aneurysm repair is below 1%. With the growing number of patients with aortic endografts and the aging population, the number of patients with EI might also increase. The diagnosis is based on an association of clinical symptoms, imaging, and microbial cultures. Angio-computed tomography is currently the gold-standard technique for diagnosis. Low-grade infection sometimes requires nuclear medicine imaging to make a correct diagnosis. There is no good evidence to guide management so far. In the case of active gastrointestinal bleeding, pseudoaneurysm, or extensive perigraft purulence involving adjacent organs, an invasive treatment should always be attempted. In the other cases (the majority), when there is not an immediate danger to the patient's life, a conservative management is started with a proper antimicrobial therapy. Any infectious cavity can be percutaneously drained. Management depends on the patient's condition and a tailored approach should always be offered. In the case of a patient who is young, has a good life expectancy, or in whom there is absence of significant comorbidities, a surgical attempt can be proposed. Surgical techniques favor, in terms of mortality, patency, and reinfection rate, the in situ reconstruction. Choice of technique relies on the center and the operator's experience. Long-term antibiotic therapy is always required in all cases, with close monitoring of the C-reactive protein.
authors.affiliation: Vascular and Endovascular Surgery Unit, University of Siena, Siena, Italy;
authors.forename: Carlo
authors.initials: C
authors.lastname: Setacci
authors.affiliation: Department of Surgery, Vascular and Endovascular Surgery Unit, "San Giovanni di Dio" Hospital, Florence, Italy; and.
authors.forename: Emiliano
authors.initials: E
authors.lastname: Chisci
authors.affiliation: P. Valdoni Department of Surgery, La Sapienza University, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Setacci
authors.affiliation: Department of Surgery, Vascular and Endovascular Surgery Unit, "San Giovanni di Dio" Hospital, Florence, Italy; and.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Ercolini
authors.affiliation: Vascular and Endovascular Surgery Unit, University of Siena, Siena, Italy;
authors.forename: Gianmarco
authors.initials: G
authors.lastname: de Donato
authors.affiliation: Department of Surgery, Vascular and Endovascular Surgery Unit, "San Giovanni di Dio" Hospital, Florence, Italy; and.
authors.forename: Nicola
authors.initials: N
authors.lastname: Troisi
authors.affiliation: Vascular and Endovascular Surgery Unit, University of Siena, Siena, Italy;
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Galzerano
authors.affiliation: Department of Surgery, Vascular and Endovascular Surgery Unit, "San Giovanni di Dio" Hospital, Florence, Italy; and.
authors.forename: Stefano
authors.initials: S
authors.lastname: Michelagnoli
keywords: Aortic aneurysm; Computed tomography scan; Endovascular; Epidemiology; Stent graft