Fecha de la publicación: 24/08/2021
Autor: Jokin Dominguez-Cainzos (1), Alejandro Rodrigo-Manjon (2), Jose Manuel Rodriguez-Chinesta (3), Ana Apodaka-Diez (4), Gonzalo Bonmatí (4), Elena Bereciartua (5)
1Servicio de Enfermedades Infecciosas, Hospital Universitario Cruces, Baracaldo, España. Electronic address: firstname.lastname@example.org.
2Servicio de Enfermedades Infecciosas, Hospital Universitario Cruces, Baracaldo, España.
3Servicio de Angiología y Cirugía Vascular, Hospital Universitario Cruces, Baracaldo, España.
4Servicio de Medicina Interna, Hospital Universitario Cruces, Baracaldo, España.
5Servicio de Enfermedades Infecciosas, Hospital Universitario Cruces, Baracaldo, España. Electronic address: email@example.com.
Introduction: 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 and little evidence has been published in our country. Endograft explantation is considered the «gold standard» treatment whereas percutaneous or surgical perigraft and sac drainage associated to antibiotics should be considered and alternative therapy.
Methods: We carried out a retrospective and descriptive review of abdominal aortic endograft infections at our tertiary center (Hospital Universitario Cruces) during last ten years (2010-2019).
Results: We describe the clinical and microbiological characteristics of 10 EVAR infections, their management and outcomes. The incidence of graft infection after EVAR was 3%. The mean time to the clinical presentation of infection was 16.9 months (median 4.5 months). The microbiological diagnosis was reached in 100% of cases (predominance of gram-positive species). The overall mortality rate was 50% (although the survival rate was 100% after surgical drainage of the sac).
Conclusions: Perigraft or aneurysm sac aspiration culture shows their diagnostic utility as microbiological diagnosis was reached in all cases despite of blood cultures being only positive in 50% of the samples. Surgical drainage and endograft preservation combined with antibiotherapy show remarkable results. The high heterogeneity in our case series makes difficult to offer general recommendations, thus far, a tailored approach to treatment is suggested.
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