Aortic endograft infections have worse outcomes compared to aortic surgical grafts or primary mycotic aortic infections.

BACKGROUND

Aortic infection is associated with high morbidity and mortality, but the outcomes of prosthetic (surgical or endovascular) grafts compared with primary aortic infections are poorly defined. This large single-center retrospective study aims to compare the outcomes of primary and prosthetic aortic graft infections.

METHODS

Patients diagnosed with primary or infected aortic grafts between January 2000 and December 2022 were included. Patients were grouped based on the type of infection (primary, surgical graft, and endograft). Baseline demographics, symptoms, imaging, interventions, and outcomes were evaluated. Primary outcomes include overall and reintervention-free survival. Kaplan-Meier survival and Cox proportional hazards analysis were performed.

RESULTS

A total of 145 patients presented during the study period with primary infection of the native aorta (33.8%) or aortic graft infection (66.2%: 44.8% surgical graft and 21.4% endograft). In-hospital mortality (39% vs 15% vs 10%; P = .007) and 30-day complication rates (68% vs 40% vs 37%; P = .015) were highest among endografts, followed by surgical grafts, and lowest among primary infections, respectively. Primary aortic infections had the highest 30-day, 1-year, and 5-year survival on Kaplan-Meier analysis compared with surgical and endograft infections. Reintervention-free survival was also highest in primary infections at 1 and 5 years (log-rank P < .001). On multivariate analysis, infected surgical grafts and endografts were associated with a significantly higher 30-day mortality (hazard ratio, 8.1; P = .016 and hazard ratio, 5.8; P = .035, respectively). Visceral artery involvement was a major determinant of mortality at 1 year and 5 years but not at 30 days, whereas treatment type did not affect mortality across all groups. There was no difference in the duration of intravenous antibiotic treatment between groups (42 vs 45 vs 44 days; P = .68).

CONCLUSIONS

Infected aortic endografts have lower short- and long-term survival as well as a lower rate of long-term intervention-free survival when compared with surgical graft and primary aortic infections. Visceral artery involvement was associated with increased mortality. Predictors of endograft infection need to be determined to minimize complications, and careful consideration is necessary before endovascular aortic interventions if there is concern an underlying infectious process.