Treatment of infected endografts after thoracic endovascular aortic repair: a systematic review.

ObjectiveThe infection of the endograft after thoracic endovascular aortic repair (TEVAR) is a rare but potentially life-threatening complication. Unfortunately, clinical reports, large case-series or randomized studies are scarce or not available yet, and the optimal management of this complication is under debate. The aim of this review is collecting and analysing data on current practice and outcomes for the treatment of infected endografts after TEVAR.MethodsA search on PubMed/MEDLINE and EMBASE for studies reporting endograft infections after TEVAR was conducted up to January 2023. Data on study design, patients demographic, infection (time from TEVAR to infection, vascular imaging, bacterial samples), clinical strategies, outcome and follow-up were extracted and analysed. The outcome after surgical and conservative treatment was compared.ResultsThirty-six articles (5 case-series; 31 case reports) were deemed eligible for this review. A total of 57 patients (mean age: 62.5 ± 13.9 years) with endograft infections after TEVAR were included. Fever and pain were the two major clinical presentations. Mean time from TEVAR to diagnosis was 19.7 ± 36.4 months. The top four isolated microorganism were Staphylococcus aureus (25%), Candida albicans (15.6%), Streptococcus (12.5%) and Pseudomonas (7.8%). Patients were treated conservatively (36.8%) or surgically (63.2%). Surgical treatments were extra-anatomic aortic bypass (50%), in-situ aortic replacement (38.9%) and graft preservation (11.1%). Overall hospital mortality was 33.3% (30-day mortality: 26.4%). The mortality was 52.4% after conservative treatment and 22.2% after surgery (p = 0.0397). Among patients who underwent surgery, the mortality was 28.6% after in-situ aortic replacement and 22.2% after extra-anatomic aortic bypass (p = 0.5387). Major in-hospital causes of death after surgery were multiple organ failure and respiratory failure (6/8 patients).ConclusionEndograft infection after TEVAR is rare but it carries a high risk of mortality. In selected patients, the surgical treatment seems to be safer, with a lower mortality rate when compared to alternative conservative options.