Bridge Endovascular Aneurysm Repair Followed by Delayed Open Reconstruction for Infected Native Abdominal Aortic Aneurysm.

OBJECTIVES

Infected native abdominal aortic aneurysm (INAA) is a life-threatening condition for which emergency open repair may carry substantial physiologic risk. This study evaluated a staged strategy using endovascular aneurysm repair (EVAR) for initial aneurysm exclusion, followed by prolonged antimicrobial therapy and delayed definitive open reconstruction.

METHODS

We retrospectively reviewed consecutive patients with INAA treated at a single tertiary referral center between January 2020 and December 2025. Patients undergoing bridge EVAR followed by delayed EVAR explantation and open reconstruction after infection control were included. Clinical characteristics, operative details, postoperative complications, infection-related outcomes, and survival were assessed descriptively.

RESULTS

Nine patients were diagnosed with INAA, of whom eight underwent staged treatment. Mean age was 68.1 years, five patients (62.5%) were male, and blood cultures were positive in six (75.0%). The median interval from EVAR to definitive reconstruction was 79.5 days (range, 55-105 days). Seven patients underwent in situ prosthetic graft reconstruction after infection control; one patient with persistent infection underwent autologous femoral vein reconstruction. During a median follow-up of 20.5 months (range, 1-39 months), two patients died. Estimated overall survival was 87.5% at 1 year and 65.6% at 3 years. No recurrent infection, graft infection, or graft-related reintervention was observed among surviving patients.

CONCLUSIONS

In this small cohort managed with a staged institutional strategy, bridge EVAR followed by prolonged antimicrobial therapy and delayed open reconstruction was feasible and achieved durable infection control among survivors. This strategy may provide time for infection control and physiologic recovery before definitive reconstruction; larger comparative studies are required.