Author(s): Fiorani P, Speziale F, Calisti A, Misuraca M, Zaccagnini D,
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Abstract PURPOSE: To investigate the frequency of aortoiliac endovascular graft infections and seek the main factors influencing their development. METHODS: To augment personal experience (1 case), a questionnaire was sent to 40 international centers of vascular and endovascular surgery. The literature was also reviewed to collect data on infections developing in endovascular grafts. RESULTS: The survey (85\% response rate) and literature review identified 62 cases of infected endovascular grafts (0.4\% frequency of endograft infection). In 22 (35\%) patients, the infection manifested initially with vague symptoms only, but 41 (65\%) patients eventually presented with abdominal abscess, groin fistula, and septic embolization. Common bacteria, such as Staphylococcus aureus, were identified as the cause of most infections (54.5\%). The majority (49, 79\%) of the 62 patients were treated surgically; 11 (17.7\%) patients received conservative therapy (no therapeutic data in 2 patients). Overall mortality was 27.4\% (17/62), and operative mortality was 16.3\% (8/49). Conservative treatment led to a mortality rate of 36.4\% (4/11). The mean follow-up for all patients was 47.8 weeks. Possible factors influencing the development of an infection were secondary adjunctive procedures, immunosuppression, treatment of false aneurysms, and infected central lines. CONCLUSIONS: Infected endovascular grafts are an urgent problem that has been heretofore underestimated and will probably increase as follow-up lengthens. New techniques should be sought to expedite the diagnosis, and an international registry should be set up to provide validated data.
This article was published in J Endovasc Ther
and referenced in Journal of Clinical & Experimental Cardiology