Vrije voordracht 22 – Eline Reinders Folmer, St. Antonius Ziekenhuis

09.55 Diagnosis and treatment of aortic endograft infection

Eline Reinders Folmer, St. Antonius Ziekenhuis

Reinders Folmer E1, Wikkeling T2, Scheurink L3, van Sambeek M4, Verhofstad N4, Zeebregts C2, Saleem B2
1St Antonius Ziekenhuis, 2Universitair Medisch Centrum Groningen, 3Deventer Ziekenhuis, 4Catharina Ziekenhuis

Background
Deployment and the advancement of endografts has been a major development within vascular surgery, but has also introduced specific complications, such as aortic endograft infection (AEI), a life threatening complication of which treatment remains challenging. The aim of this study was to present the diagnostic work up and treatment options of AEI in two specialized tertiary referral centers.

Methods
Patients with AEI treated in our centers between 2008 and 2022 were retrospectively evaluated. The primary outcome was re-infection. Secondary outcome measures were all cause mortality, infection related mortality and major amputation.

Results
Among 47 included patients, 10 (21.3%) presented early symptoms, within 3 months after initial placement. Pain (61.7%) and fever (53.2%) were the most common symptoms at presentation. An aortoenteric fistula (AEF) was present in 10 (21,3%) patients. MAGIC criteria confirmed the diagnosis in 80.9%.

Regarding the management, 20 patients were treated surgically and 27 patients conservatively. Surgical treatment consisted of total or partial explantation with vascular reconstruction or irrigation. Conservative treatment consisted of antibiotic treatment with or without percutaneous drainage.

The median follow-up time was 28.0 (8.0-51.0) months. The re-infection rate was 20.0% in the surgical group and in the conservative treated group there was a non-suppressed infection rate of 51.9%.
The all cause mortality was 40.0% in the surgical group and 66.7% in the conservative group. The infection related mortality was similar within the two groups.

Conclusion
Conservative treatment showed a high number of non-suppressed infection, while surgical treatment showed a lower amount of re-infections. In patients with AEI surgical treatment should be considered, taking the general condition of the patient and the peri-operative risks under consideration.