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DOI: 10.1055/s-0032-1332511
Complicated case of infected graft following endovascular treatment of internal iliac artery aneurysm – explantation and autologous reconstruction using deep femoral vein
Objective: Infection of endovascular grafts are rare with rates of 0.3 – 0.8% for EVAR and 1.4 – 4.8% for TEVAR. In the light of the constantly increasing absolute number of grafts being implanted and a reintervention rate of approx. 20%, a significant number of graft infections can be anticipated. Therapeutic options in that case rely on the established principles of septic vascular reconstruction, however, we propagate complete removal of prosthetic material and autologous reconstruction.
Methods: We present the case of a 69 year-old male with infected endovascular stentgraft oft he left iliac axis. The patient initially presented with a 45 mm aneurysm of the left internal iliac artery and was treated with coil-embolisation of the internal iliac artery and overstenting of the ostium of the internal iliac artery using a tapered (25 × 105 × 14 mm) graft with distal extension (16 × 80 × 16 mm). 8 months later, patient came back with recurrent episodes of fever and a retroperitoneal abscess with cutaneous fistulation. CT-Scan verified the suspicion of graft infection.
Results: Explantation of both stentgrafts and the occluder/coils was performed by transperitoneal access. Reconstruction of the left iliac axis was established by aortoiliac interposition vein graft using deep femoral vein (nonreversed, harvested from left leg). Microbiological analysis of the explanted graft confirmed presence of staph. Epi. The postoperative course was uneventful, the cutaneous fistulation stopped shortly after operation and patient was discharged home at day 15. CT-Scan after 12 months confirmed open vein graft without residual abscess. Clinically, patient was well without signs for infection.
Conclusion: Although the rate of infection in EVAR/TEVAR is low, a considerable number of endovascular graft infections must be anticipated given the constantly increasing number of grafts being implanted and the reintervention-rate. The principle of complete graft explantation combined with autologous reconstruction using deep femoral vein represents a durable treatment option for those patients.