Endovascular aortic repair (EVAR) is the preferred treatment for abdominal aortic aneurysms (AAA) in suitable patients (1). Despite its benefits, EVAR can lead to serious complications, including the rare but life-threatening endograft infection (2). These infections are difficult to diagnose and treat, often necessitating open surgical repair with endograft explantation. Bovine pericardial tube grafts have proven to be an effective and durable solution for in situ reconstruction in cases of aortic infection (2). We report the outcomes of patients who underwent open conversion after EVAR infection.

This retrospective single-center study from 2004 to 2023 assesses patients with a history of EVAR who underwent endograft explantation due to EVAR infection. Presenting symptoms included fever and pain. Diagnosis was confirmed through imaging and microbiological tests. Endpoints were recurrent aortic infection, early and late reinterventions, graft-related complications, and mortality.

During this period, nine patients underwent endograft explantation due to infection. Eight were replaced with self-made bovine pericardial graft and one with silver-impregnated graft. The latter suffered a re-infection after 12 years, requiring silver-impregnated graft explantation and replacement with bovine pericardial graft. Patient demographics are detailed in Table 1. Two patients had early reintervention: one for acute limb ischemia caused by occluded graft limb followed by graft thrombectomy and one for relevant bleeding with retroperitoneal hematoma requiring urgent evacuation. The mean time to infection diagnosis was 15±18 months post-EVAR and follow-up period was 19±32 months. In total four patients died during follow-up, two of them aortic-related.

Endograft infection after EVAR remains rare but is a severe complication. Long-term EVAR follow-up is crucial for early detection and management of these rare but serious infections. An elective repair with bovine pericardial graft promises good mid- and long-term outcome, without re-infection during follow-up. These patients have not an increased mortality after open repair of their endograft infection.