Management of Endograft Infection After Thoracic Endovascular Aortic Repair

This retrospective study from a high-volume aortic center examined the surgical outcomes of endograft infection following thoracic endovascular aortic repair (TEVAR) over a 35-year period. Among 2,220 patients undergoing descending thoracic or thoracoabdominal aortic repair, 20 (0.9 percent) required surgery for endograft infection. Of these, eight had endograft infection; seven presented with aortoesophageal fistula, and five with aortobronchial fistulas. The surgical approach involved endograft explantation (95 percent), in-situ reconstruction with rifampin-soaked Dacron grafts, and soft tissue flap coverage (80 percent). Operative mortality was 30 percent, with minimal neurologic complications. One- and five-year survival rates were 43.5 percent and 36.3 percent, respectively. These results compare favorably to conservative management and support the continued use of aggressive surgical intervention—including radical debridement, endograft removal, and tissue coverage—in appropriately selected patients with this challenging complication.