How we deal with aortic endograft infection. Elena Iborra, Emma Espinar, Ramon Vila Hospital Universitari de Bellvitge Barcelona, Spain
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1 How we deal with aortic endograft infection Elena Iborra, Emma Espinar, Ramon Vila Hospital Universitari de Bellvitge Barcelona, Spain
2 Disclosure Speaker name: Elena Iborra Ortega I have the following potential conflicts of interest to report: Consulting Employment in industry Stockholder of a healthcare company Owner of a healthcare company Other(s) I do not have any potential conflict of interest
3 Introduction endovascular implants = complications Endograft infection o Incidence 0.2-5% 1 o Optimal management: o Highly heterogeneous o Definitive source control: surgical excision o Medical/Surgical o Patient/device characteristics 1. MR Smeeds, AA Duncan, MP Harlander-Locke et al. Treatment and outcomes of aortic endograft infection. J Vasc Surg, 2016
4 Risk factors for infection Deployment in an infected field o Aortic fistulae: enteric/bronchial o Aortic ulcer o Aortic Pseudoaneurysm o Mycotic aneurysm Postoperative sepsis Aortic procedures: i.e. embolization Non-aortic related pathologies
5 Purpose Define the presentation, management and outcomes of aortic endograft infection at our institution
6 Methods Retrospective review 1/ /2017 Abdominal or thoracic endograft infections o Infection during follow-up o Aortoenteric/aortobronchial fistulae o Mycotic aneurysm
7 Methods Definition of aortic endograft infection: o MAGIC criteria 1 1. OTA Lyons, M Baguneid, TD Barwick et al. Diagnosisof Aortic Graft Infection: A Case Definition by the Management of Aortic Graft Infection Colaboration (MAGIC) Eur J Vasc Endovasc Surg, 2016
8 Methods Analysis o Demographic data and comorbidities o Indication for index procedure o Technical factors and possible sources of infection o Symptoms and Diagnosis o Treatment o Mortality
9 Results: demographic data 21/660 endovascular aortic procedures: 3,2% 20 male (95.2%) Age 70.4y (47-84y SD: 10.2) Comorbidities
10 Results: Indications index procedure 4 Mycotic 5 Ao fistulae 12 Ao 2 abdominal 1 Ao-aesophageal 1 TA Ao dissection 7 AAA 1 Ao-bronchial 1 juxtarenal AA 2 thoracic 3 Ao-enteric 2 TA Ao A 1 Thoracic An
11 Results: Indications index procedure 4 Mycotic 5 Ao fistulae 12 Ao 2 abdominal/ 2 EVAR 1 Ao-aesophageal/ 1 TEVAR 1 Ao-bronchial/ 1TEVAR 1 TA Ao dissection/ 1 TEVAR 7 AAA/ 2 AUI, 5 BIF 1 juxtarenal AA/ 1 FEVAR 2 thoracic/ 2 TEVAR 3 Ao-enteric/ 3 AUI EVAR 2 TA Ao A/ 2 BEVAR 1 Thoracic An/ 1 TEVAR
12 Results: Tq factors & Source of infection 4 Mycotic 5 Ao fistulae
13 Results: Symptoms & diagnostic Symptoms: ofever 57% opain 38.2% otoxic syndrome 28.6% oaortic fistulae 23.8% ogroin abscess 9.5% Diagnostic: omicro oct scan opet scan
14 Results: Symptoms & diagnostic T to infection: 24.3months (0-128m SD: 39.3) 4 Mycotic 5 Ao fistulae 12 Ao 3m 0.2-6m SD: m SD: m m SD: 45.4
15 Results: Treatment 4 Mycotic 5 Ao fistulae 12 Ao 2 medical treatment 1 explant/in situ 5 medical treatment 4 medical treatment 6 explant/ extranatomic 1 TEVAR 1 debridement 1 debridement
16 Results: Mortality Follow-up: 22.1months (0.5-71m SD: 22.7) 4 Mycotic 5 Ao fistulae 12 Ao 1y: 50% 2y: 50% 1y: 60% 2y: 80% 1y: 16.7% 2y: 41.7%
17 Comments Indication of index procedure highly determines kind of aortic endograft infection Time to presentation depends mainly on etiology of infection Kind of treatment depends on o Patient characteristics o Kind of infection o Device characteristics
18
19 How we deal with aortic endograft infection Elena Iborra, Emma Espinar, Ramon Vila Hospital Universitari de Bellvitge Barcelona, Spain
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