Management of Aortic Infections: Role of Open Surgery and the Value of Multidisciplinary Team Approach

Aortic graft infection is known to be a very complex and challenging pathology, whether it is a surgical graft or an endograft, and despite of all the recent surgical and medical advances, it still carries a significant risk of morbidity and mortality. Since the first aortic endograft was inserted by Volodos and colleagues in Ukraine, the use of endografts in aortic disease has increased dramatically. The majority of early endograft explantations were performed for complications in device insertion and deployment and persistent endoleak causing sac expansion. Stent infection was first reported in 1993 and is now thought to occur in 1–4% of endografts, resulting in major morbidity, mortality and economic cost. It is unclear whether or not the incidence of endograft infection is increasing, but the use of endografts in infected fields such as mycotic aneurysms or aorto-enteric fistulae will result in an ongoing case load. There are few data available to guide management and clinical approaches to this complex condition which differ widely with variable outcomes, but consensus diagnostic criteria have been defined. Large multicentre retrospective analyses have been performed using the Swedish vascular dataset and in France and the USA. Multicentre prospective data collection is underway by the Management of Aortic Graft Infection Collaboration (www.gsttbrc.com/MAGIC).