35 Management and aortic reconstruction in patients with infrarenal aortic graft infection. A UK vascular networks’ 10-year experience

Abstract Aim Aortic graft infections (AGI) are rare with no global consensus for diagnosis and management, we report our experience of management and complex in situ reconstruction. Methods Retrospective cohort study of 49 patients who developed AGI following EVAR and open aortic intervention from January 2010 to December 2020. Results Primary intervention was open aortic repair in 40 (81.6%) patients (7 ruptured aneurysm (rAAA), 22 aneurysmal disease and 11 aortoiliac-occlusive disease). Nine (18.4%) patients had an EVAR (3 for rAAA). AGI was identified at a median of 18 months post primary intervention. All patients were commenced on long term antibiotics. 22 (45%) patients were unfit for explantation, 8 (16.3%) were on surveillance for low grade infection, while 15 (30.6%) had an explant and aortic graft in situ reconstruction, with 2 (13.3%) requiring interval aortic stent prior to explant. Femoral vein (53%) and bovine pericardium (20%) were most commonly used conduit. Post-operative 30 day mortality was 13.3% (2 patients). Survival post-explant was 69% and 65% at 2 years and 5 years respectively versus 43% and 29% in the non-operative group. Conclusion Infrarenal aortic graft in situ reconstruction is safe following AGI with a reasonable 5 year survival rate. Patient fitness assessment is pertinent due to high perioperative risk.