Print this pageArterial reconstructions in infected field using covered stents or stent-grafts are effective in high risk patients with limited life expectancy
Gautam Agarwal, Haraldur Bjarnason, MD, Timothy M. Sullivan, MD, Sanjay Misra, MD, Michael A. McKusick, MD, Gustavo S. Oderich, MD and Peter Gloviczki, MD
Vascular Surgery, Mayo Clinic, Rochester, MN
Objective: Arterial reconstruction in infected field is challenging and complications following open surgical repair are frequent. The purpose of this study was to review outcome of endovascular reconstructions using covered stents or stent-grafts in high risk patients with infected aneurysms or prosthetic graft infections.
Methods: Clinical data and outcomes of ten patients treated with covered stents or stent-grafts placed in infected fields were reviewed. Technical success, morbidity, mortality, re-infection and vascular complications were assessed.
Results: Between 2001 and 2005, 10 patients, 7 males and 3 females, with a mean age of 64 years (range, 39-86), were treated with covered stents (n=9) or stent-grafts (n=1) for infected pseudo aneurysms (n=5), iliac artery-ureteral fistulas (n=4) or for aortic graft infection (n=1). All patients were symptomatic and high risk, 5 had a life expectancy < 1 year, and 8 had hostile anatomy for open repair. All pseudo aneurysms involved visceral arteries. Indications for interventions included acute bleeding in 6, prevent rupture in 3, sepsis in 1. The predominant organisms included staphylococcus in 4, E. coli in 3, enterococcus in 2 and fungus in 1. All procedures were percutaneous, performed under local anesthesia. Procedural success was 100%. No early deaths occurred; all were discharged with patent stents. Early complications occurred in 2 patients (groin hematoma: 1, intraoperative arterial dissection: 1). Mean follow-up was 7 months (range: 1- 30). Mid-term complications occurred in 1 pt, in an aortic graft infection as a direct consequence of the procedure. He required open exploration and reconstruction with native veins. Another patient with rebleeding was successfully treated with a second covered stent. Reocclusion rate during follow-up was 10%. Four deaths occurred after 30 days (40%). The cause of death was advanced cancer in 3, bleeding from aortic erosion remote from a treated pseudoaneurysm in another.
Conclusions: Covered stents or stent-grafts can be used effectively in infected fields in selected high risk patients with limited life expectancy. The incidence of re-infection or mid-term procedure related mortality is low.