Thoracic aortic vascular graft infection: outcome after conservative treatment without graft removal.

OBJECTIVES
Surgical debridement with aortic graft removal is considered the preferred treatment for thoracic aortic vascular graft infection (VGI). Conservative treatment with antibiotics only is usually reserved for inoperable patients. Due to Outpatient Parenteral Antimicrobial Therapy (OPAT) and better understanding of the antibiotic impact on biofilms, long-term targeted antibiotic therapy without graft removal may be an alternative treatment option for selected thoracic aortic VGI patients. The aim of this case series was to evaluate the outcome in patients with thoracic aortic VGI who were treated without graft removal.


METHODS
This single-centre retrospective cohort study evaluated patients with a thoracic aortic VGI diagnosed between 2008 and 2021 and who were treated without graft removal. Primary outcome parameter was 6-month mortality rate after VGI diagnosis. Secondary outcome parameters were cure rates and relapse of infection.


RESULTS
Twenty-four patients with thoracic aortic VGI who were managed without graft removal were identified. Mortality rate six months after VGI diagnosis was 8% (2/24), one of these deaths was infection-related. Median antibiotic treatment duration was 13 months (IQR 15). A total of 16 patients (67%) were cured. No relapses occurred after a median of 24 months (IQR 32) follow-up.


CONCLUSIONS
Intensive antibiotic treatment, without graft removal, may be a non-inferior option in patients with a thoracic aortic VGI who are not considered for surgery.