Treatment
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➤ In patients presenting with an infected graft in the presence of
extensive contamination with gross purulence, the SVS recommends
extra-anatomic reconstruction followed by excision of all graft material
along with aortic stump closure covered by an omental flap. (1-B)
➤ In patients presenting with an infected graft with minimal
contamination, the SVS suggests in situ reconstruction with
cryopreserved allograft. (2-B)
➤ In a stable patient presenting with an infected graft, the SVS suggests
in situ reconstruction with femoral vein after graft excision and
débridement. (2-B)
➤ In unstable patients with infected graft, the SVS recommends in
situ reconstruction with a silver or antibiotic-impregnated graft,
cryopreserved allograft, or polytetra-fluoroethylene (PTFE) graft.
(1-B)
Recommendation For Postoperative Surveillance
➤ The SVS recommends baseline imaging in the first month after EVAR
with contrast-enhanced CT and color duplex ultrasound imaging. In
the absence of an endoleak or sac enlargement, imaging should be
repeated in 12 months using contrast-enhanced CT or color duplex
ultrasound imaging. (1-B)
➤ If a type II endoleak is observed 1 month after EVAR, the SVS
suggests postoperative surveillance with contrast-enhanced CT and
color duplex ultrasound imaging at 6 months. (2-B)
➤ If neither endoleak nor AAA enlargement is observed 1 year after
EVAR, the SVS suggests color duplex ultrasound when feasible, or CT
imaging if ultrasound is not possible, for annual surveillance. (2-C)
➤ If a type II endoleak is associated with an aneurysm sac that is
shrinking or stable in size, the SVS suggests color duplex ultrasound
for continued surveillance at 6-month intervals for 24 months and
then annually thereafter. (2-C)
➤ If a new endoleak is detected, the SVS suggests evaluation for a type I
or type III endoleak. (2-C)
➤ The SVS suggests non-contrast-enhanced CT imaging of the entire
aorta at 5-year intervals after open repair or EVAR. (2-C)
