Infection after Endovascular Repair of Complex Aortic and Thoracoabdominal Aneurysms with Fenestrated and Branched Devices: A Systematic Descriptive Review.

Abstract

Endograft infection after fenestrated or branched endovascular aortic repair (F/BEVAR) is an uncommon yet serious complication due to the involvement of the visceral branches and the complexity of the required treatment. This systematic review aimed to descriptively synthesize reported cases of infection after F/BEVAR, with an emphasis on clinical presentation, microbiology, associated aortoenteric fistulas (AEFs), management strategies, and reported outcomes. A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, with MEDLINE, Scopus, and the Cochrane Library searched up to September 14, 2025; eligible reports included case reports and series describing F/BEVAR-related infections. Eleven studies encompassing 26 patients were identified. The weighted mean patient age was approximately 73 years, and 77% of patients were male. The weighted mean interval from repair to infection was approximately 20 months. Microbiological findings were heterogeneous, with both Gram-negative and Gram-positive organisms and several polymicrobial infections reported. AEFs were confirmed in at least 8/26 (31%) patients. Surgical explantation with reconstruction was performed in 12/26 patients (46%), conservative therapy in 12/26 (46%), and graft-preserving procedures in 2/26 (8%). The overall 30-day mortality rate was 4/26 (15%): 3/12 after graft explantation and reconstruction, 1/12 after conservative treatment, and 0/2 after graft-preserving procedures. Among the 22 patients who survived 30 days, 18 (82%) were alive at the last reported follow-up: 9/9 after graft explantation and reconstruction, 7/11 after conservative treatment, and 2/2 after graft-preserving procedures. Infection after F/BEVAR requires individualized management and has been reported to have a heterogeneous clinical presentation, microbiological findings, and treatment strategies. Given the limited evidence base, consisting primarily of case reports and small case series, these findings should be interpreted descriptively. Multicenter collaboration and standardized reporting are needed to better characterize this complication and inform future management strategies.