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Arch replacement following endovascular arch repair for an infected stent: case report

Endovascular graft infection is a rare but challenging complication that requires a tailored approach to remove the infected graft and restore the arterial circulation combined with long-term antibiotic therapy. We present a case with a previous endovascular repair of the aortic arch and descending thoracic aorta on a 78-year-old male deemed too high risk for surgery. Three years after the endovascular repair, he presented with fever of unknown origin and the diagnosis of stent graft infection was made based on clinical, microbiological and radiological criteria. The peri-graft infection within the arch had dislocated the stent branch on the innominate artery and caused and expanding aneurysm. Urgent surgical indication was made based on the radiological findings and he underwent a removal of the infected material followed by aortic arch and descending aorta reconstruction with a total arch replacement with a frozen elephant trunk device using cardiopulmonary bypass with moderate hypothermic circulatory arrest and antegrade cerebral perfusion. The patient made an uneventful recovery and is free of recurrence eighteen months after the operation. Treatment of endovascular graft infections require a tailored treatment after multidisciplinary team discussions. In this particular case, the patient was deemed too high risk for surgery in the first instance, but we demonstrated that with treated in highly specialised unit, uneventful recovery is possible even after a more complex aortic repair following the endovascular infection. Complex aortic repair benefits always from a specialised multi-disciplinary team discussion and referral to high volume centers in order to achieve best