Management of vascular graft and endoprosthetic infection of the thoracic and thoraco-abdominal aorta.

Infection of a vascular prosthesis or endovascular stent-graft is probably the most serious complication that may occur after implantation and dramatically affects the patient's outcome. Surgical treatment is almost always required but even after surgery, morbidity can be significant. Several approaches have been described with some advantages and/or some limitations. Complete resection of the infected foreign material with debridement of the surrounding tissue gives most probably the better results. Orthotopic reconstruction is the best option for all thoracic and thoraco-abdominal pathologies and the use of coated prostheses, homografts or self-made vascular tubes from xenopericardial tissue has to be discussed from case to case. In some exceptional situations, endovascular stent-graft can be performed as bridging to a more complete treatment if general condition of the patient has to be stabilized.