Complex endovascular aortic repair after infected vascular graft reconstruction with bovine pericardial graft: A case report and review of the literature

This report describes the management of a vascular graft infection using a bovine pericardial graft and its subsequent use as a distal landing zone to perform complex endovascular aortic repair. In addition, the current evidence supporting this approach is reviewed. A 76-year-old patient presenting with an aortouni-iliac graft infection and a 67-mm thoracoabdominal aortic aneurysm underwent open surgical reconstruction, which involved explantation of the infected graft and implantation of a bovine pericardial graft. After 7 months, branched endovascular aortic repair was performed to treat the thoracoabdominal aortic aneurysm, using the bovine pericardial graft as the distal landing zone. Completion angiography and a computed tomography angiography at the 1-month follow-up demonstrated technical success. The literature indicates that the use of bovine pericardial grafts is associated with high graft patency rates and low reinfection rates in the treatment of vascular graft and endograft infections. Although performing complex endovascular procedures in potentially infected areas is feasible, long-term follow-up is necessary to determine whether a bovine pericardial graft can provide a durable seal. Furthermore, tailored long-term antimicrobial therapy for each individual case is essential for the effective management of vascular graft infections. In this context, the sequential use of a bovine pericardial graft followed by a branched endograft could be an effective technique for managing vascular graft and endograft infections with additional proximal aortic disease.