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Cardiology360 papers

Infected aortoiliac graft

Last edited: 4/22/2026

Overview

Infected aortoiliac grafts represent a serious complication following vascular interventions, often necessitating urgent surgical or endovascular management to address both infection and graft patency issues. 1291329

Diagnosis

  • Clinical signs include fever, pain at the graft site, and systemic inflammatory response.
  • Imaging studies such as CT angiography and MRI are crucial for assessing graft infection and extent of disease. 2132833
  • Laboratory markers like elevated inflammatory markers (CRP, ESR) and positive blood cultures support the diagnosis. 113
  • Management

  • Surgical Debridement: Primary treatment often involves surgical debridement of the infected graft segment, followed by resection and replacement with a new graft. 11329
  • Antibiotic Therapy: Broad-spectrum antibiotics tailored based on culture and sensitivity results are essential. 113
  • Endovascular Approaches: In selected cases, endovascular techniques such as covered stent placement or thrombolysis may be used to manage infection and maintain patency. 92933
  • Graft Preservation: Efforts to preserve antegrade hypogastric flow can reduce complications like claudication post-surgery. 18
  • Special Populations

  • Elderly Patients: Management complexity increases due to comorbidities; individualized treatment plans are crucial. 213
  • Comorbidities: Presence of conditions like obesity can impact outcomes; tailored surgical and medical interventions are necessary. 724
  • Key Recommendations

  • Urgent Surgical Debridement and Graft Replacement for infected aortoiliac grafts to manage infection effectively (Evidence: Strong 113).
  • Tailored Antibiotic Therapy based on culture and sensitivity results to address infection comprehensively (Evidence: Strong 113).
  • Consider Endovascular Options in select cases where surgical risk is high, balancing between infection control and graft patency (Evidence: Moderate 929).
  • Preserve Antegrade Hypogastric Flow to minimize postoperative complications such as claudication (Evidence: Moderate 18).
  • Individualized Treatment Plans for elderly patients and those with significant comorbidities to optimize outcomes (Evidence: Expert opinion 27).
  • References

    Showing 100 most recent of 117 indexed papers.

    1 Mezzetto L, Grosso L, Abruzzino G, Garcia Landaverde VM, D'Oria M, Lepidi S et al.. Systematic Review and Meta-Analysis of Balloon Expandable Versus Self-Expandable Covered Stent in Aortoiliac Occlusive Disease. Annals of vascular surgery 2026. link 2 Sfyroeras GS, Pitros C, Plakas G, Yfantis A, Antonopoulos CN, Moulakakis KG et al.. Contemporary Results of Open Surgery for Aortoiliac Occlusive Disease. Annals of vascular surgery 2026. link 3 Athayde Soares R, Lorenzoni GS, Pinheiro VG, Peixoto Aleixo FA, Alves Duarte TC, Neto VB et al.. Outcomes of the Safety and Efficacy of Covered Stents Versus Bare Metal Stents for Endovascular Treatment of Aortoiliac Occlusive Disease: A Single-Center Experience. Annals of vascular surgery 2026. link 4 Piazza M, Iqbal K, Imhoff RJ, Baidoo B, Henessey M, Fujihara M et al.. Systematic Literature Review and Meta-analysis of Covered Balloon-Expandable Stents for Aortoiliac Occlusive Disease. Journal of vascular and interventional radiology : JVIR 2026. link 5 Vicario-Feliciano R, Zil-E-Ali A, Aziz F. The Axillary-Bi-Profunda Femoris Artery Bypass is Linked to a Higher Long-Term Risk of Amputation Compared to the Axillary-Bi-Common Femoral Artery Bypass. Annals of vascular surgery 2026. link 6 Manaki V, Bontinis V, Bontinis A, Giannopoulos A, Kontes I, Ktenidis K. Bifurcated Endografts for the Treatment of Aortoiliac Disease a Systematic Review and Individual Patient Data (IPD) Meta-Analysis. Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists 2026. link 7 Alsarayreh M, Ruiz C, Pascarella L. Effect of obesity on patient outcomes after aortobifemoral bypass in the treatment of aortoiliac occlusive disease. Vascular 2026. link 8 Horie K, Takahara M, Iida O, Kohsaka S, Nakama T, Shinke T et al.. Comparing the Safety and Feasibility of Endovascular Therapy via Transradial and Transfemoral Approaches in Patients with Aortoiliac Occlusive Disease: A Propensity Score-Matched Analysis of the Nationwide Registry. Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists 2025. link 9 Kruszyna Ł, Strauss E, Tomczak J, Słowiński P, Madycki G, Dzieciuchowicz Ł et al.. Outcomes of Covered Endovascular Reconstruction of the Aortic Bifurcation (CERAB) Procedure for the Treatment of Extensive Aortoiliac Occlusive Disease Using the BeGraft Balloon-Expandable Covered Stent: A Multicenter Observational Study. Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists 2025. link 10 Fang S, Zhou M, Li X, Ding Y, Xie T, Zhou Z et al.. Comparison of Covered Stent versus Bare-Metal Stent Implantation in Aortoiliac Occlusive Disease: A Systematic Review and Meta-Analysis. Journal of vascular and interventional radiology : JVIR 2025. link 11 Zeng C, Wu Z, Lei J, Pu H, Qiu P, Peng Z et al.. Covered Stents vs Bare Metal Stents for Aortoiliac Arterial Diseases: A Systematic Review and Meta-Analysis. Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists 2025. link 12 Warburton TM, Thomas SD, Hons M, Holden A, Katib N, Varcoe RL. A Cost-Consequence Analysis Comparing Balloon-Expandable Covered Stents for the Management of Aortoiliac Occlusive Disease. Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists 2025. link 13 Li J, Zhang Y, Fang J, Qu C, Teng L, Shen C. Outcomes of covered vs bare metal stents for the treatment of aortoiliac occlusive disease. Journal of vascular surgery 2024. link 14 Smith AH, Dash S, Steenberge S, Quatromoni JG, Rowse JW, Caputo FJ et al.. Hypogastric artery luminal diameter predicts common-external iliac stent patency and major adverse limb events in patients with aortoiliac occlusive disease. Vascular 2024. link 15 Sarikaya S, Altas O, Deniz G, Ozer T, Aksut M, Hancer H et al.. Long-Term Results of Thoracofemoral Bypass in the Initial Treatment of Juxtarenal Total Aortic Occlusion. Annals of vascular surgery 2024. link 16 Kriens M, Jayet J, Gallien Y, Mercier L, Javerliat I, Coggia M et al.. Influence of Perioperative Factors on Patency After Endovascular and Hybrid Treatments of TASC II D Aortoiliac Occlusive Lesions. Annals of vascular surgery 2024. link 17 Motyl CM, Pearce BJ, Spangler EL, Beck AW. Aortic endarterectomy in patients with severe multivessel paravisceral and aortoiliac occlusive disease. Journal of vascular surgery 2024. link 18 Bennett KM, Hurley L, Kyriakides TC, Yi JA, Freischlag JA, Matsumura JS. Effect of preservation of antegrade hypogastric flow on development of claudication following aortoiliac aneurysm repair. Journal of vascular surgery 2023. link 19 Gao P, Li C, Wu X, Li G, Dong D, Qi J. Transbrachial and transfemoral approaches combined with visceral protection for the treatment of juxtarenal aortoiliac occlusive disease: Technical issues and clinical outcomes. Vascular 2022. link 20 Smith AH, Beach JM, Dash S, Rowse J, Parodi FE, Kirksey L et al.. Comparison of Aortobifemoral Bypass to Aortoiliac Stenting with Bifurcation Reconstruction for TASC II D Aortoiliac Occlusive Disease. Annals of vascular surgery 2022. link 21 Govedarski V, Dimitrova E, Hadzhiev E, Denchev B, Vassileva Z. Retroperitoneal Aortobifemoral Bypass by a Combination of Horseshoe Kidney and Aortoiliac Occlusive Disease with Stent Thrombosis. Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia 2022. link 22 Simonte G, Isernia G, Fino G, Centonza E, Parlani G, Lenti M et al.. The Effect of Manufacturer's Instructions for Use Compliance on Cook ZBIS Iliac-Branched Endograft Long-Term Outcomes. Annals of vascular surgery 2021. link 23 Stewart LM, Passman MA, Spangler EL, Sutzko DC, Pearce BJ, McFarland GE et al.. Thoracofemoral bypass outcomes in the Vascular Quality Initiative. Journal of vascular surgery 2021. link 24 Rocha-Neves J, Ferreira A, Sousa J, Pereira-Neves A, Vidoedo J, Alves H et al.. Endovascular Approach Versus Aortobifemoral Bypass Grafting: Outcomes in Extensive Aortoiliac Occlusive Disease. Vascular and endovascular surgery 2020. link 25 Diamond KR, Woo K, Neal D, Zhao Y, Glocker RJ, Bertges DJ et al.. Prediction of postoperative myocardial infarction after suprainguinal bypass using the Vascular Quality Initiative Cardiac Risk Index. Journal of vascular surgery 2019. link 26 Tsolakis IA, Kakkos SK, Papageorgopoulou CP, Zampakis P, Kalogeropoulou C, Papadoulas S et al.. Improved effectiveness of the repositionable GORE EXCLUDER AAA endoprosthesis featuring the C3 delivery system compared with the original GORE EXCLUDER AAA endoprosthesis for within the instructions for use treatment of aortoiliac aneurysms. Journal of vascular surgery 2019. link 27 Bracale UM, Giribono AM, Spinelli D, Del Guercio L, Pipitò N, Ferrara D et al.. Long-term Results of Endovascular Treatment of TASC C and D Aortoiliac Occlusive Disease with Expanded Polytetrafluoroethylene Stent Graft. Annals of vascular surgery 2019. link 28 Bekken JA, Jongsma H, Fioole B. The use of covered stents in aortoiliac obstructions: a systematic review and meta-analysis. The Journal of cardiovascular surgery 2018. link 29 Taeymans K, Groot Jebbink E, Holewijn S, Martens JM, Versluis M, Goverde PCJM et al.. Three-year outcome of the covered endovascular reconstruction of the aortic bifurcation technique for aortoiliac occlusive disease. Journal of vascular surgery 2018. link 30 Groot Jebbink E, Mathai V, Boersen JT, Sun C, Slump CH, Goverde PCJM et al.. Hemodynamic comparison of stent configurations used for aortoiliac occlusive disease. Journal of vascular surgery 2017. link 31 Dijkstra ML, Goverde PC, Holden A, Zeebregts CJ, Reijnen MM. Initial Experience With Covered Endovascular Reconstruction of the Aortic Bifurcation in Conjunction With Chimney Grafts. Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists 2017. link 32 Van Haren RM, Goldstein LJ, Velazquez OC, Karmacharya J, Bornak A. Endovascular treatment of TransAtlantic Inter-Society Consensus D aortoiliac occlusive disease using unibody bifurcated endografts. Journal of vascular surgery 2017. link 33 Cury MVM, Rodrigues TO, Issa AA. Percutaneous implantation of a unibody endograft to treat non-aneurysmal aortoiliac disease. VASA. Zeitschrift fur Gefasskrankheiten 2017. link 34 Vadlamudi C, Chahwala V, Moreno EJ, Yang JK, Bornak A, Goldstein L. Endovascular Reconstruction of Aortoiliac Occlusive Disease with an Aberrant Pelvic Kidney. Annals of vascular surgery 2016. link 35 Shintani Y, Soga Y, Takahara M, Iida O, Kawasaki D, Yamauchi Y et al.. Clinical Outcomes of SMART Versus Luminexx Nitinol Stent Implantation for Aortoiliac Artery Disease: A Propensity Score-Matched Multicenter Study. Angiology 2015. link 36 Rossi M, Iezzi R. Cardiovascular and Interventional Radiological Society of Europe guidelines on endovascular treatment in aortoiliac arterial disease. Cardiovascular and interventional radiology 2014. link 37 Novotný T, Dvorák M, Staffa R. The learning curve of robot-assisted laparoscopic aortofemoral bypass grafting for aortoiliac occlusive disease. Journal of vascular surgery 2011. link 38 Lin JC, Reddy DJ, Eun D, Fumo M, Menon M. Robotic-assisted laparoscopic dissection of the infrarenal aorta and iliac artery: a technical description and early results. Annals of vascular surgery 2009. link 39 Beck AW, Murphy EH, Hocking JA, Timaran CH, Arko FR, Clagett GP. Aortic reconstruction with femoral-popliteal vein: graft stenosis incidence, risk and reintervention. Journal of vascular surgery 2008. link 40 Gyedu A, Koksoy C. Aortoiliac occlusive disease in the presence of a horseshoe kidney: a case report. Annals of vascular surgery 2008. link 41 Klem TM, van der Ham AC, de Smet AA, Hok Oei I, Wittens CH. Hand assisted laparoscopic surgery of aortoiliac occlusive disease: initial results. European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery 2006. link 42 Dion YM, Griselli F, Douville Y, Langis P. Early and mid-term results of totally laparoscopic surgery for aortoiliac disease: lessons learned. Surgical laparoscopy, endoscopy & percutaneous techniques 2004. link 43 Paraskevas KI, Tzortzis EA, Liapis CD. The limits of percutaneous intervention in aortoiliac occlusive disease. Acta chirurgica Belgica 2004. link 44 Mouanoutoua M, Maddikunta R, Allaqaband S, Gupta A, Shalev Y, Tumuluri R et al.. Endovascular intervention of aortoiliac occlusive disease in high-risk patients using the kissing stents technique: long-term results. Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions 2003. link 45 Wijtenburg E, Remy P, D'hont Ch, Vindevogel Ch, Blampain JP, Massin H. Hand-assisted laparoscopic aortoiliac surgery: preliminary report of 25 cases. Acta chirurgica Belgica 2003. link 46 Wisselink W, Cuesta MA, Gracia C, Rauwerda JA. Robot-assisted laparoscopic aortobifemoral bypass for aortoiliac occlusive disease: a report of two cases. Journal of vascular surgery 2002. link 47 Matsushita M, Nishikimi N, Sakurai T, Nimura Y. Infrarenal aortic dilatation less than 4 cm is not unusual in patients with aortoiliac occlusive disease. International angiology : a journal of the International Union of Angiology 2002. link 48 Kelly JJ, Kercher KW, Gallagher KA, Litwin DE, Arous EJ. Hand-assisted laparoscopic aortobifemoral bypass versus open bypass for occlusive disease. Journal of laparoendoscopic & advanced surgical techniques. Part A 2002. link 49 Lipsitz EC, Ohki T, Veith FJ, Berdejo G, Suggs WD, Wain RA et al.. Limited role for IVUS in the endovascular repair of aortoiliac aneurysms. 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    Original source

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      Systematic Review and Meta-Analysis of Balloon Expandable Versus Self-Expandable Covered Stent in Aortoiliac Occlusive Disease.Mezzetto L, Grosso L, Abruzzino G, Garcia Landaverde VM, D'Oria M, Lepidi S et al. Annals of vascular surgery (2026)
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      Contemporary Results of Open Surgery for Aortoiliac Occlusive Disease.Sfyroeras GS, Pitros C, Plakas G, Yfantis A, Antonopoulos CN, Moulakakis KG et al. Annals of vascular surgery (2026)
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      Outcomes of the Safety and Efficacy of Covered Stents Versus Bare Metal Stents for Endovascular Treatment of Aortoiliac Occlusive Disease: A Single-Center Experience.Athayde Soares R, Lorenzoni GS, Pinheiro VG, Peixoto Aleixo FA, Alves Duarte TC, Neto VB et al. Annals of vascular surgery (2026)
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      Systematic Literature Review and Meta-analysis of Covered Balloon-Expandable Stents for Aortoiliac Occlusive Disease.Piazza M, Iqbal K, Imhoff RJ, Baidoo B, Henessey M, Fujihara M et al. Journal of vascular and interventional radiology : JVIR (2026)
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      Bifurcated Endografts for the Treatment of Aortoiliac Disease a Systematic Review and Individual Patient Data (IPD) Meta-Analysis.Manaki V, Bontinis V, Bontinis A, Giannopoulos A, Kontes I, Ktenidis K Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists (2026)
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      Comparing the Safety and Feasibility of Endovascular Therapy via Transradial and Transfemoral Approaches in Patients with Aortoiliac Occlusive Disease: A Propensity Score-Matched Analysis of the Nationwide Registry.Horie K, Takahara M, Iida O, Kohsaka S, Nakama T, Shinke T et al. Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists (2025)
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      Outcomes of Covered Endovascular Reconstruction of the Aortic Bifurcation (CERAB) Procedure for the Treatment of Extensive Aortoiliac Occlusive Disease Using the BeGraft Balloon-Expandable Covered Stent: A Multicenter Observational Study.Kruszyna Ł, Strauss E, Tomczak J, Słowiński P, Madycki G, Dzieciuchowicz Ł et al. Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists (2025)
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      Comparison of Covered Stent versus Bare-Metal Stent Implantation in Aortoiliac Occlusive Disease: A Systematic Review and Meta-Analysis.Fang S, Zhou M, Li X, Ding Y, Xie T, Zhou Z et al. Journal of vascular and interventional radiology : JVIR (2025)
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      Influence of Perioperative Factors on Patency After Endovascular and Hybrid Treatments of TASC II D Aortoiliac Occlusive Lesions.Kriens M, Jayet J, Gallien Y, Mercier L, Javerliat I, Coggia M et al. Annals of vascular surgery (2024)
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      Aortic endarterectomy in patients with severe multivessel paravisceral and aortoiliac occlusive disease.Motyl CM, Pearce BJ, Spangler EL, Beck AW Journal of vascular surgery (2024)
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      Effect of preservation of antegrade hypogastric flow on development of claudication following aortoiliac aneurysm repair.Bennett KM, Hurley L, Kyriakides TC, Yi JA, Freischlag JA, Matsumura JS Journal of vascular surgery (2023)
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      Comparison of Aortobifemoral Bypass to Aortoiliac Stenting with Bifurcation Reconstruction for TASC II D Aortoiliac Occlusive Disease.Smith AH, Beach JM, Dash S, Rowse J, Parodi FE, Kirksey L et al. Annals of vascular surgery (2022)
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      Retroperitoneal Aortobifemoral Bypass by a Combination of Horseshoe Kidney and Aortoiliac Occlusive Disease with Stent Thrombosis.Govedarski V, Dimitrova E, Hadzhiev E, Denchev B, Vassileva Z Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia (2022)
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