Preservation of the infected thoracic aortic endograft with thoracoscopic drainage and continuous irrigation

The gold standard for aortic endograft infection includes the excision of infected endograft, debridement, and reconstruction. However, these methods are not always the best option for patients with poor clinical status. We assessed the suitability of alternative methods for managing aortic endograft infection. The patient was a 72-year-old man whose previous abdominal surgeries provoked recurrent cholangitis. The patient had also undergone thoracic endovascular aortic repair (TEVAR). One month after the TEVAR, he was readmitted with high-grade fever and diagnosed with endograft infection. Due to his frail condition, we chose a less invasive and conservative strategy; thoracoscopic drainage with endograft preservation, followed by continuous irrigation. He recovered well, and has survived more than 2 years after the drainage procedure. In unstable patients or those with severe comorbidities who cannot tolerate endograft excision, thoracoscopic drainage with endograft preservation is less invasive, and can be a bridging or temporary solution.