Treatment of an Infected TEVAR with Extra- and Endovascular Bacteriophage Application

• Published in: EJVES vascular forum 2022-01, Vol.56, p.20-23
• Main Authors: Grambow, Eberhard, Junghans, Simon, Kröger, Jens Christian, Reisinger, Emil Christian, Krause, Bernd Joachim, Groß, Justus
• Format: Article
• Language: English
• Subjects: Antibiotic resistance; Case Report; Graft infection; Phage therapy; Staphylococcus aureus sepsis
• ISSN: 2666-688X; 2666-688X
• DOI: 10.1016/j.ejvsvf.2022.02.004

Graft infections are severe complications. Surgical resection of infected aortic stent grafts is associated with high mortality and morbidity. Therefore, alternatives or adjuncts to antibiotic treatment and extensive surgery are urgently needed. A 67 year old woman was admitted with a methicillin sensitive Staphylococcus aureus infected stent graft in the thoracic aorta. Local infection was confirmed by PET-CT imaging. Surgical resection of the stent graft was not feasible because of comorbidities. Therefore, a three step approach for local bacteriophage treatment was performed as a last resort treatment. Firstly, the para-aortic tissue was debrided via left thoracotomy, a bacteriophage suspension was applied on the outer surface of the aorta, and an irrigation vacuum system was installed. After repeated alternating instillation of the bacteriophage suspension for three days, as a second step vacuum sponges were removed and a bacteriophage containing gel was applied locally on the outer surface of the aorta. In the third step, the bacteriophage containing gel was applied to a thoracic stent graft, which in turn was endovascularly placed into the infected stent. After 28 days, the patient was discharged from hospital with normalised infection parameters. PET-CT imaging at three and 12 months post intervention did not show signs of infection in or around the thoracic aorta. This case demonstrates successful treatment of an infected endovascular stent graft by application of bacteriophages both to extravascular and, as a novel approach, endovascular sites using a bacteriophage coated stent graft. •Infections of vascular grafts are severe complications in vascular surgery.•Bacteriophages are viruses that have lytic activity against specific bacteria.•An infected stent graft in the thoracic aorta was treated with bacteriophages.•Bacteriophages were applied both endo- and extravascularly.•Local bacteriophage application was combined with systemic antibiotic treatment.