Thoracic aortic stent graft infection carries high mortality despite surgical intervention

This narrative review, supplemented by a case series of 3 patients admitted between 2015 and 2025, addresses the challenging management of thoracic aortic stent graft infections, including aorto-esophageal fistula, aorto-tracheal fistula, and aorto-tracheoesophageal fistula. The authors describe surgical interventions such as abscess debridement and drainage, re-intervention with covered stent, esophageal resection, and lobectomy, as well as staged aortic bypass.

Key findings from the case series show a 30-day postoperative mortality of 33.3% (1 of 3 patients) and a 1-year mortality of 100% (3 of 3 patients). No p-values or confidence intervals are reported. The narrative literature review component synthesizes existing evidence but does not provide pooled effect sizes.

The authors acknowledge limitations including the small sample size and the narrative review methodology, which preclude definitive conclusions. Optimal management remains challenging, though early recognition and timely definitive source control may be important.

Given the high mortality and limited evidence, clinicians should interpret these findings cautiously. The review underscores the need for larger studies to guide treatment decisions for these rare but life-threatening complications.