From the Research
Antibiotic prophylaxis is necessary prior to Endovascular Aneurysm Repair (EVAR) to reduce the risk of surgical site infections and serious complications. The standard approach is to administer a single dose of a first-generation cephalosporin, such as cefazolin (1-2g IV), within 60 minutes before the procedure 1. For patients with beta-lactam allergies, alternatives include vancomycin (15mg/kg IV) or clindamycin (600-900mg IV) 2. The antibiotic should be given as a single preoperative dose, with additional doses only if the procedure extends beyond 4 hours or involves significant blood loss. Some key points to consider:
- The timing of antibiotic administration is crucial, with the ideal time being 40 minutes prior to incision for cefazolin and 45 minutes prior to incision for clindamycin 1.
- The frequency of dual allergy to cefazolin and natural penicillins is low, suggesting that most patients with a penicillin allergy history may safely receive cefazolin 3.
- Prophylactic antibiotics are important for EVAR because the procedure involves placement of a prosthetic graft in the vascular system, creating a risk for infection that could lead to serious complications such as endograft infection or sepsis.
- The vascular access sites and manipulation of catheters through the bloodstream also present opportunities for bacterial entry.
- While the overall infection rate for EVAR is relatively low (1-3%), the consequences of infection can be severe, justifying the use of prophylactic antibiotics to reduce this risk 4, 5.