Perigraft air mimicking infection on CT angiography following open abdominal aortic aneurysm repair

Abstract

Aortic graft infection is a feared complication after open abdominal aortic aneurysm repair secondary to its high mortality. Perigraft air is a common finding after open aortic aneurysm repair; however, it is also associated with aortic graft infection. Delineating between graft infection and common postoperative finding is a challenge. This is further complicated by use of hemostatic agents such as Gelfoam, which is also documented to cause perigraft air. Correct diagnosis has crucial implications in management of potential aortic graft infection, which is a vascular emergency. We report a case of perigraft air in a patient status after open aortic aneurysm repair with associated clinical manifestations of infection in whom conservative management and surveillance was selected for treatment. We then discuss the timeline of perigraft air, potential causation, importance of history, and physical examination, and finally, we discuss how specific findings on computed tomography imaging for infection in other areas may be useful in aortic graft infection.

Mimics of Complications in the Postsurgical Aorta at CT

“…Hemostatic agents help control intraoperative bleeding not controlled by cautery or ligation. A gelatin bioabsorbable sponge (Gelfoam; Pfizer) is made of a water-insoluble, purified porcine skin product that aids hemostasis by form-ing an artificial clot and providing a mechanical matrix for platelet aggregation (35). A similar hemostatic gauze (Surgicel; Ethicon) is made of oxidized regenerated cellulose (36).…”