Aortic graft infection with enteric organism after embolization of late type II endoleak

Abstract

An 82-year-old man with a history of endovascular repair for ruptured abdominal aortic aneurysm 6 years ago presented with a type II endoleak and enlarging sac. He had successful transabdominal direct sac puncture embolization but developed fever 2 days postoperatively. Contrast-enhanced computed tomography showed a rim-enhancing collection, and sac aspiration was positive for enteric organisms, confirming endograft infection. The patient underwent graft explantation and neoaortic reconstruction using superficial femoral veins. Three months postoperatively, computed tomography showed complete resolution of fluid collection and no signs of graft infection. This report illustrates direct puncture embolization complicated by endograft infection from enteric bacteria.

Embolization therapy for type 2 endoleaks after endovascular aortic aneurysm repair: imaging-based predictive factors and clinical outcomes on long-term follow-up

“…Complications related to the embolisation procedure are uncommon, with an incidence ranging from 0-10%, and may include septic, ischaemic and neurological events (19). In the presented case series, two (3.2%) stent-graft infections, most probably related to contamination during direct percutaneous puncture, occurred (29,30). Curative surgical invention with stent-graft resection and aorto-bi-iliac reconstruction with autologous deep vein as performed in the two reported cases provides by far the best outcome (31).…”

“… 19 In the presented case studies, two (3.2%) stent-graft infections occurred, most probably related to contamination during direct percutaneous puncture. 29 , 30 Curative surgical intervention with stent-graft resection and aorto-bi-iliac reconstruction with autologous deep vein, as performed in the two reported cases, provided by far the best outcome. 31 Sella et al 32 described another infectious complication related to translumbar direct T2EL percutaneous puncture, namely osteomyelitis and discitis of L3-L4 vertebral bodies.…”

Type II Endoleaks After EVAR: A Literature Review of Current Concepts

“…Available largely in the form of case reports. [44][45][46] Organisms introduction into the body at the time of any percutaneous intervention may lead to colonization and infection of prosthetic material. When this situation does occur, the long-term prognosis is quite poor with a estimated mortality of up to 40% with surgery.…”