Periaortic endograft infection due to Listeria monocytogenes treated with graft preservation

Abstract

A 67-year-old man presented to our hospital with general malaise, fever and diffuse abdominal and lower back pain 7 weeks after endovascular aneurysm repair. Blood samples showed a leukocyte count of 10.9 x 10(9)/l and a C-reactive protein of 239 mg/l. The computed tomography (CT)-scan showed fluid collections behind the proximal part of the endovascular graft and dorsal to the aorta. CT-guided translumbar needle aspiration of these collections yielded growth with Listeria monocytogenes. Prosthetic endograft infection is an extremely rare event, especially when it is caused by L. monocytogenes. Given the scarcity of this complication, no consensus has been reached for its treatment. In the described case, radiological drainage and prolonged antibiotic treatment resulted in favourable outcome at midterm follow-up with preservation of the endograft.

The relevance of aortic endograft prosthetic infection

“…13 Also with endovascular repair, treatment with graft removal has been described, as cases left untreated may even end up in rupture of the AAA. 14,15 One case previously published by our group, 3 however, suggests that there is also a place for conservative treatment with endograft preservation as the patient described is still alive and well after almost 4 years of conservative treatment with antibiotics.…”

“…Graft infection following EVAR has scarcely been reported and so far appears to be confined to single cases. [1][2][3][4][5][6][7][8] The incidence of graft infection following open aneurysm repair is reported to be between 0.4% and 3%. 9,10 The minimal invasive character of EVAR may have given rise to the hypothesis that endograft infection is a negligible complication that only very rarely occurs.…”

Percutaneous Treatment of an Infected Aneurysmal Sac Secondary to Aortoesophageal Fistula with a History of Stent-Graft Treatment for Thoracic Aortic Aneurysm

“…All of these factors may preclude a patient from being a desirable surgical candidate. Highrisk patients have been reported to survive with conservative treatment consisting of antimicrobial therapy and percutaneous drainage [15]. However, the clinical outcome of conservative treatment is poor and this option should be reserved for selected patients such as patients with a nonbleeding AEF, who has comorbidities or poor general conditions.…”

Femoropopliteal prosthetic bypass graft infection due to Mycobacterium abscessus localized by FDG-PET/CT scan

“…1,2,8,9 The causative organisms for infection are most commonly reported as Staphylococcus aureus and coagulase-negative staphylococci, although in as many as 25% of cases, the causative organism is never identified. 10,11 To the best of our knowledge and literature review, there have been no previous reports of prosthetic vascular graft infections due to Mycobacterium abscessus.…”