Stent graft infection after endovascular repair of abdominal aortic aneurysm: a case report and literature review

Alaa Sedik, Meriem Touahria, Ahmed Wahdan, Nader Twfeek, Alaa Osman


Aortic end graft (EVAR) infection isa challenging management problem in aortic surgery with 0.2% to 0.7% incidence, which is similar to aortic graft infection after open abdominal aortic aneurysm (AAA) repair. Although much attention has been given to the more common problem of endo leak management, yet only sporadic case reports have been reported about the late complication of endograft infection. We reported a case of elderly Saudi male, known to have multiple medical problems presented to our emergency department with severe progressive abdominal pain, vomiting, and fever over the last 7 days. He was evaluated and diagnosed as septic shock due to and infected stent graft following Endovascular Aneurysm Repair of abdominal aortic aneurysm, 4 years ago, with peritonitis. He underwent emergency laparotomy and a left paraaortic abscess was drained and a part of exposed metals of the stent graft found. Other intraperitoneal abcesses were drained and abdomen closed over drains. Patient remained under ICU care, but unfortunately deteriorated and died 3 days postoperatively.


Stent-graft infection, Endovascular aneurysm repair, Antibiotics, Surgery

Full Text:



Hobbs SD, Kumar S, Gilling-Smith GL. Epidemiology and diagnosis of endograft infection. J Cadiovsc Sur. 2010;51:5-14.

Vogel TR, Symons R, Flum DR. The incidence and factors associated with graft infection after aortic aneurysm repair. J Vasc Surg. 2008;47:264-9.

Ohta T, Ishibashi H, Sugimoto I, Takahashi M, Kawanishi J, Yamada T. Graft infection after vascular reconstruction surgery. Jpn J Vasc Surg. 2004;15:373-8.

Lane JS, Barleben AR, Kubaska SM, Fujitani RM. Aortoduodenal fistula after endovascular aneurysm repair presenting with aneurysm sac abscess. J Vasc Surg. 2009;50:919-20.

Baker M, Uflacker R, Robison JG. Stent graft infection after abdominal aortic aneurysm repair: a case report. J Vasc Surg. 2002;36:180-3.

Chenu C, Marcheix B, Barcelo C, Reanpang T, Settakorn J, Laohapensang K. Aorto-enteric fistula after endovascular abdominal aortic aneurysm repair: case report and review. Eur J Vasc Endovasc Surg. 2009;37:401-6.

Sharif MA, Lee B, Lau LL. Prosthetic stent graft infection after endovascular abdominal aortic aneurysm repair. J Vasc Surg. 2007;46:442-8.

Ducasse E, Calisti A, Speziale F, Rizzo L, Misuraca M, Fiorani P. Aortoiliac stent graft infection: current problems and management. Ann Vasc Surg. 2004;18:521-6.

Setacci C, De Donato G, Setacci F. Management of abdominal endograft infection. J Cardiovasc Surg (Torino). 2010;51:33-41.

Hsu RB, Tsay YG, Wang SS, Chu SH. Surgical treatment for primary infected aneurysm of the descending thoracic aorta, abdominal aorta, and iliac arteries. J Vasc Surg. 2002;36:746-50.

Sicard GA, Zwolak RM, Sidawy AN, White RA, Siami FS. Society for Vascular Surgery Outcomes Committee. Endovascular abdominal aortic aneurysm repair: long-term outcome measures in patients at highrisk for open surgery. J Vasc Surg. 2006;44:229-36.