J Korean Soc Radiol.  2014 Mar;70(3):195-199. 10.3348/jksr.2014.70.3.195.

Unusual Perigraft Abscess Formation Associated with Stent Graft Infection after Endovascular Aortic Repair of Abdominal Aortic Aneurysm: A Case Report

• Lee HJ
• Kim SS
• Ahn M
• Lee JH
• Shin BS
• Kim JH

• KMID: 1839431
• DOI: http://doi.org/10.3348/jksr.2014.70.3.195

Abstract

Although a stent graft infection after endovascular aortic repair (EVAR) of abdominal aortic aneurysm (AAA) is a rare complication, it carries a high mortality and morbidity rate. We report a rare case of stent graft infection that led to an unusual perigraft abscess formation without any associated aortoenteric fistula two years after the EVAR of AAA.

MeSH Terms

Abscess*
Aneurysm
Aorta
Aortic Aneurysm, Abdominal*
Blood Vessel Prosthesis*
Fistula
Mortality
Stents*

Figure

• 

  Fig. 1 Initial post operative CT images 1 month after placement of a stent graft for abdominal aortic aneurysm. The maximal diameter of the native aneurysmal sac was about 69 mm with perigraft soft tissue (Hounsfield unit: 52 on precontrast images) (A). There was no evidence of endoleak complications on arterial and delayed phase images (B, C).

• 

  Fig. 2 CT images 2 years after placement of a stent graft showing an increase in the diameter of the native aneurismal sac from 70 to 80 mm, an increase in the thickness of perigraft fluid from 35 to 42 mm, and a decrease in the CT density of perigraft soft tissue from 47 to 30 Hounsfield unit on precontrast images (A) when compared to those of the last follow-up CT scan taken 1 year after the placement. New radiologic findings are seen: a thickened native aneurismal wall with slightly irregular or interrupted wall enhancement, a small eccentric luminal bulging (arrow), and streaky opacity surrounding aneurismal wall due to inflammatory infiltration into mesenteric fat (arrowhead) on arterial phase images (B).

• 

  Fig. 3 CT scan was undertaken 2 days after Fig. 2, there are an increase in the diameter of the aneurysmal sac from 80 to 89 mm, an increase in the thickness of perigraft fluid from 42 to 48 mm with further extending inflammatory infiltration (arrowhead), and an eccentric bulging contour of the aorta wall (arrow) suggestive of an impending rupture (A-C).

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