Korean Circ J.  2012 May;42(5):366-368. 10.4070/kcj.2012.42.5.366.

A Case of Stent Graft Infection Coupled With Aorto-Esophageal Fistula Following Thoracic Endovascular Aortic Repair in a Complex Patient

• Lee SH
• Song PS
• Kim WS
• Park KB
• Choi SH

• KMID: 2028769
• DOI: http://doi.org/10.4070/kcj.2012.42.5.366

Abstract

The incidence of peri-stent graft infection (PGI) following thoracic endovascular aortic repair (TEVAR) is low, but the associated mortality rates are extremely high. The diagnosis of this complication can be difficult due to nonspecific symptoms. Here, we report a case of PGI combined with an aorto-esophageal fistula (AEF) diagnosed by computed tomography (CT) and positron emission tomography (PET) imaging after TEVAR. A 50-year-old woman with a history of diabetes mellitus and chronic hemodialysis had received a stent graft for a contained rupture of a pseudoaneurysm of the descending thoracic aorta. Three months after stent-grafting, she experienced back pain. CT and PET imaging suggested a PGI. The patient underwent surgical treatment for PGI with AEF.

Keyword

Thoracic aorta; Stents; Complications; Infection; Esophageal fistula

MeSH Terms

Aneurysm, False
Aorta, Thoracic
Back Pain
Diabetes Mellitus
Esophageal Fistula
Female
Fistula
Humans
Incidence
Lymphokines
Middle Aged
Positron-Emission Tomography
Positron-Emission Tomography and Computed Tomography
Renal Dialysis
Rupture
Stents
Transplants
Lymphokines

Figure

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  Fig. 1 Initial CT scan demonstrating a contained rupture of a pseudoaneurysm (A) and a follow-up CT scan after thoracic endovascular aortic repair (B).

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  Fig. 2 CT scan reveals the stent graft surrounded by soft tissue with air bubbles in the descending thoracic aorta (A). Positron emission tomography scan shows increased segmental fluorodeoxyglucose uptake, mostly at sites of abnormal CT findings (B and C), increasing the likelihood of these findings representing peri-stent graft infection.

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  Fig. 3 Esophago-gastro-duodenoscopy revealed an outpouching lesion covered with clotted blood, suspected of being an aorto-esophageal fistula.

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