Improved Diagnosis of Aortobifemoral Vascular Graft Infection by In-111-Labeled Leukocyte SPECT

A 78-year-old man with a more than 10-year-old aortobifemoral vascular graft was referred for inguinal tumefaction suspicious of abscess. Planar whole-body In-111-labeled leukocyte scan only revealed mild increased activity in the right iliac fossa. In contrast, the SPECT study clearly demonstrated aortobifemoral prosthesis uptake extending to the left inguinal region and the right iliac fossa. A contrast-enhanced abdominal CT scan confirmed the presence of a right distal pseudoaneurysm as well as the presence of a periprosthetic collection. The inguinal abscess was drained and the aortobifemoral vascular graft was removed after ligation of the subrenal aorta. Then, an axillobifemoral vascular graft was implanted. The surgical procedure was further associated for 6 weeks with vancomycin targeted against the suspected staphylococcal pathogen with subsequent complete clinical and biologic responses. One year after this infectious event, the patient is still in complete recovery.