Aortic Stent-Graft Infection Due to a Presumed Aortoenteric Fistula

Purpose: To report a case of late stent-graft infection with aortoenteric fistula. Case Report: A 76-year-old Colombian man received an AneuRx stent-graft for a 5.5-cm infrarenal AAA. The aneurysm sac progressively shrank until 22 months postoperatively, when an increase in diameter was noted on magnetic resonance imaging without evidence of endoleak or air in the sac. Two months prior, the patient had developed fever and an elevated white blood cell count; he underwent a 6-week course of intravenous antibiotics. Shortly thereafter, the fever recurred, along with progressive weight loss, which prompted admission. The computed tomographic scan showed no evidence of endoleak, but gas collection was seen anteriorly in the sac; aspirated material was positive for a variety of organisms. At surgery 23 months after stent-graft implantation, pronounced inflammatory reaction and scarring were seen around the graft in conjunction with evidence of a healed duodenal perforation, suggestive of an aortoenteric fistula. The excised stent-graft was intact; no deterioration was seen. The patient had a protracted recovery but has been afebrile and asymptomatic >1 year after stent-graft explantation Conclusions: Close surveillance after endovascular AAA repair is essential to detect late leaks, secondary migration, endotension, structural failure, and infection with or without aortoenteric fistula.