title: A diagnostic dilemma: does peri stent-graft air after thoracic aortic endografting necessarily imply infection?
abstract: The radiographic finding of air bubbles around a surgically placed prosthetic graft is traditionally assumed to be a sign of infection until proven otherwise. Direct delivery of atmospheric air bubbles, shown in an imaging study performed very soon after a surgical intervention, or percutaneously introduced during an endovascular procedure could be possible causes of air bubble presence and not necessarily infection. However, if air around a prosthetic aortic graft is identified in an imaging study after a previous one did not document its presence, or if the amount of air is increasing on serial imaging studies, the suspicion level should increase. The case presented here is of a 49-year-old male who underwent an endovascular repair of a possible symptomatic penetrating aortic ulcer, who was found to have peri stent-graft air 3 weeks after intervention. Previous imaging postoperative studies did not reveal air around the aortic prosthesis. The diagnosis of endovascular stent-graft infection was very difficult due to several challenging factors that are herein presented.
authors.affiliation: University of Arizona Health Science Center, and Southern Arizona Veteran Affairs Health Care System, Vascular Surgery Section, Tucson, Arizona 85723, USA. luis.leon@va.gov
authors.forename: Luis R
authors.initials: LR
authors.lastname: Leon
mesh_terms: D000890:Anti-Infective Agents / Q000627:therapeutic use; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D001027:Aortography; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D016459:Prosthesis-Related Infections / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology; D015607:Stents / Q000009:adverse effects*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000890:Anti-Infective Agents