title: Purulent cutaneous fistula: as the first symptom of the late aortic stent-graft infection-a case report and review of the literature.
abstract: Purpose. Aortic stent-graft infection with fistula formation is a rare complication with high mortality rate when treated surgically by stent-graft removal. We report a case of a patient with aortic stent-graft infection, prosthetic-duodenal, and prosthetic-cutaneous fistulas operated without the removal of an infected prosthesis and ineffectively tailored antibiotic therapy. Case Report. A 66-year-old patient with high cardiovascular risk and endovascular stent-graft implantation developed a symptomatic infection of the aortic stent graft 42 months after procedure. It was manifested by iliolumbar muscle abscess and two fistulas: prosthetic cutaneous and prosthetic duodenal. The prosthetic-duodenal fistula was excised and separated from the prosthesis. The perforation within the duodenum was closed in layers. Iliolumbar abscess was removed and drainage was effected .The stent graft was left. The patient received tailored antibiotic therapy. He was readmitted to hospital after 4 weeks with symptoms of infection and leakage of pus discharge in the lumbar area. Despite the antibiotic therapy, the total parenteral nutrition of the patient's clinical status and malnutrition deteriorated and he died of cardiac arrest. Conclusion. The presented case confirms that leaving off of the infected stent graft in the patient with severe comorbidity and treated with a tailored antibiotic therapy may not be effective.
authors: Department of General and Vascular Surgery, Medical University of Silesia, 40-635 Katowice, Poland.
authors: Damian
authors: D
authors: Ziaja
authors: Grzegorz
authors: G
authors: Biolik
authors: Jerzy
authors: J
authors: Chudek
authors: Krzysztof
authors: K
authors: Ziaja
references: Ann Vasc Surg. 2007 Mar;21(2):228-31
references: 17349370
references: Chir Ital. 2009 Jan-Feb;61(1):61-6
references: 19391341
references: Ann Vasc Surg. 2004 Sep;18(5):521-6
references: 15534730
references: J Vasc Interv Radiol. 2009 Feb;20(2):173-9
references: 19097807
references: J Vasc Interv Radiol. 2008 Feb;19(2 Pt 1):163-5
references: 18341942
references: J Endovasc Ther. 2008 Aug;15(4):441-8
references: 18729556
references: J Vasc Surg. 2003 Dec;38(6):1199-205
references: 14681612
references: J Endovasc Ther. 2003 Oct;10(5):919-27
references: 14656181
references: Vasc Endovascular Surg. 2006 Jan-Feb;40(1):1-10
references: 16456600
references: Ann Vasc Surg. 2005 Mar;19(2):154-60
references: 15776307
references: J Vasc Surg. 1997 Feb;25(2):277-84; discussion 285-6
references: 9052562
references: J Vasc Surg. 2007 Sep;46(3):442-8
references: 17826231