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.
Highlights
The massive gastrointestinal haemorrhage form prostheticduodenal fistula is a well-known surgical complication that is rarely observed after endovascular stent-graft implantation [1]
We report a case of a patient with two fistulas diagnosed four years after a stentgraft implantation for having symptomatic abdominal aortic aneurysm and severe comorbidities
After the 4 months, a purulent cutaneous fistula appeared in the lumbar area (Figure 1)
Summary
The massive gastrointestinal haemorrhage form prostheticduodenal fistula is a well-known surgical complication that is rarely observed after endovascular stent-graft implantation [1]. In the case of such sargical complication, the closure of the duodenal fistula and the removal of the infected stent graft and its replacement with silver prosthesis, homograft, homogeneous vein, or extra-anatomic bypass are usually carried out; the outcome is usually bad [2]. A series of cases of closing the fistula without removing the stent graft, followed by prolonged antibiotic therapy with good 1-year outcomes, were reported [2, 3]. We report a case of a patient with two fistulas (prostheticduodenal and prosthetic-cutaneous fistulas without massive gastrointestinal bleeding) diagnosed four years after a stentgraft implantation for having symptomatic abdominal aortic aneurysm and severe comorbidities. The first symptoms of stent-graft infection were lumbar pain and purulent cutaneous fistula
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