Abstract 10551: Air-Ortitis

Background: Vascular graft infections (VGI) are serious complications of open and endovascular types of surgery with 30-60% perioperative mortality and 40-60 % morbidity. High index of suspicion is necessary in patients with multiple risk factors for graft infection to ensure early detection and intervention. This is a patient who presented with occult graft infection 4 years after endovascular aortic aneurysm repair (EVAR). Case: A 79M with DM, hypertension, coronary artery disease s/p bypass surgery and angioplasty, and abdominal aortic aneurysm s/p EVAR 4 years ago, presented with mild central abdominal pain associated with nausea and loss of appetite. He denied change in bowel habits, fever, or rectal bleeding. Initial workup showed WBC 10,000/ml with left shift of 90%, together with anemia of 7g/dl. Urinalysis showed pyuria and initial blood cultures grew gram negative bacilli later revealed to be Klebsiella pneumonia. Abdominal CT then showed an aortoiliac stent in place with an air-fluid level in the native aortic aneurysm, 6.4 cm in diameter. There was immediate concern for an aorto-enteric fistula and the patient underwent exploratory laparotomy which instead revealed an infected endograft with purulent drainage to the aortic sac. The post operative period was complicated with respiratory failure, requiring intubation for a few days. Tissue culture isolated multidrug resistant Klebsiella pneumoniae necessitating a 6-week course of meropenem. After a long hospital stay, his family opted for comfort care and was discharged to a hospice facility. Conclusions: Surgical treatment of VGI is challenging and involves debridement of infected periprosthetic tissues, excision of the infected graft and secondary revascularization usually in a critically ill patient. VGI have exceedingly high mortality rates; thus, early identification, and screening of high-risk patients with infectious focus for VGI is needed.