Endovascular treatment and complete regression of an infected abdominal aortic aneurysm

To report a case of successful endovascular treatment of an infected abdominal aortic aneurysm (AAA) following Salmonella septicemia.

A 60-year-old man was admitted for rapid onset of urinary frequency, fever, and suprapubic pain extending to the flanks. Blood cultures were positive for Salmonella enteritidis, and appropriate antibiotic treatment was started. After 4 weeks, fever ceased and the C-reactive protein fell to 5.8 mg/dL, but the erythrocyte sedimentation rate remained unchanged. Back pain prompted computed tomography, which showed a large AAA with a very irregular aortic wall suspicious of impending rupture. A tube stent-graft was introduced under general anesthesia from a left groin incision and deployed immediately below the renal arteries; a proximal type I endoleak was suspected but not repaired. Oral antibiotic therapy was continued for 2 months after discharge. By 6 months, the endoleak had sealed with a concomitant decrease in the maximal diameter of the aneurysm from 7.4 to 5.6 cm. At 4 years, the aneurysm sac was no longer visible.

Although experience is limited, endovascular grafting in combination with antibiotic therapy in selected infected aneurysms might represent an effective low-risk alternative to conventional surgery with the potential to restore normal vascular anatomy.