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Surgical strategy for aortic prosthetic graft infection with (18)F-fluorodeoxyglucose positron emission
Katsuhiro Yamanaka1, Takashi Matsueda1, Shunsuke Miyahara1
1Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-Cho, Chuo-ku, Kobe, 650-0017, Japan.
Abstract:
A 30-year-old man with Marfan syndrome who underwent Crawford type II extension aneurysm repair about 9 years ago was referred to our hospital with persistent fever. Computed tomography (CT) showed air around the mid-descending aortic prosthetic graft. Because the air did not disappear in spite of intravenous antibiotics, (18)F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) was performed. FDG-PET/CT revealed four high-uptake lesions. After dissecting the aortic graft particularly focusing on the high-uptake lesions, this patient underwent in situ graft re-replacement of descending aortic graft with a rifampicin-bonded gelatin-impregnated Dacron graft and omentopexy. The patient remains well without recurrent infection at 3 months after surgery.
Insights
A patient with Marfan syndrome experienced persistent fever due to aortic graft infection. Surgical re-replacement with a specialized graft successfully resolved the infection, demonstrating effective treatment for aortic prosthetic graft complications.
Area of Science:
- Cardiovascular Surgery
- Infectious Diseases
- Medical Imaging
Background:
- Marfan syndrome predisposes individuals to aortic complications, including aneurysms requiring prosthetic repair.
- Aortic prosthetic graft infection is a serious complication, often presenting with persistent fever and challenging diagnosis.
- Early detection and intervention are crucial for managing aortic graft infections to prevent severe morbidity.
Observation:
- A 30-year-old male with Marfan syndrome presented with persistent fever 9 years post-Crawford type II aortic extension repair.
- Computed tomography (CT) revealed periprosthetic air, which persisted despite antibiotic treatment.
- (18)F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) identified four high-uptake lesions indicative of infection.
Findings:
- In situ graft re-replacement of the infected descending aortic graft was performed using a rifampicin-bonded gelatin-impregnated Dacron graft.
- Omentopexy was utilized in conjunction with the graft re-replacement.
- Histopathological examination of the explanted graft confirmed infection.
Implications:
- This case highlights the utility of FDG-PET/CT in diagnosing prosthetic aortic graft infections when conventional imaging is inconclusive.
- In situ re-replacement with antibiotic-bonded grafts and omentopexy is a viable strategy for managing complex aortic graft infections.
- Successful management of aortic graft infection in Marfan syndrome patients can lead to improved long-term outcomes and prevent recurrent sepsis.
