Infected Endograft with Perigraft Abscess, Graft-Enteric Fistula Following Endovascular Repair of Leriche`s Syndrome

INTRODUCTION: Perigraft infection with a development of a graft-duodenal fistula is one of the most serious complications following aortic surgery. It is a dangerous complication resulting in prosthesis infection and unavoidable bacteremia.CASE PRESENTATION: A 39-year-old man with Leriche`s syndrome presented with high fever, erythema, edema and soreness in both inguinal folds, where prior femoral incisions are seen. Five years earlier the patient underwent vascular reconstruction with an aortobifemoral (ABFB) and axillofemoral by-passes to treat the diagnosed Leriche`s syndrome. Blood tests demonstrated a severe septic condition and therefore a computed tomography angiography (CTA) was performed. On the CTA, concentric, around the entire length of the crossover prosthesis, abscess cavity with liquid-equivalent contents and gas collections was formed. An infiltrate is also present around the ABFB at the level of the external iliac artery in the structure of the psoas muscle. After further peroral administration of contrast media, a fistula between the duodenum and the thrombosed aortobifemoral prosthesis was detected. The periprosthetic abscesses were drained, all of the infected prostheses were removed and an autogenous patch of the left axillary artery was placed. The integrity of the duodenum was restored surgically through gastrointestinal and intestinal anastomoses. Intravenous antibiotic therapy was started. The patient showed stable vital signs after the removal of the by-passes.CONCLUSION: A secondary graft-enteric fistula with periprosthetic abscess is recognized as a fatal complication after vascular reconstruction of Leriche`s syndrome. Fistula was formed between the vascular prosthesis and the duodenum with a septic condition of the patient. Survival can only be achieved by complete surgical removal of the infected artificial prosthesis and closure of the fistulas