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Infected Endoluminal Stent-Graft: Implications for Endotension, Late Endoleaks, and Prophylactic Antibiotics

Purpose: To retrospectively review a case of stent-graft infection that presented as continued aneurysm expansion after endoluminal repair. Case Report: A 75-year-old man with an asymptomatic 6.1-cm abdominal aortic aneurysm (AAA) was treated with a Talent stent-graft, which was complicated by postimplantation syndrome. At 1 year, a secondary intervention was performed for migration with type I endoleak. Despite the absence of a demonstrable endoleak thereafter, the AAA continued to expand until it was 9 cm in diameter and symptomatic. At this stage, 6 months after the secondary procedure, the graft was explanted and an axillobifemoral graft inserted. Propionibacterium acnes was cultured from all specimens of thrombus, aortic wall, and graft. The patient recovered and was asymptomatic until his death from myocardial infarction 6 months after discharge. Conclusions: Stent-graft infection may be a cause of unexplained endotension. Special culture techniques may be required to identify the infecting organism. Prophylactic antibiotics against skin organisms should be considered for all implantations and arterial diagnostic and therapeutic procedures traversing a stent-graft.