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Aortic Prosthetic Graft Infections: Radiologic Manifestations and Implications for Management¹

¹ From the Department of Radiology, Veterans Affairs Medical Center, 4101 Woolworth Ave, Omaha, NE 68105 (D.F.O., J.A.S.); the Radiology Service, Veterans Administration Medical Center, Gainesville, Fla (R.F.L.); and the Departments of Radiology (W.C.C., J.L.F., T.C.G., T.C.M.) and Surgery (T.J.L.), University of Nebraska Medical Center, Omaha. Recipient of a Certificate of Merit award for a scientific exhibit at the 1994 RSNA scientific assembly. Received August 17, 1998; revision requested October 19; final revision received November 8, 1999; accepted November 9. Address correspondence to D.F.O. (e-mail: dorton@unmc.edu).

Prosthetic graft infections are an uncommon complication of aortic bypass. These infections may have serious sequelae such as limb loss and can be lethal. They are hard to eradicate and, under certain circumstances, difficult to diagnose. Usually, computed tomography (CT) is the most efficacious imaging method for diagnosis of graft infections due to its quick availability. The sensitivity of magnetic resonance imaging in detection of perigraft infection has not been thoroughly investigated but is probably similar to that of CT. After the early postoperative period, persistent or expanding perigraft soft tissue, fluid, and gas are the CT findings of graft infection. Aortoenteric fistula should be considered a subset of aortic graft infection; however, perigraft air is more likely to be seen with an aortoenteric fistula. Other conditions associated with graft infection include pseudoaneurysm, hydronephrosis, and osteomyelitis. Adjunctive studies such as sinography, ultrasonography, gallium scanning, and labeled white blood cell scanning can be quite useful in diagnosis, determination of the extent of disease, and selection of the treatment modality. White blood cell scanning is an important complementary test to CT in ambiguous cases, such as in the early postoperative period, and may be more sensitive in detection of early graft infection.

Index Terms: Aorta, grafts and prostheses, 89.457, 943.4522, 981.4522 • Aorta, surgery, 89.457, 943.4522, 981.4522 • Grafts, infection, 89.458, 943.458, 981.4522

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