Infection of aortobifemoral bypass graft implanted 20 years ago proved by labeled leukocytes SPECT-CT.

Abstract

Correspondence to: Olgierd Chrabanski, Department of Radiodiagnostics, Invasive Radiology and Nuclear Medicine, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland, e-mail: olgierdchrabanski@gmail.com Aortic graft infections are very serious complications of arterial reconstructive surgery. The described in literature longest interval between primary reconstruction and aortic graft infections was 20 years [1]. This research reports a case of a 60-year-old man with a suspected infection of an aortobifemoral bypass graft implanted 20 years ago due to an aneurysm of the abdominal aorta. He was referred to a nuclear medicine department for scintigraphic detection or exclusion of active infection within the stent-graft. The patient had many comorbidities: renal failure, arterial hypertension, hypertensive cardiomyopathy, ischemic heart disease. This year, the patient underwent thrombosis of the left saphenous vein with cellulitis of the left leg and was treated surgically due to an abscess of the left buttock. Laboratory tests revealed: leukocytosis, significantly elevated CRP and anaemia. Enterococcus faecalis susceptible to ampicillin, teicoplanin and vancomycin were grown on venous blood cultures. Despite the implementation of antibiotic therapy, no significant improvement in the patient’s clinical condition was achieved. The computed tomography examination showed changes suggesting infection of the vascular prosthesis. Due to the high risk of the surgery, it was decided to operate after obtaining scintigraphic detection of infection within the stentgraft. The examination was performed with Technetium-99m labelled leukocytes using HMPAO. The patient was examined 1, 4 and 24 hours after radiotracer injection using Symbia Intevo with a protocol including SPECT/CT with LEHR collimator, low-dose CT.