Periaortitis na endovasculaire aortareparatie

Background

Infection is the most obvious cause of fever following implantation of an endovascular prosthesis; however, fever and inflammation around the arterial wall can also be caused by a sterile inflammatory reaction: periaortitis.

Case study

An 81-year-old man was referred because of fever and back pain. He had undergone an endovascular aortic repair (EVAR) 1 year earlier; an endovascular prosthesis had been placed during this procedure, to repair an abdominal aortic aneurysm. A positive emission tomography (PET)-CT scan revealed uptake of 18F-fluorodeoxyglucose around the endovascular prosthesis, consistent with infection; however, intensive microbiological investigation, including biopsy from the site of the endovascular prosthesis, revealed no micro-organisms. Empirical administration of antibiotics had no effect. Decreased renal function occurred approximately 4 weeks later, and a CT scan revealed spread of the inflammatory process accompanied by hydronephrosis, consistent with periaortitis. Following treatment with glucocorticoids, renal function returned to normal and the symptoms disappeared.

Conclusion

Periaortitis is a rare, late complication of an EVAR. Clinical presentation can closely resemble an infection, while distinguishing infection from (sterile) periaortitis is important for the choice of treatment.

Conflict of interest: none declared. Financial support: none declared.