Graft Infection Masquerading as Rheumatologic Disease: a Rare Case of Aortobifemoral Graft Infection Presenting as Hypertrophic Osteoarthropathy

Ann Vasc Surg. 2017 May:41:283.e11-283.e18. doi: 10.1016/j.avsg.2016.10.041. Epub 2017 Mar 7.

Abstract

Background: Prosthetic vascular graft procedures are a common treatment modality for peripheral vascular disease. A relatively common complication is graft infection, occurring at a rate of 0.5-5%. When they occur, graft infections are associated with significant morbidity and mortality. Vascular graft infections also represent a diagnostic and therapeutic challenge for the physician METHODS: Here, we report a case where the rare finding of secondary hypertrophic osteoarthropathy was an important indication of underlying aortic graft infection that was initially misdiagnosed. A review of the literature revealed 34 cases of vascular graft infection associated with hypertrophic osteoarthropathy.

Results: The mean interval from surgery to time of infection was approximately 5 years. Mortality was 35%. When combined with hypertrophic osteoarthropathy, vascular graft infection was complicated by an aortoenteric fistula in 53% of the cases.

Conclusion: The complexity of this case highlights the challenges physicians face in order to diagnose and treat this condition.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aorta / surgery*
  • Blood Vessel Prosthesis / adverse effects*
  • Blood Vessel Prosthesis Implantation / adverse effects*
  • Blood Vessel Prosthesis Implantation / instrumentation*
  • Device Removal
  • Diagnostic Errors
  • Fatal Outcome
  • Female
  • Femoral Artery / surgery*
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Osteoarthropathy, Secondary Hypertrophic / diagnosis*
  • Osteoarthropathy, Secondary Hypertrophic / diagnostic imaging
  • Osteoarthropathy, Secondary Hypertrophic / microbiology
  • Osteoarthropathy, Secondary Hypertrophic / surgery
  • Peripheral Arterial Disease / surgery*
  • Predictive Value of Tests
  • Prosthesis-Related Infections / diagnosis*
  • Prosthesis-Related Infections / diagnostic imaging
  • Prosthesis-Related Infections / microbiology
  • Prosthesis-Related Infections / surgery
  • Treatment Outcome