Am J Case Rep. 2026 Jan 11;27:e949903. doi: 10.12659/AJCR.949903.
ABSTRACT
BACKGROUND Endovascular aneurysm repair (EVAR) effectively treats abdominal aortic aneurysms but risks complications, including endoleak and graft infection. CASE REPORT A 74-year-old man with EVAR, complicated by endoleak the following month with persistent pain following endoleak repair, presented with multiple abscesses (epidural, psoas, and disc space) and an aorto-disc fistula 7 months after the endoleak repair. Long-term corticosteroid use and an interleukin-6 inhibitor for presumed polymyalgia rheumatica contributed to immunosuppression. This misdiagnosis, along with immunosuppression and inconclusive outside imaging, diagnostic tunneling contributed to a delayed diagnosis until discitis, osteomyelitis, and abscesses were discovered on computed tomography (CT). This case is a rare presentation, and there is scant literature on spinal abscess from EVAR. Given the uniqueness and complexity of the presentation, a multidisciplinary approach was required for a better outcome, including multiple surgery teams and multiple medical teams. Management included abscess drainage, EVAR explant with rifampin-soaked Dacron graft reconstruction, surgical debridement, antibiotic beads, and 6 weeks of intravenous daptomycin for coverage of previously positive spinal tissue cultures (methicillin-sensitive Staphylococcus aureus and Cutibacterium acnes) with a plan for lifelong suppression with doxycycline. The patient ultimately had a new endoleak requiring repair, but was doing well as of his last appointment 8 months after his presentation to our facility. CONCLUSIONS This case demonstrates the need for postoperative vigilance and multidisciplinary care for patients undergoing EVAR. Comprehensive source control and close follow-up have thus far yielded a successful clinical outcome.
PMID:41520165 | DOI:10.12659/AJCR.949903