Usefulness of Gallium Scintigraphy in Follow up after Endovascular Aortic Repair for Mycotic Abdominal Aortic Aneurysm

Abstract

Open surgery remains the treatment of choice for mycotic abdominal aortic aneurysm (MAAA). However, open surgery for MAAA is often associated with a significant perioperative risk and there have been some reports in which MAAA was successfully treated with endovascular aortic repair (EVAR). We report a case of MAAA treated with EVAR. Gallium scintigraphy was useful in postoperative evaluation of infection. A 61-year-old man presented with back pain. Computed tomography (CT) revealed a 50-mm saccular abdominal aortic aneurysm(AAA). The patient underwent EVAR for symptomatic AAA but developed a high fever 5 days after surgery. Serum C-reactive protein level was elevated and blood culture was positive for Salmonella. Intravenous antibiotics were commenced with a diagnosis of MAAA and the fever and inflammatory parameters subsided with a decrease in the size of the aneurysm. Accumulation of gallium was observed on scintigraphy 1 month after surgery. The patient received intravenous antibiotics for 8 weeks after surgery and was discharged home with oral antibiotics. At 6 months after surgery, accumulation of gallium disappeared. Oral antibiotics were ceased when CT showed disappearance of the aneurysm 9 months after surgery. At present, the patient has been doing well without signs or symptoms of recurrent infection.