Diagnostics
Aortic Endograft Infection After COVID-19: A Single-Centre Case Series and a Proposed Descriptive Clinical–Radiological PET/CT Staging Framework
By Sherif Sultan, Kalliopi-Maria Tasopoulou, Yogesh Acharya and 4 others.
Abstract
Background
Aortic endograft infection (AEI) after endovascular aneurysm repair (EVAR) is rare but life-threatening. The Management of Aortic Graft Infection Collaboration (MAGIC) criteria define infection, but there is no standard way to report the extent of infection. We describe patients who developed AEI after coronavirus disease 2019 (COVID-19) and propose a descriptive clinical–radiological PET/CT staging framework.
Methods
Retrospective, single-centre case series of EVAR patients who underwent [18F] fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) between 2020 and 2023. Six index patients (Group A) were managed for AEI after PCR-confirmed COVID-19. Five reference patients without COVID-19, imaged during the same period for suspected infection at another site (Group B, n = 2) or malignancy (Group C, n = 3), were included to describe endograft uptake in the absence of AEI; they were not matched controls. Each patient was classified according to MAGIC, with the finding supporting each criterion recorded. Each endograft was assigned a descriptive clinical–radiological stage (0–III): Stages 0–II were defined by PET/CT uptake pattern and anatomical extent, and Stage III by an additional imaging-defined (e.g., endograft limb thrombosis) or clinical (sepsis) complication, recorded separately.