CTICasesInfected Endovascular Stent Graft (Gas in Excluded Aortic False Lumen)
Imaging findings
Chest radiograph and CT in a patient with a prior type B aortic dissection treated with thoracic endovascular aortic repair (TEVAR) demonstrate gas throughout the excluded false lumen of the descending thoracic aorta. The stent graft is in good position with no contrast filling of the false lumen or endoleak identified. There is no communication to adjacent structures identified by CT.
Key takeaways
Gas in the excluded aortic false lumen after TEVAR raises concern for infection, most likely through a fistula to an adjacent structure (esophagus, bronchus, bowel) rather than a gas-forming organism. Infection of an endovascular graft is associated with high morbidity and mortality; patients often require lifelong antibiotic suppression when surgical re-intervention is not feasible.
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