Aortic bypass graft material may become infected with Aspergillus (Echenne et al, 1980; Glotzbach. 1982; Anderson & Kron, 1984; Hargrove & Edmunds, 1984; Brandt et al, 1985; Nussaume et al, 1990; Aguado et al, 1992; Banzo et al, 1992; Motte et al, 1993). Most cases are probably attributable to airborne contamination at the time of surgery as has been reported in numerous instances. Aspergillus fumigatus, Aspergillus terreus (amphotericin B resistant) and Aspergillus flavus have all been implicated.
In most cases, presentation occurs weeks or months after surgery typically one to six months and less often two to three years later. Either the aortic or thoracic aorta may be involved. Direct extension to vertebral bodies was observed in some patients.
All survivors have received antifungal therapy, had the original graft resected and had an extraanatomic bypass created. Localised extension to, for example, the vertebral column requires treatment as for osteomyelitis.
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Case histories: