Endovascular aneurysm repair (EVAR) has revolutionized vascular surgery, offering reduced early mortality compared to open surgery. Yet, rare complications can turn catastrophic, as illustrated in a recent case reported by Teguh Marfen Djajakusumah and colleagues.

The case involved a 65-year-old man who developed acute limb ischemia years after EVAR. Imaging revealed massive gas formation around the endograft and thrombosis of the iliac and femoral arteries. Despite amputation and aggressive care, the infection proved uncontrollable, and the patient succumbed to sepsis.

Microbiological analysis identified antibiotic-resistant Escherichia coli as the causative pathogen. Histopathology demonstrated true vasculitis with chronic arteritis—an exceptionally rare presentation of endograft infection. The absence of replacement grafts precluded definitive surgical management, leaving only palliative amputation.

The authors stress that while endograft infections occur in less than 1% of EVAR cases, their mortality rate can exceed 70%. Early follow-up and routine imaging are essential for timely detection, as late infections may spread to adjacent arteries and cause irreversible ischemia.

This tragic case highlights both the progress and the perils of modern vascular interventions. It underscores the necessity of vigilant postoperative surveillance and rapid intervention when graft-related infections are suspected.

By raising awareness of rare but fatal complications, this study strengthens SDG 3: Good Health and Well-Being and SDG 9: Industry, Innovation, and Infrastructure, emphasizing safer and more resilient health systems. It also demonstrates Universitas Padjadjaran’s critical role in global surgical research and contributes to its advancement in the THE Impact Rankings.