Hypertrophic osteoarthropathy as indication of aortic graft infection and aortoenteric fistula.

Diagnosis of an infected bifurcation graft or aortoenteric fistula can be extremely difficult, and delay in diagnosis may lead to the lethal complication of a ruptured aortoenteric fistula. Hypertrophic osteoarthropathy limited to the lower extremities was the initial symptom of aortoenteric fistula in two of our patients with infected aortic bifurcation grafts. Review of the literature discovered six additional patients with a similar diagnosis, indicating its possible value as an early diagnostic sign of aortoenteric fistula.