Diagnosis and treatment of vascular graft and endograft infections: a structured clinical approach

Wouthuyzen-Bakker, Marjan; Oosten, Marleen van; Bierman, Wouter F W; Winter, Rik; Glaudemans, Andor W J M; Slart, Riemer H. J. A.; Toren-Wielema, Marlous; Tielliu, Ignace F.J.; Zeebregts, Clark J.; Prakken, Niek H J; Vries, Jean Paul de; Saleem, Ben R.

doi:10.1016/j.ijid.2022.11.011

Cited by 14 publications

(14 citation statements)

References 30 publications

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“…one-third of blood cultures remain negative, and a polymicrobial flora is frequent [ 12 , 17 , 34 ]. Hence, preoperative classification according to a single microorganism identified might not be justified [ 36 , 37 ]. The additional sonication of explanted grafts increased the microorganism yield by 16% [ 38 ].…”

Section: Discussionmentioning

confidence: 99%

Aortic Vascular Graft and Endograft Infection–Patient Outcome Cannot Be Determined Based on Pre-Operative Characteristics

Puttini,

Kapalla,

Braune

et al. 2024

JCM

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Vascular graft/endograft infection (VGEI) is a serious complication after aortic surgery. This study investigates VGEI and patient characteristics, PET/CT quantification before surgical or conservative management of VGEI and post-intervention outcomes in order to identify patients who might benefit from such a procedure. PET standard uptake values (SUV) were quantitatively assessed and compared to a non-VGEI cohort. The primary endpoints were in-hospital mortality and aortic reintervention-free survival at six months. Ninety-three patients (75% male, 65 ± 10 years, 82% operated) were included. The initial operation was mainly for aneurysm (67.7%: 31% EVAR, 12% TEVAR, 57% open aortic repair). Thirty-two patients presented with fistulae. PET SUVTLR (target-to-liver ratio) showed 94% sensitivity and 89% specificity. Replacement included silver-coated Dacron (21.3%), pericardium (61.3%) and femoral vein (17.3%), yet the material did not influence the overall survival (p = 0.745). In-hospital mortality did not differ between operative and conservative treatment (19.7% vs. 17.6%, p = 0.84). At six months, 50% of the operated cohort survived without aortic reintervention. Short- and midterm morbidity and mortality remained high after aortic graft removal. Neither preoperative characteristics nor the material used for reconstruction influenced the overall survival, and, with limitations, both the in-hospital and midterm survival were similar between the surgically and conservatively managed patients.

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Section: Discussionmentioning

confidence: 99%

Aortic Vascular Graft and Endograft Infection–Patient Outcome Cannot Be Determined Based on Pre-Operative Characteristics

Puttini,

Kapalla,

Braune

et al. 2024

JCM

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“…18 F-fluorodeoxyglucose positron emission tomography/computed tomography ( 18 F-FDG PET/CT) is recommended when VGEI is still suspected after a negative or inconclusive CTA [4]. Furthermore, in a recently published structural clinical approach for the diagnosis and treatment of VGEI, 18 F-FDG PET/CT imaging is recommended for all suspected VGEIs when the interval between the index surgery is more than three months; CTA is recommended in early postoperative suspected VGEI [5]. Other imaging modalities to consider in the diagnostic workup of VGEI are ultrasonography (US) and radiolabelled white blood cell (WBC) scintigraphy [6].…”

Section: Introductionmentioning

confidence: 99%

“…Although 18 F-FDG PET/CT is recommended in some of the structured literature as a diagnostic method for VGEI [4,5], a standardized interpretation and reporting criteria for VGEI on 18 F-FDG PET/CT is lacking. Existing interpretation criteria are based on tracer uptake patterns (homogeneous or heterogeneous), a visual grading scale (VGS), and sometimes semi-quantitative analysis by calculating the standardized uptake value (SUV) or target-to-background ratio (TBR) [1].…”

Section: Introductionmentioning

confidence: 99%

Added Value of Abnormal Lymph Nodes Detected with FDG-PET/CT in Suspected Vascular Graft Infection

Rijsewijk

Helthuis

Glaudemans

et al. 2023

Biology

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Vascular graft and endograft infections (VGEI) cause a serious morbidity and mortality burden. 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) imaging is frequently used in the diagnostic workup, but the additional value of abnormal (18F-FDG active and/or enlarged) locoregional lymph nodes is unknown. In this retrospective study, the additional diagnostic value of abnormal locoregional lymph nodes on 18F-FDG PET/CT imaging for VGEI was evaluated, including 54 patients with a culture-proven VGEI (defined according to the Management of Aortic Graft Infection [MAGIC] group classification) and 25 patients without VGEI. 18F-FDG PET/CT was qualitatively and quantitatively assessed for tracer uptake and pattern at the location of the vascular graft, and locoregional lymph node uptake and enlargement (>10 mm). 18F-FDG uptake intensity and pattern independently predicted the presence of VGEI by logistic regression (Χ2: 46.19, p < 0.001), with an OR of 7.38 (95% CI [1.65, 32.92], p = 0.009) and 18.32 (95% CI [3.95, 84.88], p < 0.001), respectively. Single visual assessment of abnormal locoregional lymph nodes predicted the presence of VGEI with a sensitivity of 35%, specificity of 96%, PPV of 95%, and NPV of 41%. The visual assessment of abnormal lymph nodes after qualitative assessment of 18F-FDG uptake intensity and pattern at the vascular graft location did not independently predict the presence of VGEI by logistic regression (Χ2: 3.60, p = 0.058; OR: 8.25, 95% CI [0.74, 63.37], p = 0.096). In conclusion, detection of abnormal locoregional lymph nodes on 18F-FDG PET/CT has a high specificity (96%) and PPV (95%) for VGEI. However, it did not add to currently used 18F-FDG PET/CT interpretation criteria.

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“…The prognosis of aortic stent graft infections is different from that of endoleaks because of the port of entry and virulence of the pathogens [ 7 ]. In patients with high operative risk, conservative management without surgery may be helpful; however, the implanted stent graft must ultimately be removed to achieve infection control [ 5 7 8 9 ]. The extent and severity of the perianeurysmal infection determines the surgical approaches, which are often different from those used for explantation due to endoleaks.…”

Section: Introductionmentioning

confidence: 99%

Clinical outcomes of in situ graft reconstruction in treating infected abdominal aortic stent grafts following endovascular aortic aneurysm repair: a single-center experience

et al. 2023

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Purpose This study aimed to review our experience with the explantation of infected endovascular aneurysm repair (EVAR) grafts. Methods This single-center, retrospective, observational study analyzed the data of 12 consecutive patients who underwent infected aortic stent graft explantation following EVAR between January 1, 2010 and December 31, 2019, of which 11 underwent in situ graft reconstruction following graft removal. The presentation symptoms, infection route, original pathology of abdominal aortic aneurysms (AAA), graft materials, and clinical outcomes were analyzed. Results Six patients underwent total explantation, whereas 5 underwent removal of only the fabric portions. For in situ reconstructions, prosthetic grafts and banked allografts were used in 8 and 3 patients, respectively. Four mechanisms of graft infection were noted in 11 patients: 4 had bacteremia from systemic infections, 3 had persistent infections following EVAR of primary infected AAA, 3 had ascending infections from adjacent abscesses, and 1 had an aneurysm sac erosion resulting in an aortoenteric fistula. No infection-related postoperative complications or reinfections occurred during the mean 65.27-month (standard deviation, ±52.51) follow-up period. One patient died postoperatively because of the rupture of the proximal aortic wall pseudoaneurysm that had occurred during forceful bare stent removal. Conclusion Regardless of graft material, in situ graft reconstruction is safe for interposition in treating an infected aortic stent graft following EVAR. In our experience, the residual bare stent is no longer a risk factor for reinfection. Therefore, it is important not to injure the proximal aortic wall when removing the bare stent by force.

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Diagnosis and treatment of vascular graft and endograft infections: a structured clinical approach

Cited by 14 publications

References 30 publications

Aortic Vascular Graft and Endograft Infection–Patient Outcome Cannot Be Determined Based on Pre-Operative Characteristics

Aortic Vascular Graft and Endograft Infection–Patient Outcome Cannot Be Determined Based on Pre-Operative Characteristics

Added Value of Abnormal Lymph Nodes Detected with FDG-PET/CT in Suspected Vascular Graft Infection

Clinical outcomes of in situ graft reconstruction in treating infected abdominal aortic stent grafts following endovascular aortic aneurysm repair: a single-center experience

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