Guided Aspiration for Determining the Microbiological Aetiology of Aortic Vascular Graft and Endograft Infections

Abstract

WHAT THIS PAPER ADDSThis study describes the technique of guided aspiration to identify the etiology of vascular graft infections, using both standard culturing methods and 16S rRNA/18S rRNA.Objective: Open and endovascular aortic repair may be complicated by aortic vascular graft or endograft infection (VGEI). Confirming the microbiological aetiology is a key element in providing the best available treatment to patients with a VGEI. The primary aim of this study was to describe the technique of direct aneurysm sac guided aspiration (DASGA) in determining the microbiological aetiology in a cohort of patients with VGEIs, and to report its diagnostic value. Methods: This was a retrospective observational single centre study performed between the years 2011 to 2020 in Malmö, Sweden. Patients with a suspected aortic VGEI, where a DASGA was performed at the Vascular Centre, were included in the study. Results: In total, 31 guided aspirations were performed in 27 patients (25 male [93%]; median age 77 years [range 57 e 82 years]). The combination of culture and 16S rRNA/18S rRNA gave a microbial aetiology in 25/ 31 (81%) DASGAs. Importantly, excluding three cases where infection was ruled out, this rate increases up to 89%. A polymicrobial aetiology was found in six (24 %) cases. The most common bacteria found were Cutibacterium spp. (n ¼ 8) and Listeria monocytogenes (n ¼ 4). In total, the dominant aetiology could be further characterised into normal gut flora (n ¼ 12; 48%) or skin commensals (n ¼ 8; 32%). No patients had persistent morbidity related to the DASGA. Conclusion: DASGA can be used successfully to determine the microbiological aetiology of open and endovascular graft infections. This method appears to be safe, with a high success rate for confirming the microbiological aetiology of VGEIs, particularly if standard culturing methods are combined with 16S rRNA/ 18S rRNA. Finding the causative microbial aetiology is crucial, and in the vast majority of cases translumbar puncture can be used without serious complications.

BCG Aortitis, a Rare Complication of BCG Therapy

“…Thereby, the only option for vascular documentation was the use of DASGA, which has mostly been studied for common bacteria but can be contributory in up to 81% of cases. 5 …”

“…After the aortic aneurysm's exclusion, direct aneurysm sac guided aspiration (DASGA) 5 was performed by interventional radiologists for microbiological diagnosis as well as a hepatic biopsy. Specimens were sent to bacteriology, mycology, and pathology; autoimmune and infectious tests were also performed.…”

Vascular graft infections

“…Extra-anatomical bypass [53] and thorough debridement with complete removal of the infected prosthesis were historically the gold standard. However, due to the aggressiveness of the operation and subsequent high perioperative mortality [54] , alternatives have emerged to achieve infection control. Techniques with selective debridement and irrigation are an example of such procedures.…”

“…Although perioperative outcomes were better, mortality was higher during follow-up. Other authors have also addressed this important topic [54,75] . In this specific scenario where patients often are hemodynamically unstable due to bleeding or sepsis, an endovascular treatment might be used as a stabilization strategy and "bridge to surgery".…”