Management of Infected Grafts and Aneurysms of the Aorta

Femoropopliteal prosthetic bypass graft infection due to Mycobacterium abscessus localized by FDG-PET/CT scan

“…7 Furthermore, amputation rates up to 70% and cumulative mortality rates ranging from 25% up to 88% are seen after prosthetic vascular graft infection. 1,2,8,9 The causative organisms for infection are most commonly reported as Staphylococcus aureus and coagulase-negative staphylococci, although in as many as 25% of cases, the causative organism is never identified. 10,11 To the best of our knowledge and literature review, there have been no previous reports of prosthetic vascular graft infections due to Mycobacterium abscessus.…”

“…Most cases involve gram-positive cocci-like Staphylococcus epidermidis and aureus. [1][2][3][4][5] It is easy to recognize a graft infection when localizing symptoms (ie, warmth, swelling, pain, or drainage) are present. However, the diagnosis can be challenging with only nonspecific signs and symptoms (ie, elevated white blood cell [WBC] count, C-reactive protein or erythrocyte sedimentation rate, or bacteremia).…”

Abdominal Aortic Graft Infection

“…The conventional approach of graft removal and extra-anatomic reconstruction is associated with 12% mortality and 2% incidence of aortic stump infection/disruption (2). Three-year survival is estimated at 63% (Kitamura et al, 2005). Clearly, axillofemoral graft complications occur more frequently in patients with infected aortofemoral prosthetic grafts than in those with aortoiliac bypasses.…”

“…It is estimated that Staphylococcus aureus accounts for approximately 25% to 50% of graft infections (FitzGerald et al, 2005). Methicillin-resistant (MRSA) strains of Staphylococcus aureus are increasingly common in early infections, and gram-negative bacilli, such as Enterobacter, Klebsiella, Escherichia coli, Proteus, and Pseudomonas, have also been slowly increasing in frequency (Kitamura et al, 2005). For all organisms, bacterial adherence to the prosthetic graft is the initial event in the process of graft infection.…”

“…Organisms that produce a biofilm are more difficult to culture from an infected graft. Proteases produced by gram-negative organisms contribute to the higher rates of vessel wall necrosis, anastomotic disruption, and pseudoaneurysm formation with infectionfrom these bacteria (Kitamura et al, 2005;O'Brien & Colin, 1992). Finally, it is important for every vascular surgeon to bear in mind that, in contrast to primary aortic infections, Salmonella almost never is the causative organism for prosthetic graft infection.…”