The relevance of arterial wall microbiology to the treatment of prosthetic graft infections: Graft infection vs. arterial infection

Abstract

One potential, but poorly studied source for intraoperative contamination of vascular grafts is the native artery to which the prosthetic graft is attached. The purpose of this study was to analyze the relationship between arterial wall microbiology and graft infection. Between July 1, 1981, and March 31, 1982, arterial specimens were cultured from 88 (30%) of 298 patients undergoing clean, elective arterial reconstructive procedures. Control cultures were obtained from adjacent adipose or lymph node tissue. Positive cultures were obtained from 38 of 88 (43%) of the arterial walls cultured but from none of the control cultures (0 of 20) (p less than 0.001). The most common organism cultured was Staphylococcus epidermidis (27 of 38; 71%). Our overall graft infection rate since January 1, 1981, is 0.9% (3 of 335). All three graft infections occurred in patients with positive arterial cultures. Arterial and graft cultures were also obtained from 20 patients treated for 22 graft infections over the past 13 years. Organisms recovered included staphylococcal species (36%), enteric organisms (46%), and mixtures of the two (18%). These patients with culture-positive graft infections were divided retrospectively into two groups: those with positive and those with negative arterial cultures. Positive arterial cultures were associated with suture line disruption in 8 of 14 cases (57%), but there were no arterial disruptions in patients with negative cultures (0 of 8) (p less than 0.01). These data document a significant correlation between positive arterial wall cultures and subsequent prosthetic infection and also suggest that infection involving the arterial wall is a major determinant of the morbidity and mortality associated with the treatment of prosthetic graft sepsis.

Prosthetic vascular infection complicated or not by aortoenteric fistula: Comparison of treatment with and without cryopreserved allograft (homograft)

“…However, for patients without aortoenteric fistula, cryopreserved allografts are very resistant; rupture of the proximal allograft±aortic anastomosis has not been reported. Several authors 20,21 insist on the importance of complete excision at the infected proximal anastomosis. Was our surgical excision too limited?…”

Pseudoaneurysm rupture with hemorrhagic shock in a patient with periprosthetic hip joint infection

“…[ 4 ] Coexisting infection may result in further aneurysmal degeneration of the arterial wall, complicating this condition and worsening its prognosis. [ 3 ] Given the potential of a PA for causing significant morbidity and mortality, the surgeon should have an elevated index of suspicion in the presence of high-risk factors. Previous studies have demonstrated that revision surgery, female sex, left-sided as opposed to right-sided surgery, and intrapelvic migration of the acetabular component with or without PJI are associated with an increased risk of vascular injury.…”

“…[ 1 , 2 ] Coexisting periprosthetic joint infection (PJI) may result in further aneurysmal degeneration of the arterial wall, complicating this condition and worsening its prognosis. [ 3 ] The PA is unstable and prone to rupture because of poor support of the PA wall. Once PA rupture occurs it can have serious consequences for both patients and doctors.…”

Die primär bakteriell infizierte Arterie

“…Neben anderen Keimen finden sich häufig Salmonellen, Staphylokokken, Streptokokken, Proteus und auch Escherichia coli [12]. Neben anderen Keimen finden sich häufig Salmonellen, Staphylokokken, Streptokokken, Proteus und auch Escherichia coli [12].…”