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35. Arterial and Vascular Graft Infection

Etiology

• Bacterial contamination at the time of graft implantation.
• Hematogenic contamination.
• Lymphogenic contamination.

Microbiology and immunology

• Most commonly involved organisms.
• The effect of graft material.
• The effect of systemic and local immunosuppression.

Clinical presentation

• Depending on the anatomic location.
• Depending on the type of graft.
• Depending on the infecting organism.

Diagnostic evaluation

• Duplex ultrasonography.
• Computed tomography.
• Magnetic resonance imaging.
• Nuclear medicine techniques.
• Arteriography.
• Endoscopy.

Prevention

• Asepsis – antisepsis.
• The role of prophylactic antibiotics.
• Antibiotics bonded to the vascular graft.

Management

• Aortic graft infection.
• Femoropopliteal graft infection.

References

Williams GM. Complications of vascular surgery. Surg Clin North Am 1993;73:323-335.

Hemorrhage, early thrombosis of a graft or vessel nerve injury, graft infection, and renal failure are frustrating problems for vascular surgeons. All frequently arise from technical complications. Methods of avoiding these problems are discussed.

Earnshaw JJ. Methicillin-resistant Staphylococcus aureus: vascular surgeons should fight back. Eur J Vasc Endovasc Surg 2002;24:283-286.

This article addresses the problem of methicillin-resistant Staphylococcus aureus (MRSA) which is now the commonest cause of serious vascular wound and graft infection. Preoperative, intraoperative and postoperative measures against MRSA infections are briefly reviewed.

Valentine RJ. Diagnosis and management of aortic graft infection. Semin Vasc Surg 2001;14:292-301.

This report summarizes the currently available methods of diagnosing and treating aortic graft infections. Available imaging techniques and complementary tests are presented, followed by a discussion of the therapeutic options which include graft excision and extra-anatomic revascularization or in situ replacement with autogenous vein, allograft or rifampin-bonded prosthesis.

Seeger JM. Management of patients with prosthetic vascular graft infection. Am Surg 2000;66:166-177.

This review discusses diagnosis and treatment of patients with prosthetic vascular graft infection, emphasizing the basic principles necessary for successful management of this complex problem. Basic information about the incidence, etiology, and bacteriology of prosthetic vascular graft infections is also be briefly reviewed.

Bandyk DF. Antibiotics-Why so many and when should we use them? Semin Vasc Surg 2002;15:268-274.

This article summarizes the indications and efficacy of antibiotic prophylaxis and treatment in vascular surgery. Well-established indications, as well as new applications for antibiotics in vascular surgery are discussed.