Overview
Aortic graft infections (AGI) are rare complications following aortic reconstructive surgeries, occurring at an incidence of 0.6%-3%, with outcomes significantly influenced by whether the initial surgery was emergency or elective 1.Diagnosis
Clinical suspicion based on signs of infection post-surgery (fever, pain, swelling) 1.
Imaging studies (CT, MRI) to identify signs of infection around the graft 1.
Blood cultures and tissue biopsies for microbiological analysis 1.
Elevated inflammatory markers (CRP, ESR) 1.Management
Aggressive surgical debridement: Removal of infected graft and surrounding tissue 2.
In situ preservation strategy: Alternative to complete graft removal, involving coverage with vascular tissue flaps 2.
Silver-coated prostheses: Considered cautiously for resistant infections, though efficacy remains questionable 4.
Antibiotic therapy: Tailored based on culture and sensitivity results; specific drug classes and doses not detailed in abstracts 1.Special Populations
Elderly patients: Higher risk of complications and mortality; management should consider comorbidities 1.
Comorbidities: Significant occlusive atherosclerosis increases risk of complications like pelvic necrosis post-excision 5.Key Recommendations
Perform aggressive surgical debridement for infected aortic grafts, including removal of infected prosthetic material 2 (Evidence: Strong).
Consider in situ preservation strategies as an alternative to complete graft removal in selected cases 2 (Evidence: Moderate).
Use silver-coated prostheses cautiously in critical cases due to potential limitations in preventing infection 4 (Evidence: Weak).
Monitor and manage comorbidities closely, especially occlusive atherosclerosis, to prevent severe complications like pelvic necrosis 5 (Evidence: Moderate).References
1 Pettersson J, Daryapeyma A, Gillgren P, Hultgren R. Aortic Graft Infections after Emergency and Non-Emergency Reconstruction: Incidence, Treatment, and Long-Term Outcome. Surgical infections 2017. link
2 Tossios P, Karatzopoulos A, Tsagakis K, Sapalidis K, Grosomanidis V, Kalogera A et al.. Treatment of infected thoracic aortic prosthetic grafts with the in situ preservation strategy: a review of its history, surgical technique, and results. Heart, lung & circulation 2014. link
3 Labruzzo C, El Tayar AR, Hakim NS. Graft pancreatitis: literature review. International surgery 2006. link
4 Pupka A, Skóra J, Janczak D, Ruciński A, Korta K, Barć P et al.. The treatment of massive prosthetic grafts infections with the use of silver/collagen coated dacron vascular prosthesis. Polimery w medycynie 2003. link
5 Das BM, Zama N, Satiani B, Vaccaro PS. Pelvic necrosis: a complication of infected aortic graft excision. Cardiovascular surgery (London, England) 1993. link