[Infections of vascular prostheses of the abdominal aorta. Diagnostic and therapeutic problems]

Aortic graft infection is one of the most serious complication of vascular surgery. While the incidence of such infections has declined over the years, it continues to be associated with high mortality and high rates of limb loss. Graft implanted in the inguinal area have a higher rate of infection than those that lie entirely within the abdomen. Infection of the intraabdominal extremities of vascular grafts is most frequently associated with prostheto-enteric fistula.

Despite the many available sophisticated imaging techniques diagnosis remains difficult, particularly with intra-abdominal grafts because of nonspecific clinical and imaging findings. A variety of approaches to aortic graft infection have been proposed and optimal treatment usually requires an association of systemic antibiotic administration with surgery. Removal of the entire infected graft is often necessary for cure and there are only few situations in which conservative treatment is acceptable. A careful identification of the infecting microorganisms and in vitro susceptibility testing are essential for successful therapy.

Prevention consists in a strict adherence to principles of asepsis and the use of prophylactic antibiotics in vascular surgery. The use of antibiotics-bound knitted grafts has been recently proposed.