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Management of aortic graft infections - the present strategy and future perspectives

V Treska, B Certik, J Molacek

    Bratislavske Lekarske Listy
    |March 2, 2016
    PubMed

    Insights

    Aortic graft infections (AGI) are severe surgical complications with high mortality and morbidity. This review covers AGI diagnosis, treatment, and prevention, highlighting the need for new strategies for infected aortic endografts.

    Area of Science:

    • Vascular Surgery
    • Infectious Diseases

    Background:

    • Aortic graft infections (AGI) are serious complications following open and endovascular aortic surgery, with incidence rates of 0.6-3%.
    • These infections are linked to high perioperative mortality (30-60%), morbidity (40-60%), and limb amputation rates (10-40%).
    • A significant majority of patients (90%) present with predisposing factors for AGI at the time of aortic reconstruction.

    Purpose of the Study:

    • To review current knowledge on the incidence, predisposing factors, etiology, diagnosis, treatment, and prevention of aortic vascular graft and endograft infections.
    • To address the anticipated increase in infected aortic endografts due to rising endovascular procedures and patient comorbidities.
    • To emphasize the necessity for developing less invasive, sophisticated, and individualized treatment strategies for complex cases.

    Main Methods:

    • Review of current literature on aortic graft and endograft infections.
    • Synthesis of information regarding diagnostic modalities, including clinical presentation, laboratory markers, microbial cultures, and imaging.
    • Analysis of established and emerging treatment principles, encompassing surgical interventions and conservative management.

    Main Results:

    • Diagnosis relies on a combination of clinical symptoms, laboratory findings, microbial analysis, and imaging techniques.
    • Standard surgical treatment involves infected graft removal, debridement, and vascular reconstruction (in situ or extra-anatomic bypass) with long-term antibiotics.
    • Conservative management is reserved for select cases of endograft infection.

    Conclusions:

    • The increasing prevalence of endovascular aortic procedures necessitates advanced, individualized treatment approaches for infected endografts, especially in patients with severe comorbidities.
    • Future strategies must focus on less invasive and sophisticated methods to manage these challenging infections.
    • Continued research and development are crucial for optimizing patient outcomes in aortic graft and endograft infections.

    Keywords:
    aortic graft infectionsetiologyincidencemanagementtreatment perspectives.

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