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Management of abdominal aortic prosthetic graft and endograft infections. A multidisciplinary update
Roberta Maria Antonello1, Mario D'Oria2, Marco Cavallaro3
1School of Medicine, University of Trieste, Trieste, Italy.
Abstract:
Abdominal aortic graft infections (AGIs) occur in 1-5% of aortic prosthetic placements. It can result in limb amputation, pseudo-aneurysm formation, septic emboli, aorto-enteric fistulae, septic shock and death. The most frequently involved pathogens are methicillin-susceptible Staphylococcus aureus, methicillin-resistant Staphylococcus aureus and coagulase-negative staphylococci, followed by Enterobacteriaceae and uncommon bacteria. In case of gut involvement the presence of fungi has to be considered. Computed tomography angiography is actually the gold standard diagnostic imaging but magnetic resonance is a valid alternative. Nuclear medicine imaging is commonly used to improve sensitivity and specificity. Signs and symptoms are often aspecific and blood cultures can be negative, requiring alternative ways to detect the microorganism responsible for infection, such as 16S rRNA gene sequencing and molecular rapid diagnostic tests. Curative surgical intervention is the first choice approach, with in-situ reconstruction providing by far the best outcome and xenopericardial bovine patch as a promising option. For patients unable to undergo major surgery, the outcome of conservative approach remains uncertain but usually provides for life-long suppressive therapy. However, in selected cases an attempt of stopping antibiotic treatment after 3-6 months can be done. Given the difficulty in their management, we performed a review of AGIs, in order to raise awareness on clinical presentation, current available diagnostic tools, prophylaxis, surgical and anti-infective treatment of AGIs.
Insights
Abdominal aortic graft infections (AGIs) are serious complications of aortic surgery. Early diagnosis and appropriate treatment, including surgery and antibiotics, are crucial for better patient outcomes.
Area of Science:
- Vascular Surgery
- Infectious Diseases
- Medical Imaging
Background:
- Abdominal aortic graft infections (AGIs) complicate 1-5% of aortic prosthetic placements.
- AGIs can lead to severe complications including limb loss, pseudo-aneurysm, septic emboli, aorto-enteric fistulae, septic shock, and death.
- Common pathogens include Staphylococcus aureus (methicillin-susceptible and resistant), coagulase-negative staphylococci, Enterobacteriaceae, and fungi (with gut involvement).
Purpose of the Study:
- To review the clinical presentation, diagnostic tools, prophylaxis, and treatment of abdominal aortic graft infections.
- To raise awareness among healthcare professionals regarding the challenges in managing AGIs.
Main Methods:
- Review of existing literature on abdominal aortic graft infections.
- Discussion of diagnostic modalities including computed tomography angiography (CTA), magnetic resonance imaging (MRI), and nuclear medicine.
- Exploration of microbiological detection methods such as 16S rRNA gene sequencing and rapid molecular diagnostic tests.
Main Results:
- Computed tomography angiography is the gold standard for diagnosis, with MRI as a viable alternative.
- Nuclear medicine imaging enhances diagnostic sensitivity and specificity.
- In-situ reconstruction offers the best surgical outcomes, with xenopericardial bovine patch showing promise.
- Conservative management for non-surgical candidates typically involves lifelong suppressive antibiotic therapy.
Conclusions:
- Effective management of AGIs requires a multidisciplinary approach, integrating advanced diagnostics and tailored treatment strategies.
- Surgical intervention, particularly in-situ reconstruction, is the preferred curative approach.
- Further research is needed to optimize conservative management strategies and antibiotic treatment cessation protocols.
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