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Related Concept Videos

Aneurysm III: Interprofessional Care01:26

Aneurysm III: Interprofessional Care

Aneurysm management involves either conservative medical therapy or surgical intervention, depending on the size and symptoms of the aneurysm. Conservative management is generally reserved for smaller, asymptomatic aneurysms, while larger or symptomatic aneurysms often necessitate surgical repair.Conservative Medical TherapyFor small, asymptomatic aneurysms, particularly abdominal aortic aneurysms (AAA) less than 5.5 centimeters in diameter, conservative medical therapy is recommended. This...

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Orthotopic Aortic Transplantation in Mice for the Study of Vascular Disease
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Aortic Vascular Graft and Endograft Infection-Patient Outcome Cannot Be Determined Based on Pre-Operative

Ilaria Puttini1, Marvin Kapalla2, Anja Braune3

  • 1Department for Vascular and Endovascular Surgery, Klinikum Rechts der Isar, Technical University of Munich, 80333 Munich, Germany.

Journal of Clinical Medicine
|January 11, 2024
PubMed
Summary

Vascular graft/endograft infection (VGEI) is a serious complication. PET/CT imaging shows high accuracy in diagnosing VGEI, but patient outcomes remain poor regardless of treatment approach.

Keywords:
aortic graft infectionpericardial prosthesissilver graftvascular graft endograft infection

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Area of Science:

  • Vascular Surgery
  • Infectious Diseases
  • Nuclear Medicine

Background:

  • Vascular graft/endograft infection (VGEI) is a significant complication following aortic surgery, associated with high morbidity and mortality.
  • Accurate diagnosis and effective management strategies for VGEI are crucial for improving patient outcomes.

Purpose of the Study:

  • To investigate patient characteristics, PET/CT quantification, and outcomes associated with VGEI.
  • To identify potential predictors of successful management and to evaluate the efficacy of surgical versus conservative treatment.

Main Methods:

  • A cohort of 93 patients with VGEI was analyzed, including demographic data, surgical history, and presence of fistulae.
  • Positron Emission Tomography/Computed Tomography (PET/CT) was used to quantify infection using standard uptake values (SUV) and target-to-liver ratio (SUVTLR).
  • Outcomes, including in-hospital mortality and 6-month aortic reintervention-free survival, were compared between operative and conservative management groups.

Main Results:

  • PET SUVTLR demonstrated high diagnostic accuracy for VGEI, with 94% sensitivity and 89% specificity.
  • In-hospital mortality rates were similar for both operative (19.7%) and conservative (17.6%) management groups (p = 0.84).
  • At six months, 50% of the surgically treated patients survived without aortic reintervention. Graft material did not impact overall survival (p = 0.745).

Conclusions:

  • While PET/CT is effective in diagnosing VGEI, short- and midterm morbidity and mortality remain high.
  • Neither preoperative patient characteristics nor the material used for aortic reconstruction influenced overall survival.
  • Outcomes were comparable between surgical and conservative management, suggesting a need for further research into optimizing VGEI treatment strategies.