Prosthetic graft infection: diagnostic and therapeutic role of interventional radiology

Aortic graft infection is a rare complication of aortic surgery associated with high mortality and morbidity rates. The aim of the study was to evaluate the authors' experience with diagnostic and interventional procedures in the management of aortic graft infection.

Six patients with clinical signs suggestive of graft infection were studied. Abdominal computed tomography (CT) was performed in all patients. Diagnostic work-up was performed with perigraft puncture for fluid aspiration and contrast medium injection to confirm clinical signs or CT findings of graft infection, and to detect graft-enteric fistulas. Percutaneous drainage of the peri-prosthetic abscess was performed as attempted therapy in four patients.

In four patients, CT examination findings were considered positive for graft infection. Culture and cytologic examination of aspirates revealed numerous white blood cells but did not show any growth. In three patients, direct contrast medium injection into the perigraft space allowed the detection of a graft-enteric fistula. In three patients, percutaneous drainage was performed as preoperative therapy, allowing improvement of the surgical outcome; in one patient the catheter was left in place as an attempt at definitive therapy, allowing a complete recovery.

The percutaneous approach to prosthetic graft infection permits both the drainage and aspiration of the fluid in the perigraft area for laboratory studies. Percutaneous drainage can offer the possibility of definitive cure in patients for whom surgical management is considered too risky or, at least, represents a temporizing maneuver to improve the patient's general condition before surgery.