Behind The Knife: The Surgery Podcast

Clinical Challenges in Vascular Surgery: Aortic Graft Infections

Jul 13, 2023
Explore the rare but serious issue of aortic graft infections and their devastating implications. Learn about the risk factors such as diabetes and obesity, and how patients present with diverse symptoms. Discover various surgical strategies, including in-situ and extra-anatomic bypass options. Get insights on innovative techniques like rifampin-soaked grafts and autogenous reconstructions. The discussion emphasizes postoperative care and the importance of managing infections effectively. It's a deep dive into critical vascular surgery challenges!
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INSIGHT

High Morbidity Of Aortic Graft Infection

  • Aortic graft infections are uncommon but highly morbid, with contemporary incidence around 1–6% and ~4% overall.
  • These infections often require extensive open surgery and carry poor long-term survival, especially after EVAR.
INSIGHT

Common Sources And Risk Factors

  • Most prosthetic aortic graft infections likely stem from contamination at the initial operation, commonly skin organisms like coagulase-negative staph.
  • Diabetes, obesity, uremia, malnutrition, immunosuppression, and postoperative wound problems raise infection risk.
ADVICE

Workup: Image, Culture, And Map Veins

  • When concerned about graft infection, obtain a detailed history, blood cultures, labs, and a high-quality CT angiogram.
  • Look for perigraft fluid, gas, abscess, pseudoaneurysm, and map veins if planning vein conduit reconstruction.
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