Vascular Graft Infection Research Articles

A Head-to-Head Comparison Between [18F]Fluorodeoxyglucose ([18F]FDG) Positron Emission Tomography/Computed Tomography (PET/CT) and 99mTechnetium-Hexamethylpropylene Amine Oxime (HMPAO)-Labeled Leukocyte Scintigraphy in a Case Series of Patients with Suspected Vascular Prosthesis Infection: To Trust Is Good, but to Check Is Better

Background: Prosthetic vascular graft infection (PVGI) is a serious complication associated with vascular prostheses. Nuclear medicine techniques, including [18F]fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) and 99mtechnetium-hexamethylpropylene amine oxime (HMPAO)-labeled leukocyte (WBC) scintigraphy, are part of the MAGIC diagnostic criteria for PVGI. Methods: In this retrospective study, we analyzed eight patients with suspected PVGI who underwent both [18F]FDG PET/CT and WBC scintigraphy within an average of 8 days. Results: Of all eight patients (median age 69 years), three showed concordant positive results with both PET/CT and WBC, and their final diagnosis confirmed the presence of infection; five showed discordant results: in all five of these patients, PET/CT showed false-positive findings, whereas WBC correctly identified five true-negative cases. Conclusions: [18F]FDG PET/CT is highly sensitive but prone to false positives. WBC scintigraphy, combined with SPECT/CT, particularly in the evaluation of the treatment response, showed greater specificity, and it may warrant consideration as a MAGIC major diagnostic criterion for PVGI.

Real-world Use of Dalbavancin for Treatment of Vascular Graft and Endograft Infection (VGEI)

Real-world Use of Dalbavancin for Treatment of Vascular Graft and Endograft Infection (VGEI)

Perioperative and mid-term outcome of prefabricated bovine pericardial grafts in the context of infected aortic/iliac pathologies.

Perioperative and mid-term outcome of prefabricated bovine pericardial grafts in the context of infected aortic/iliac pathologies.

Peripheral Prosthetic Vascular Graft Infection: A 5-Year Retrospective Study

Background/Objectives: Peripheral prosthetic vascular graft infection represents a very serious complication after lower limb revascularization, with amputation and mortality rates up to 70% and 30%, respectively. This study was designed to determine the incidence of prosthetic graft infection, amputation, and mortality rate in our institution, analyzing different types of treatment. Methods: A retrospective cohort single institution review of peripheral prosthetic bypass grafts evaluated patient demographics, comorbidities, indications, location of bypass, type of prosthetic material, and case urgency and evaluated the incidence of graft infections, amputations, and mortality. Results: Between January 2016 and December 2021, a total of 516 bypasses were recorded (318 male, 198 female, mean age 74.2): 320 bypasses in venous material and 196 prosthetic bypasses using Dacron or PTFE. Among patients with a prosthetic bypass, 16 (8.2%) presented a graft infection at a mean follow-up of 39 months. Thirteen other patients who submitted to prosthetic peripheral bypass in other centers presented to our institution with a graft infection, so a total of 29 infected grafts were treated. Infected grafts were removed in 20 patients (68.9%), while a conservative treatment was helpful in nine cases (31.1%). The germs involved were Gram-negative in 27.6% and Gram-positive in 41.4%. During follow-up, we recorded five deaths (17.2%) and six amputations (20.7%) directly after bypass excision; another two amputations (6.9%) occurred after failure of the new bypass replacing the prosthesis removed. Conclusions: Redo-bypass, active infection at the time of bypass, and advanced gangrene were associated with a higher risk for prosthetic graft infection and major extremity amputation. Complete graft removal and replacement by venous material or Omniflow II represents the typical treatment. However, aggressive local treatment including drainage, debridement, vacuum-assisted closure therapy application, and muscle transposition seem to be a better solution in selected patients without the need for graft removal and with rates of limb salvage superior to those obtained with excisional therapy.

Outcomes of conservative treatment for thoracic vascular graft infections

OBJECTIVESThoracic vascular graft infections are devastating complications after aortic surgery, entailing high mortality. The gold standard treatment combines excisional surgery and antimicrobial therapy, but patients deemed inoperable might benefit from a conservative approach. Outcomes of patients treated only with antimicrobial agents without reoperative surgery are scanty. We aim to describe patients’ characteristics and outcomes using an antibiotic-only strategy without thorough debridement.METHODSRetrospectively collected data from a prospective cohort in a tertiary centre. Descriptive analysis for baseline characteristics and Kaplan–Meier estimates for survival were performed.RESULTSFrom November 2012 to December 2022, 66 patients were identified with aortic root, ascending aortic and aortic arch graft infections. Of these, 44 received an antibiotic-only strategy or in combination with selective debridement after achieving multidisciplinary consensus. Median follow-up was 4.8 years [interquartile range (IQR) 1.7–6.1], and cumulative survival was 82.9% (CI 95%, 69.7–96.1). Streptococcus spp were the most common isolated microorganisms.CONCLUSIONSIn selected cases, a conservative approach with antibiotics only or in combination with selective debridement showed acceptable results at follow-up, suggesting a valuable therapy option for this cohort of patients.

Characteristics and outcomes of patients with infective native aortic aneurysm or vascular graft and endograft infection

Background Infections of the aorta and its branches can occur either in native tissue, known as infective native aortic aneurysms (INAAs), or following vascular surgery involving native or prosthetic grafts, referred to as vascular graft or endograft infections (VGEIs). Objectives First, this study aimed to assess the all-cause on-year mortality of patients with INAAs and VGEIs. Second, this study described patients’ characteristics and prognostic factors. Methods This observational study included patients hospitalised for INAA or VGEI, between 2014 and 2022, at Nancy University Hospital (France). Data were retrospectively collected from patients’ medical record (ClinicalTrials.gov ID NCT05660733). Results Forty-seven patients were included in the INAAs group versus 40 in the VGEIs group. A history of immunosuppression or autoimmune disease were more frequent in INAAs patients. VGEIs patients had more chronic organ failure or cardiovascular pathology. The most commonly affected site was the infrarenal aorta, with thoracic involvement being more frequent in the INAAs group. Staphylococcus aureus was the most frequent identified pathogen (38.3% vs. 27.5%). There was no significant difference between groups in terms of all-cause 1-year mortality (40.4% in the INAAs group vs. 32.5% in the VGEIs group, log-rank test, p = .4803). The absence of surgery worsened the prognosis in the overall population (HR 2.8, 95% CI [1.2–6.3], p = .0125); this was also observed in the INAA group. Conclusions Despite different comorbidities and clinical presentations between groups, there was no significant difference in 1-year mortality. Surgical management appeared to be associated with improved outcomes.

Systematic Review and Meta-analysis of Occurrence Rate, Treatments, and Outcomes of Vascular Graft and Stent Infections in the Supra-aortic Trunks.

This study aimed to systematically review and synthesise the available evidence on the management of vascular graft and stent infections in the supra-aortic trunks (SATs). MEDLINE, Scopus, Cochrane databases, and citation searching. All study designs (case reports and series, cohort studies, and trials) addressing treatments for post-operative infections of prosthetic vascular grafts and stents in the SAT were included. GRADE methodology was used to assess the certainty of evidence. Seventy one studies were included in this systematic review. Fifty four were case reports and case series (215 patients) describing SAT infections following surgery. Among these, 11 studies with 149 patients who initially underwent carotid endarterectomy (CEA) with patch closure were included in the meta-analysis. The estimated infection rate after CEA with patch closure was 0.7% (95% confidence interval [CI] 0.4 - 0.9%). Surgical treatment was mostly based on complete removal of the infected material and in situ arterial reconstruction (82.2%, 95% CI 71.4 - 92.9%). Post-operative complications occurred in 25.9% (95% CI 16.0 - 35.9%). Cranial nerve injury occurred in 12.5% (95% CI 5.7 - 19.4%), with 28.4% (95% CI 5.2 - 57.4%) of these being permanent. Re-infections during a mean follow up of 37.7 months occurred in 3.4% of patients. Seventeen studies were case reports documenting SAT infections in 21 patients following endovascular treatment. Stent explantation was performed in 18 of 21 cases. A reconstruction to restore SAT flow was performed in 11 of 18 cases. GRADE analysis determined the certainty of evidence for all outcomes to be very low. Vascular graft and stent infections in the SATs are uncommon. The preferred treatment was removal of the infected graft and autologous reconstruction. Alternatives included drainage, stent relining, and antibiotics. Cranial nerve injuries were common, with one third resulting in permanent damage.

Merits of Puncture and Drainage of Perigraft Material in Patients with Vascular and Endovascular Prosthetic Graft Infection.

Merits of Puncture and Drainage of Perigraft Material in Patients with Vascular and Endovascular Prosthetic Graft Infection.

Incidence and Comparison of Postoperative Explained and Unexplained Fever in Open Aortic Repair.

Incidence and Comparison of Postoperative Explained and Unexplained Fever in Open Aortic Repair.

Outcomes of biosynthetic collagen prostheses with comparison to cryopreserved arterial homografts for bypass reconstruction in infrainguinal vascular graft infections.

Managing infrainguinal vascular graft infections (VGI) in bypass reconstruction is complex. Although an autologous vein is the preferred graft material, alternative conduits are required when autologous veins are unavailable. This study aimed to compare the efficacy of cryopreserved arterial homografts and biosynthetic glutaraldehydemodifiedovine collagen grafts (Omniflow II) for the treatment of infrainguinal VGI. The study was retrospective across two centers and included patients with infrainguinal VGI treated with cryopreserved arterial homografts or Omniflow II grafts between 2009 and 2019. Freedom from reinfection, primary patency rates, amputation-free survival, and overall survival were analyzed using 5-year Kaplan-Meier estimates. Overall, 63 patients with infrainguinal VGI were treated with either Omniflow II grafts (n = 34) or cryopreserved arterial homografts (n = 29). At 5 years, freedom from reinfection was 97.1% for Omniflow II grafts and 93.1% for cryopreserved arterial homografts (p = .4). Primary patency was 50% for Omniflow II grafts and 55.2% for the cryopreserved arterial homografts (p = .5). Amputation-free survival was 52.9% for Omniflow II grafts and 55.2% for cryopreserved arterial homografts (p = .7). No graft degeneration or graft ruptures were observed during the follow-up. This study suggests that biosynthetic grafts are viable and accessible alternatives for traditional graft materials, offering similar efficacy and ease of use. Although autologous vein grafts remain the gold standard for VGI management, biosynthetic grafts may serve as a viable alternatives to cryopreserved arterial homografts in the treatment of infrainguinal VGIs.

Diagnosis of prosthetic vascular graft infection using the management aortic graft infection collaboration (MAGIC) criteria.

BackgroundVascular graft infection (VGI) is a devastating complication that necessitates immediate diagnosis to reduce morbidity and mortality. In 2016, The Management of Aortic Graft Infection Collaboration (MAGIC) proposed a diagnostic algorithm for identifying aortic graft infection which uses clinical, radiological, and laboratory findings to determine risk. The purpose of this study was to retrospectively validate the MAGIC criteria for VGI diagnosis and potentially broaden its application.MethodsAn IRB approved retrospective cohort study was performed with 28 suspected VGI patients from our institution. A blinded chart review categorized patients based on MAGIC criteria into "infected," "suspected infection," or "insufficient evidence" groups. Due to the MAGIC criteria's placement of a third outcome, "suspected infection," the results were dichotomized into two systems whereby "suspected infection" patients were considered as infected (S = I) or uninfected (S = NI). Both dichotomized systems from the MAGIC criteria were then compared to the clinical diagnosis (with surgical evidence when possible) from which sensitivity and specificity were calculated.ResultsA total of 15 patients (54%) presented with definitive VGI, two patients (7%) presented with suspicion for VGI, and 11 patients (39%) presented with insufficient evidence to suspect VGI; placement in these categories were determined by the MAGIC criteria at entry to the study. When using clinical diagnoses, 17 out of 28 had VGI (61%). When using the categorization system S = I, sensitivity was 88.2% and specificity of 100%, for S = NI, sensitivity dropped to 76.4%, but specificity remained at 100%. These results were recomputed using only 25 of the 28 patients who were good surgical candidates. Using this new surgical threshold and smaller cohort to compare MAGIC against, sensitivity was calculated to be 93.3% with a specificity of 100% when S = I. When S = NI, the sensitivity was calculated to be 86.7% with specificity remaining at 100%.ConclusionsThe MAGIC criteria provide excellent specificity and reasonable sensitivity for diagnosis of VGI for peripheral and aortic revascularization.

FDG PET/CT in vascular graft infection: a pictorial review.

Vascular graft infections (VGI) are rare but severe complications following vascular surgery, with significant morbidity and mortality. Diagnosing VGI requires a multidisciplinary approach combining clinical, laboratory, and imaging findings. While CTA remains the first-line imaging modality, its limitations in detecting chronic or low-grade infections highlight the value of advanced nuclear medicine techniques, particularly [18F]FDG PET/CT. In this review, we discuss the role of [18F]FDG PET/CT in diagnosing VGI, emphasizing its high sensitivity and negative predictive value, which are critical for ruling out infection. Nevertheless, there are currently no universally accepted criteria for analyzing PET/CT findings in VGI, which poses challenges for consistent interpretation and clinical decision-making. This review aims to provide a comprehensive understanding of FDG PET/CT imaging in the context of VGI by exploring visual grading scales, uptake patterns, and semi-quantitative parameters while highlighting potential pitfalls such as post-surgical inflammation and false-positive results due to graft materials or surgical adhesives. Through a series of illustrative cases, we outline characteristic imaging patterns of infected and non-infected grafts, offering practical guidance for accurate interpretation. Additionally, we discuss the evolving role of FDG PET/CT in assessing treatment response and guiding follow-up in VGI management. This pictorial review seeks to enhance diagnostic accuracy and bridge the gap in standardized PET/CT interpretation criteria, ultimately contributing to improved patient care.

Axillary EndoVac procedure: a novel hybrid procedure for an infected axillary-profunda bypass

This paper reports an axillary artery EndoVac procedure for the management of an infected left axillary-profunda polytetrafluoroethylene (PTFE) bypass. Our patient presented with peri-graft infection and dehiscence of the distal anastomosis. Three separate surgical procedures subsequently took place over a seven-day period: day 1 required profunda artery ligation with sub-total explantation of the mid to distal PTFE bypass, day 2 required a left above-knee amputation, and the final operation on day 7 was the left axillary artery EndoVac procedure. The EndoVac procedure involved endovascular relining of the axillary artery with a covered stent graft, immediately followed by explantation of the remaining proximal PTFE graft and vacuum-assisted closure (VAC) application within the same operative setting. This resulted in successful wound healing within six weeks. It is not recommended currently as first-line management in treating vascular graft and endograft infections of the axillary vessels but the EndoVac approach should be considered in a select cohort of patients.

Phase 3, multicentre, randomized, double-blind, placebo-controlled, parallel-group study of ustekinumab in patients with Takayasu arteritis.

Takayasu arteritis (TAK) is a rare, chronic large vessel vasculitis with unmet treatment needs. This phase 3 study aimed to evaluate efficacy, safety, pharmacokinetics and immunogenicity of ustekinumab (UST) in Japanese patients with TAK. Patients with TAK who had relapsed ≤12 weeks prior to study intervention administration and achieved remission thereafter with standard-of-care including corticosteroid intensification were randomized 1:1 to receive UST or matching placebo with protocol-defined oral glucocorticoid taper regimen. The double-blind (DB) phase was up to the patient's relapse/total of 35 relapse events, followed by the open-label extension (OLE) phase. Primary endpoint was the time to relapse of TAK per protocol-defined criteria through the end of the DB phase. The study was terminated early due to patient recruitment challenge. Of 14 patients randomized, 8 relapsed during the DB phase (UST: 4/6; placebo: 4/8). The median time to relapse (weeks) was 11.14 (95% CI: 4.14, not estimated [NE]) for UST and 12.64 (95% confidence interval [CI]: 12.14, NE) for placebo (hazard ratio [HR] = 1.86 [95% CI: 0.41, 8.47]). In the DB phase, one patient in each group reported serious adverse event (SAE; UST: vascular pseudoaneurysm and brachiocephalic artery stenosis; placebo: cholecystitis); none were related to study intervention. Through the OLE phase, 1/4 (25.0%) patients in the UST-UST group (vascular graft infection considered related to study intervention) and none in the placebo-UST had SAEs. There were no serious infections/deaths throughout the study. The efficacy of UST in patients with TAK cannot be adequately assessed as the pre-determined sample size was not reached, and the study was prematurely terminated. No new safety signal of UST was identified. Clinicaltrials.gov, https://clinicaltrials.gov, NCT04882072; jrct.niph.go.jp, https://jrct.niph.go.jp, jRCT2061210007; Clinical Registry, CR108981.

Treatment of Peripheral Vascular Graft Infections with Xenogeneic Grafts-A Single-Center Experience.

Introduction: Vascular graft infections (VGEIs) are rare but severe complications in vascular surgery. The choice of reconstruction material following graft removal is critical, particularly for infection prevention. This study evaluates the use of No-React® BioIntegral Surgical Grafts, made from bovine pericardium, in the treatment of VGEIs. Materials and Methods: A retrospective study of 12 patients (mean age 66.5 years; 67% male) treated between 2020 and 2022 was conducted. The follow-up period included in the study extended from the date of the procedure to 30 June 2024. Results: The study observed a 0% reinfection rate, underscoring the anti-infective potential of No-React® grafts. However, in-hospital complications were frequent, affecting six (50%) patients, with sepsis (3; 25%) related to preoperative VGEIs being the most common. Most importantly, in-hospital mortality was notably high (42%), primarily driven by infection-related sepsis. The overall complication rate after discharge was 14%, with only one case of graft occlusion (1/7) observed. Among discharged patients (7; 58%), the three-month survival rate was 71%. In-hospital complications were a predictive factor for overall survival (OS) (HR = 15.88, 95% CI = 1.81-139.47). Conclusions: Xenogeneic No-React® grafts show promise for managing VGEIs, offering low reinfection rates. However, high morbidity and mortality underline the challenges of treating patients with severe VGEIs. Early postoperative complications were a key predictor of OS. Further research is needed to confirm these findings and optimize treatment protocols for VGEIs.

P-1623. Implementation of MRSA Nasal PCR Pharmacy Protocol on Vancomycin Use for SSTI

Abstract Background Recent published literature has shown that methicillin-resistant Staphylococcus aureus (MRSA) polymerase chain reaction (PCR) nasal swabs have similar utility for skin and soft tissue infections (SSTI) to well-established pneumonia data with a specificity ranging from 92.2-94% and negative predictive value ranging from 92-94%. The purpose of this study was to evaluate the effect of implementing a pilot pharmacy-led protocol for ordering MRSA PCR nasal swabs in vancomycin-treated SSTI. Methods A single-center, pre- and post-implementation observational study was conducted on adult floor patients admitted to a single institution between March 2023 to January 2024 who were on vancomycin for only the indication of SSTI. Exclusion criteria included Gram positive organism in blood culture, admission to any ICU, or if the suspected infection was a deep surgical site infection, necrotizing fasciitis, osteomyelitis, or a vascular graft infection. The primary outcome of duration of vancomycin therapy was compared between pre- and post-implementation groups. Secondary outcomes included length of hospitalization, acceptance rate of de-escalation, total duration of antibiotic therapy, SSTI-related readmissions within 30 days, and MRSA PCR statistics. Results A total of 229 patients were included in the study with 160 patients in the pre-protocol group and 70 patients in the post-protocol group. 52.4% of patients were male and 78.2% of patients were white with majority of SSTI being lower extremity cellulitis. There was an increase in MRSA PCR collection from 14.4% to 48.6% in the post-protocol group and in MRSA PCR pharmacy interventions from 0.6% to 28.6%. Duration of vancomycin therapy was similar between both groups and the average total duration of antibiotic therapy was longer than current guideline recommendations for SSTI. Conclusion While there was an increase in MRSA PCR nasal swab usage after piloting a new MRSA PCR protocol, the PCR results did not have a significant change on antibiotic utilization for skin and soft tissue infections. As a result of this study, alternative stewardship efforts have been identified for skin and soft tissue infection management. Disclosures All Authors: No reported disclosures

P-375. Long-Term Suppressive Antimicrobial Therapy in Prosthetic Vascular Graft Infection: a Five-Year Retrospective Evaluation

BackgroundProsthetic vascular graft infection (PVGI) is a rare but life-threatening complication of surgery. Complete removal and replacement of the endograft is the only curative strategy but is frequently impracticable for the high mortality risk, therefore, suppressive antimicrobial therapy (SAT) is the best treatment option.This retrospective study aimed to describe the indication and outcome of SAT in patients with a PVGI evaluated since 2019 at Tor Vergata Hospital in Rome.MethodsPatients with a PVGI (no cardiac valve replacement infections) were enrolled. The outcome was defined based on the latest available outpatient evaluation. PVGI was stratified as early/late and suspected/diagnosed according to guidelines.ResultsTwenty-one patients were enrolled (Tab. 1-3). At least one causative organism was identified in 41% of cases, mainly through blood samples (57%): 38% were Gram positive (GPB) and 29% were Gram negative (GNB) bacteria. Unexpectedly, early PVGI were more frequently caused by GNB than GPB (p-value 0.006).All patients were SAT treated; only 3 patients underwent surgery without reaching source-control. Several options, including long-acting antibiotics (LAA), were available for GPB, while cotrimoxazole, ciprofloxacin and ertapenem were the principal long-term SAT for GNB.The CT-PET scan monitoring was done after a median follow-up (FU) time of 90 [IQR 90-180] days; a positive early CT-PET FU (≤3 months from the first test) was associated with treatment failure needing a modification of SAT (p-value 0.003). Drug adverse effects occurred in 38% of cases and were followed by a change in SAT.Subsequently to clinical/radiological improvement (71%) or patient decision (29%), SAT was discontinued in 7 patients after a median time of 336 [292-404] days. Patients who experienced SAT discontinuation were younger, with fewer comorbidities, early infections, known pathogen and LAA therapy, although no statistically significant association was observed. Two patients showed a radiological failure needing to resume treatment; 3 patients (14%) successfully suspended SAT currently without relapse.ConclusionOur results support SAT as a suitable option for patients with PVGI at high surgical risk. Larger prospective studies are needed to guide empirical practice.DisclosuresAll Authors: No reported disclosures

P-2228. Utility of Microbial Cell-Free DNA Next-Generation Sequencing for Evaluation of Vascular Graft Infection

BackgroundVascular graft infection (VGI) is a rare but serious condition. Pathogen identification can be difficult given the deep-seated nature. Microbial cell-free DNA next-generation sequencing (mcfDNA NGS) is an emerging tool in non-invasive microbiologic workup. One commercially available mcfDNA is the Karius Test (KT). There is a paucity of data regarding utility and impact of mcfDNA NGS testing in the evaluation of VGI.MethodsWe retrospectively evaluated adult patients who underwent KT for evaluation of VGI at our institution. Only patients who met the Management of Aortic Graft Infection Collaboration (MAGIC) classification for suspected or confirmed VGI were included. We investigated the concordance between KT and conventional microbiologic workup. Conventional workup (CW) included pathogen identification through blood cultures, peri-graft/graft cultures, or histopathology. Concordance was defined by identical pathogen identification on KT and CW. We examined the influence of the KT result on clinical management.Figure 1.KT Results for Confirmed and Suspected VGI.ResultsWe identified 25 patients who met criteria for either suspected or confirmed VGI per the MAGIC criteria. Microbiology was undefined in 8 patients who had negative KT and negative CW. A total of 17 patients had positive workup with 6 having positive KT and negative CW, 3 having negative KT and positive CW, and 8 having both positive KT and positive CW (Table 1). KT was less likely to be positive for patients who met criteria for suspected infection (4/10; 40%) as opposed to confirmed infection (10/15; 66.67%), albeit non-significant (OR 0.33, p=0.188) (Figure 1). The KT led to antimicrobial de-escalation in 27.3% of patients with positive CW and 35.7% of patients with negative CW (Figure 2). Full concordance of KT and CW was noted in 3 patients (Table 2).Figure 2.Influence of KT on VGI cases with positive and negative conventional work-up.Treatment escalation was defined as the broadening of antimicrobial coverage due to KT results. Treatment de-escalation was defined as narrowing/discontinuation of antimicrobial coverage due to KT results.ConclusionWe found that the positivity rate for KT was 56%. KT impacted management in 40% of cases. Patients with confirmed VGI had a higher likelihood of having a positive KT. KT was the only positive microbiological definitive test in one case. Further studies are needed to explore the utility and impact of KT in the workup of VGI.DisclosuresAll Authors: No reported disclosures

P-925. Diagnostic value of 18-F-FDG-PET scan in endovascular infections

Abstract Background There have been multiple studies evaluating the use of 18-fluorine-fluorodeoxyglucose positron emission tomography (18F-FDG PET) as a diagnostic tool for endovascular infections with mixed results. The aim of this study will be to assess the efficacy of 18F-FDG PET scan in endovascular infections demographic details of confirmed IE by criteria Methods Our study plan to evaluate the accuracy of PET scan in diagnosing VPGI, infective endocarditis and other endovascular infection. We will use MAGIC criteria3 and Modified Dukes criteria 1 regarding comparative diagnosing evaluation of VPGI and Infective endocarditis which has been previously validated. It will be correlated with 18 FDG PET report to calculate sensitivity, specificity, negative and positive predictive value of PET scan in diagnosing endovascular infections. IE according to location (True positives- as per criteria ) Results •Referred with suspected IE ,Graft infections, endovascular infections and FUO- 158 cases.Analysed PET scan report – IE ,endovascular infections. PET scan with positive/negative reports for endovascular infections was analysed with confirmed cases by Modified Dukes and MAGIC criteria to calculate sensitivity, specificity, positive and negative predictive value.53- Confirmed and possible IE.Of 53 , 44 positive in PET scan Sensitivity- 83.01%.PET scan done for 14 suspected cases Vascular graft infections. Sensitivity of 64.28%.Sensitivity is variable: excellent for the diagnosis of PVE and CDRIE-pocket infections, but poor for NVE and CDRIE-lead infections. Conclusion PET scan was found to be efficient diagnostic tool in endocarditis and vascular graft infection.Need prospective studies for validation in vascular graft inefctions Disclosures All Authors: No reported disclosures

Leg Ulcer and Venous Symptoms Related to Lower Extremity Arteriovenous Access for Hemodialysis: A Retrospective Review with Emphasis on Wound Complications.

Lower extremity arteriovenous (AV) access serves as a crucial alternative for hemodialysis when upper extremity options are no longer viable. While there are numerous reports on functional patency, limited information exists regarding complications related to venous insufficiency and postoperative quality of life. This study aims to assess the actual incidence of such complications and provide evidence-based insights for clinical decision-making. We retrospectively analyzed 121 end-stage renal disease patients who underwent lower extremity AV access at Maharaj Nakorn Chiang Mai Hospital from 2006 to 2023. Among them, 105 patients (86.8%) had lower extremity AV grafts, while 16 patients (13.2%) had lower extremity AVF. Primary and secondary patency rate were 69.4% and 81.8% at one year, respectively. The mortality probability was 50.4% with a mean follow-up of 58 months. Mortality predictors included age (P = .001), aspirin use (P = .022) and statin use (P = .005). Primary failure occurred in 8 patients (6.6%) and vascular graft infection is the primary cause. There were no occurrences of venous leg ulcers developed, suggesting that the risk of this complication may be lower than previously thought in the short to medium term. However, 13.3% of patients experienced leg swelling and 21.7% had hyperpigmentation. The mean revised venous clinical severity score was 1.22 and the average EQ-5D-5L quality of life score was 0.99. Our findings suggest that the risk of venous leg ulcers in patients with lower extremity AV access may be lower than previously thought, at least in the short to medium term. This should encourage surgeons to consider this technique when upper extremity options are exhausted, while maintaining vigilance for early signs of venous insufficiency. Continued research into the detrimental effects of the hyper-dynamic blood flow rate on AV access and preventive strategies will enhance the benefit of lower extremity AV access in the future.