Prosthetic Graft Infection Research Articles

Prosthetic vascular graft infections: A center experience

IntroductionProsthetic graft infection is a major complication of vascular surgery associated with high morbid-mortality rates. This retrospective non-randomized single center study evaluated our experience in the management of prosthetic vascular graft infections. MethodsWe review the clinical files of patients who had vascular grafts implanted at our center between June 2007 and December 2011 and analysed the cases that developed Samson group 3, 4 and 5 infections until December 2012. ResultsFrom June 2007 to December 2012, 18 consecutive patients (14 males, 4 females) with median age 70 years were admitted to our institution with the diagnosis of vascular graft infection accounting for an incidence of 3.8%. 50% of these infections were early infections and MRSA was the most prevalent pathogen. 44% of infections were due to infection of a femoro-popliteal bypass. Using Samson classification, 72% were group 4 and 5 infections. We performed graft preservation in one patient, graft excision without revascularization in 50% (nine) patients; Excision + insitu replacement in 39% (seven) patients; Excision + Extra-anatomic bypass in one patient. Our amputation rate was 55% and our related death rate was 16%. ConclusionsOur amputation and mortality rates are according the published reviews. Besides allowing recognition of our reality this offers the opportunity to review diagnosis and therapeutic issues in prosthetic vascular graft infections. Each situation needs to be individualized as there is no consensus nor guiding algorithms about what should be the best medical treatment.

Factors predictive of treatment failure in staphylococcal prosthetic vascular graft infections: a prospective observational cohort study: impact of rifampin.

BackgroundThere exists considerable debate concerning management of prosthetic vascular graft infection (PVGI), especially in terms of antimicrobial treatment. This report studies factors associated with treatment failure in a cohort of patients with staphylococcal PVGI, along with the impact of rifampin (RIF).MethodsAll data on patients with PVGI between 2006 and 2010 were reviewed. Cure was defined as the absence of evidence of infection during the entire post-treatment follow-up for a minimum of one year. Failure was defined as any other outcome.Results84 patients (72 M/12 F, median age 64.5 ± 11 y) with diabetes mellitus (n = 25), obesity (n = 48), coronary artery disease (n = 48), renal failure (n = 24) or COPD (n = 22) were treated for PVGI (median follow-up was 470 ± 469 d). PVGI was primarily intracavitary (n = 47). Staphylococcus aureus (n = 65; including 17 methicillin-resistant S. aureus) and coagulase-negative Staphylocococcus (n = 22) were identified. Surgical treatment was performed in 71 patients. In univariate analysis, significant risk factors associated with failure were renal failure (p = 0.04), aortic aneurysm (p = 0.03), fever (p = 0.009), aneurysm disruption (p = 0.02), septic shock in the peri-operative period (p = 0.005) and antibiotic treatment containing RIF (p = 0.03). In multivariate analysis, 2 variables were independently associated with failure:septic shock [OR 4.98: CI 95% 1.45-16.99; p=0.01] and antibiotic containing rifampin [OR: 0.32: CI95% 0.10-0.96; p=0.04].ConclusionResults of the present study suggest that fever, septic shock and non-use of antibiotic treatment containing RIF are associated with poor outcome.

Early Host Tissue Response to Different Types of Vascular Prostheses Coated with Silver Acetate or Vaporized Metallic Silver

In vascular surgery, the infection of prosthetic vascular grafts represents a serious life-threatening complication. Due to the increasing resistance of hospital micro-organisms to standard antibiotic therapies, maximum effort should be put in the primary prevention of such infections. For this purpose, grafts may be coated with different antibacterial silver formulations. In the present study the different effects of silver acetate-coating and vaporized metallic silver-coating on the vascularization and perigraft inflammation during the initial phase after implantation of Intergard Silver (IS) and Silver Graft (SG) were compared. Silver acetate-coated IS and vaporized metallic silver-coated SG were implanted into the dorsal skinfold chamber of C57BL/6 mice (n = 8 per group) to study angiogenesis and leukocyte inflammation at the implantation site by means of repetitive intravital fluorescence microscopy over a 14-day period. At the end of the in vivo experiments, apoptosis and cell proliferation in the newly developed granulation tissue surrounding the implants was analyzed by immunohistochemistry. IS exhibited an improved vascularization, resulting in a significantly higher functional capillary density when compared to SG. Moreover, the leukocyte inflammatory response to IS was less pronounced, as indicated by a reduced number of adherent leukocytes in perigraft venules. This was associated with a higher proliferative activity of the granulation tissue incorporating the IS when compared to SG. The numbers of apoptotic cells in the perigraft tissue were low and did not differ between the two groups. Silver acetate-coated IS exhibits an improved vascularization and reduced perigraft inflammation during the first 14 days after implantation when compared to vaporized metallic silver-coated SG. This may contribute to reducing the risk of early perigraft seroma formation and subsequent infection.

Successful surgical in situ treatment of prosthetic graft infection by staged procedure after Bentall operation and total aortic arch replacement.

We report a case of a 29-year-old Marfan patient who developed prosthetic graft infection 10 months after Bentall operation and successive replacement of the remaining ascending aorta and the entire aortic arch for acute aortic dissection. Instead of an aggressive high-risk aortic redo procedure with removal and replacement of the infected prosthetic graft we elected a staged graft-sparing surgical approach. After 18 months of close follow-up the patient is in good condition and free from infectious sequela. This case and our review of the literature suggest that open extensive disinfection followed by tissue flap coverage is highly effective in controlling thoracic aortic prosthetic graft infection and may be considered as first-line treatment in such high-risk aortic arch redo patients.

リンパ漏を伴った鼠径部人工血管感染に対する外科治療経験:VAC 療法と縫工筋弁充填による人工血管温存

リンパ漏を伴った鼠径部人工血管感染に対する外科治療経験:VAC 療法と縫工筋弁充填による人工血管温存

18F-FDG Uptake in Noninfected Prosthetic Vascular Grafts: Incidence, Patterns, and Changes over Time

(18)F-FDG PET/CT is of value in the diagnosis of prosthetic vascular graft infection, but potential pitfalls related to tracer uptake in noninfected implants have been described. The current study assesses the incidence and patterns of (18)F-FDG uptake over time in noninfected grafts, in relationship to prosthetic material and location. A 12-y PET/CT database was retrospectively searched for cancer patients with prosthetic vascular grafts. Data retrieved from patient files included graft location, material, and time from surgery. Images were reviewed by 2 nuclear medicine physicians in consensus, with the presence and patterns (focal, diffuse homogeneous, inhomogeneous) of increased (18)F-FDG uptake in grafts recorded. The mean standardized uptake value in grafts (SUV-G) and mediastinum (SUV-M) was measured. The ratio of SUV-G to SUV-M (SUV-G/SUV-M) was calculated for each graft. One hundred seven prostheses were identified in 102 studies in 43 cancer patients. Sixty-seven prostheses were made of Dacron, 33 of Gore-Tex, and 7 were native veins. No increased (18)F-FDG uptake was found in 9 grafts (native veins, 4; Gore-Tex, 3; Dacron, 2). There was diffuse homogeneous uptake in 68 and inhomogeneous uptake in 30 grafts. The homogeneous pattern was more prevalent in Gore-Tex whereas the inhomogeneous uptake was seen more in Dacron vascular grafts. None of the grafts demonstrated focal uptake. The SUV-G range was 0.4-6.3 (average, 1.9), and SUV-M range was 0.6-2.4 (average, 1.4). The intensity of uptake was significantly higher in Dacron (SUV-G = 2.35 and SUV-G/SUV-M = 1.72) than in Gore-Tex (SUV-G = 1.09, SUV-G/SUV-M = 0.91) and native vein grafts (SUV-G = 1.07, SUV-G/SUV-M = 0.75) (P < 0.005). Native vein grafts showed a significant decrease in (18)F-FDG uptake over time whereas synthetic grafts showed no change in intensity for a follow-up of up to 16 y. Diffuse (18)F-FDG uptake was found in 92% of noninfected vascular prostheses, more in Dacron grafts than with other materials. The intensity of (18)F-FDG uptake of synthetic grafts did not change over time. With knowledge of the presence, patterns, and persistence of (18)F-FDG uptake in noninfected vascular prostheses, misinterpretation of PET/CT studies in patients referred for suspected prosthetic infection and in those assessed for diseases unrelated to their graft status can be avoided.

Late prosthetic graft infection after frozen elephant trunk presenting by hemoptysis and positive FDG PET/CT

Introduction: Late prosthetic graft infection confronts a surgeon with both diagnostic and therapeutic challenges especially in case of complex previous surgery.

Which Graft must be Preferred in Firearm Injury of the Axillary Artery

Aims: Interposition graft technique is used mostly in firearm wounds of axillary artery, because of excessive defect of the vessel. Autologous vein has been preferred in general application, even though there is a mild size discrepancy between native artery and autologous vein. However, in many series, prosthetic graft infection risk has been reported as low. Presentation of Case: I am presenting a patient with a gunshot wound to the right upper chest. As a first choice I preferred saphenous vein which was occluded by thrombosis at the post-repair third week in spite of anticoagulant therapy and was replaced with prosthetic graft which was patent at the eight month follow-up. Discussion: Although the theoretical risk of infection of prosthetic grafts, many previous reports have demonstrated that prosthetic grafts are nearly as safe as autologous grafts and they have high long-term patency rate. Conclusion: There is no point in insisting on autologous grafts in cases of the diameter discrepancy between native artery and autologous graft, prosthetic graft may be used more frequently in axillary artery trauma, and post-repair anticoagulants may be administered in the consequences of size discrepancy between the native artery and the graft.

Successful Diagnosis of an Atypical Prosthetic Vascular Graft Infection Without Perivascular Abscess

A 62-year-old woman with a vascular prosthesis for a common hepatic artery aneurysm (3 years ago) was hospitalized because of a 2-week history of lumbago and fever. Six months previously, she was hospitalized at another medical facility for 1 month because of a fever of unknown pathogenesis. Laboratory examination revealed moderate inflammation with an elevated C-reactive protein level of 6.5 mg/dL and a white blood cell count of 7070/mm3. Initial 8-row multi-detector computed tomography (CT) with contrast agent in the emergency department did not show any focus for the origin of the fever. She was referred to the orthopedic surgery department, and MRI of the pelvis revealed inflammation of the left sacroiliac joint (Figure 1). Her first 2 sets of blood cultures were positive for Streptococcus anginosus . Intravenous administration of ampicillin/cloxacillin sodium was started. She was then transferred to the cardiology department for the evaluation of septicemia, which could have been caused by infectious endocarditis. A transthoracic echocardiogram showed severe aortic regurgitation, which was not seen at the time of previous surgery for the vascular prosthesis (Figure 2A). However, a transesophageal echocardiogram only detected a small degenerative change in the right coronary cusp of the aortic valve, which could be healed …

Immunosuppressive protocol with delayed use of low-dose tacrolimus after aortic transplantation suppresses donor-specific anti-MHC class I and class II antibody production in rats.

Arterial allografts are used as vascular conduits in the treatment of prosthetic graft infection. Immunosuppression decreases their rupture risk rate. However, immunosuppression can be unprofitable in florid infection. Previously, we confirmed inhibition of cell-mediated destruction of rat aortic grafts by delayed use of tacrolimus. In this work, we studied the influence of this protocol on the antibody-mediated rejection. Flow cytometry was used for the retrospective analysis of day 0, 14, and 30 sera obtained from Lewis rat recipients of isogeneic fresh infrarenal aortic grafts (group A) or Brown-Norway rat aortic grafts (group B,C,D) for the presence of donor-specific anti-MHC class I and II antibodies. Tacrolimus in daily dose of 0.2 mg/kg was administered from day 1 to day 30 (group C) or from day 7 to day 30 (group D). Inhibition of fluorescence-labeled anti-BN MHC class I and MHC class II antibodies binding to BN-splenocytes was observed only by day 14 and day 30 sera of allogeneic non-immunosuppressed Lewis rats (group B). The day 30 sera significantly decreased anti-MHC I (42±3%) and anti-MHC II antibody binding (56±3%) compared to day 0 (76±9%, p=0.005 and 79±5%, p=0.003, respectively). Deposition of immunoglobulins G into the tunica media was observed only in non-immunosuppressed aortic allografts on day 30. Fresh aortic allografts induce donor-specific anti-MHC class I and anti-MHC class II antibody production. Delayed administration of tacrolimus completely suppressed antibody production and antibody-mediated destruction of aortic allografts.

The Use of Positron Emission Tomography in the Diagnosis of Prosthetic Arteriovenous Hemodialysis Graft Infection: A Case Study

Patients on chronic hemodialysis (HD) required efficient arterio-venous access. Different types of vascular access are commonly used, such as native arteriovenous (AV) fistula, prosthetic AV graft, central venous catheter, or temporary and tunnelled cuffed catheters. Vascular access—related morbidity remains the major issue for patients requiring long-term therapy. Vascular access infection constitutes the most challenging and life-threatening complication of vascular access and causes significant morbidity, loss of access and mortality. Vascular access infection is defined as local signs at the vascular access site or a positive blood culture with no know source other than the vascular access. The critical issue in the management of AV graft infection is the need to remove the infection and to maintain HD access with reduced morbidity. The diagnosis of infected AV graft is not always easy, especially with low-grade infection or atypical presentation. Fluorodeoxyglucose positron emission tomography (FDG-PET) is an imaging method that uses a radioactively labelled tracer (18 fluorodeoxy glucose) which is taken up by tissue with high metabolic activity, such as neoplastic and inflammatory lesions. FDG-PET has been proposed to visualise localisation of infection in patients with suspected prosthetic graft infection. We report a case of methicilin resistant staphylococcus aureus (MRSA) hemodialysis access infection without local inflammatory signs diagnosed on the PET-CT.

18F-Fluorodeoxyglucose positron emission tomography/CT scanning in diagnosing vascular prosthetic graft infection.

Vascular prosthetic graft infection (VPGI) is a severe complication after vascular surgery. CT-scan is considered the diagnostic tool of choice in advanced VPGI. The incidence of a false-negative result using CT is relatively high, especially in the presence of low-grade infections. 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) scanning has been suggested as an alternative for the diagnosis and assessment of infectious processes. Hybrid 18F-FDG PET/CT has established the role of 18F-FDG PET for the assessment of suspected VPGI, providing accurate anatomic localization of the site of infection. However, there are no clear guidelines for the interpretation of the uptake patterns of 18F-FDG as clinical tool for VPGI. Based on the available literature it is suggested that a linear, diffuse, and homogeneous uptake should not be regarded as an infection whereas focal or heterogeneous uptake with a projection over the vessel on CT is highly suggestive of infection. Nevertheless, 18F-FDG PET and 18F-FDG PET/CT can play an important role in the detection of VPGI and monitoring response to treatment. However an accurate uptake and pattern recognition is warranted and cut-off uptake values and patterns need to be standardized before considering the technique to be the new standard.

A Case of In-Situ Reconstruction with a Rifampicin-Bonded Gelatin-Sealed Woven Dacron Graft for Prosthetic Graft Infection with Pseudoaneurysms after Ascending Aortic Replacement for Type A Dissection

A 74-year-old woman underwent replacement of the ascending aorta for acute type A aortic dissection. The patient suffered from bacteremia postoperatively and repeated computed tomography showed an increasing diameter of pseudoaneurysms at the site of the proximal anastomosis due to graft infection. Re-mechanical Bentall operation and arch replacement were therefore performed using a composite graft of a rifampicin-bonded gelatin-sealed 24-mm woven Dacron graft and a mechanical valve. The postoperative course was uneventful. We report the successful in situ reconstruction using the above-mentioned Dacron graft and describe the preparation of the rifampicin solution using a surfactant.

Use and durability of femoral vein for autologous reconstruction with infection of the aortoiliofemoral axis

To analyze early and late mortality, venous morbidity, reinfection, and freedom from reintervention after using the femoral vein (FV) for vascular reconstruction with infection of the aortoiliofemoral axis. By reviewing our database, 86 patients could be identified with implantation of FV grafts in infected fields between November 1995 and July 2012. The patient records were retrospectively analyzed and follow-up information obtained from patients or their general physician. Seventy-one patients presented with prosthetic graft infection and 15 with an infected aneurysm. For data analysis, patients were divided into an aortoiliac (n = 67) and a femoral group (n = 19). Study end points assessed were early and late mortality, incidence of deep vein thrombosis of the FV donor limb, graft patency, limb salvage, reinfection, and freedom from reintervention. Sixty-seven aortoiliac reconstructions were performed using 84 FV grafts with an operative mortality of 9%. After a mean follow-up of 45 months, survival, patency, limb salvage, and freedom from reintervention were 45%, 97%, 94%, and 91%, respectively, at 5 years. Twenty FV grafts were employed for 19 femoral reconstructions with an operative mortality of 10.5%. Here, mean follow-up was 35 months and survival, patency, limb salvage, and freedom from reintervention were 29%, 87%, 93%, and 81%, respectively, at 5 years. Specimen culture confirmed Staphylococcus (epidermidis and aureus) as the predominant microorganism. Venous morbidity after FV harvest showed an incidence of deep venous thrombosis of 13.7% for popliteal and 10.6% for tibial level at a follow-up of 24 months with only mild clinical symptoms (21% limb swelling). Vascular reconstruction using autologous FV in arterial and graft infection of the aortoiliofemoral axis provides durable long-term results with acceptable mortality and morbidity.

Comprehensive evaluation of fibrin glue as a local drug-delivery system—efficacy and safety of sustained release of vancomycin by fibrin glue against local methicillin-resistant Staphylococcus aureus infection

Infection of prosthetic grafts, especially with methicillin-resistant Staphylococcus aureus (MRSA), often becomes critical. Although topical administration of antibiotics has been applied empirically, no comprehensive data are available showing long-lasting effects and safety of local antibiotic usage. By means of animal experiments we assessed fibrin glue (FG) as a slow-release vehicle for vancomycin (VCM) against local MRSA infection. Preliminary in-vitro experiments were performed to confirm that the FG-VCM mixture maintained viscosity as a sealant and led to slow-release of VCM. We next created a subcutaneous pocket in a rodent back and implanted a 1 cm (2) woven graft with 1 ml FG alone, or with serial concentrations of VCM (0-120 mg/ml. n = 3 for each group). MRSA of 1 × 10(7) colony-forming units (CFU) was injected into the pocket after wound closure. The graft was explanted 7 days later and was submitted for culture ("Culture-graft"). Blood samples were obtained for regular blood work, serum VCM concentration measurements, and blood culture ("Culture-blood"). The pocket tissue was also submitted for measurement of local VCM concentration. There was a remarkable infectious response in the group without vancomycin; however, no other groups developed any sign of infection. "Culture-graft" resulted in MRSA growth for V0 only. "Culture-blood" was negative in all groups, and only minimal serum concentrations of vancomycin were detected. One-dose topical administration of VCM via FG was effective against localized MRSA graft infection without systemic VCM administration. Topical administration of antibiotics may help treat difficult graft infections and reduce systemic use of potent antibiotics.

Homografts for the management of graft infections in the ascending aortic position

We read with great interest the article by Khaladj et al. [1] describing their experience with cryopreserved homografts for the management of a severe complication following reconstructive surgery on the ascending aorta and aortic arch, namely prosthetic graft infection. However, we would like to add some comments on the topic. According to their institutional policy, all patients with infected grafts of their ascending aorta, where the aortic arch was also involved, were treated by removal and replacement of the prosthetic material with homografts. Historically, replacement of infected thoracic aortic graft has been reported by individual surgeons, however, with unsatisfactory results. Hospital mortality rates have been as great as 46% [2] typically resulting from the invasiveness and complexity of the procedure, emergency conditions, contaminated field and the difficulties of exposure in the redo aortic setting. Our group, as others [3] too, experienced exceptionally disappointing results following the principle of redo ascending/arch prosthetic graft replacement, due to uncontrollable infective process. We congratulate the outstanding work of Khaladj et al. [1] from Hannover, who reported in their explants series a hospital mortality rate of 24%. This is the largest single-centre experience published so far treating 17 patients with cryopreserved homografts in the ascending/arch and aortic root. However, surgical mortality and morbidity are still a major concern with this aggressive treatment strategy. Moreover, there are no surgical guidelines on proper surgical management for such cases. Other strategies that have been applied in the surgical treatment of ascending/arch prosthetic graft infection are based on the principle of a more conservative, non-resectional, and thus, graftsparing surgical approach [2–6]. It is well documented that many institutions have switched during the last decades to this so-called ‘in situ preservation’ concept performing debridement of perigraft-infected mediastinal tissue, open surgical disinfection and transposition of viable omentum, as suggested by Hargrove and Edmunds [4] and Coselli et al. [5], with excellent clinical results. We were, therefore, surprised to read that ‘the use of omentum has not been evaluated for ascending aortic graft infections’. The literature certainly provides sufficient information concerning the role of this method which is feasible, safe and highly effective in controlling thoracic aortic prosthetic graft infection with superior outcomes when compared with traditional redo ascending/arch prosthetic graft replacement [2–6]. Inspired by a case we treated successfully with open surgical disinfection followed by omentum flap coverage after the Bentall operation and total aortic arch replacement, we reviewed the literature and recognized 77 similar cases for the treatment of infected ascending/arch prosthetic grafts with a collective early survival rate of 95% and a 100% success rate in terms of non-recurrence of graft infection [2–6]. Many of these patients with ascending aortic grafts also received an arch graft, composite valve graft or separate aortic valve prosthesis. We think, as other authors [2–6] too, that the dogma of the need for removal and replacement of the prosthetic graft is unjustified, at least in certain patients with ascending/arch prosthetic graft infection, even after composite aortic root replacement, as long as the infection is not associated with native or prosthetic aortic valve endocarditis or valve dysfunction. The present evidence and knowledge on current preservation strategies has the potential to spare patients high-risk procedures and higher mortality.

Late Prosthetic Vascular Graft Infections after Reconstructions on Aortoiliac Segment: An Eleven Years Experience

Summary The purpose of the study was to evaluate the frequency and etiology of late prosthetic vascular graft infections after reconstructions on aortoiliac segment. From 2001 to 2011,545 primary reconstructions were performed on 545 consecutive patients. We had 18 cases of late intracavitary graft infections in 14 of them. A total of 58 clinical specimens collected from patients before, during and after reoperation were analyzed. Pathogens were isolated using conventional methods for aerobic and anaerobic bacteria. The isolates were identified down to species level by conventional biochemical methods, VITEK 2 and mini API Systems (bioMereux, France). During an 11-year period after prosthetic grafting of the abdominal aorta and aortoiliac segment the incidence of late (more than 4 months after implantation) infection was 3.11%. The mean interval between the initial operation and development of infection was 39.2 months (range 4 to 84). Positive microbial cultures were found in 46 clinical specimens. A total of 66 microbial isolates were cultured, comprising 27 clinical strains. Gram-positive bacteria were predominant - 15 (55.55%) strains, followed by Gram-negative bacteria - 9 (3 3.33%), Candida albicans - 2 (7.4%) and Bacteroides fragilis - 1 (3.7%). In 7 cases, the infection was monobacterial, caused predominantly by Staphylococcus species. In the rest of the cases, the infections were polymicrobial, caused by association between two microbial species. Mortality rate was 35.71% (5 cases) - in 4 of them the infection was caused by association between two species of Gram-negative bacteria or between Gram-negative bacteria and Candida albicans. The incidence of late intracavitary vascular graft infection was low. The average period for development of this complication was about 3 years after reconstruction. Among the causative agents, Gram-positive microorganisms had a predominant role but infections caused by Gram-negative bacteria, especially when they were in association, had a worse outcome.

Reporting standards for adverse events after medical device use in the peripheral vascular system

New York, NY;Phoenix, Ariz; Houston, Tex; London, Ontario, Canada; Delhi, India; Silver Spring, Md; and Lewiston, MeAdverse event reporting after medical device implanta-tion is essential to understanding the safety and perfor-mance of a device. Standardization of reporting attainsgreat importance when comparing different devices andfor the ongoing surveillance of a marketed device.Although some work has been done to standardize adverseevent reporting for medical devices, a single reference withrecommendations that span investigational and postmarketuse does not exist.Standardization of nomenclature for reporting vascularconditions is one of the objectives of the Society forVascular Surgery (SVS) in its Bylaws.

FDG-PET in Prosthetic Graft Infections

Graft infection following prosthetic vascular reconstruction is an uncommon but severe complication. The clinical presentation is often subtle and nonspecific and may occur long after surgery. Although defining a prosthetic vascular graft infection can be difficult, early diagnosis and treatment are essential for the correct choice of treatment to prevent further complications as well as the high morbidity and mortality associated with repeat surgery and removal of infected grafts. False-positive results may lead to unnecessary surgery while failure to diagnose graft infection may have life-threatening sequels. Scarce literature that is currently available regarding the role of (18)F-labeled fluorodeoxyglucose imaging for assessment of vascular graft infection suggests that this modality may represent reliable noninvasive imaging modality in this specific clinical setting. PET/CT increases the test specificity and thus improves diagnostic accuracy. The precise anatomic localization of increased (18)F-labeled fluorodeoxyglucose PET/CT enables accurate differentiation between graft and adjacent soft tissue infection leading to more accurate diagnosis and subsequent optimized therapeutic strategy.

Purpura localisé révélateur d’une infection tardive de prothèse vasculaire

Prosthetic graft infection after vascular reconstruction is a rare but serious complication. We report a case of infection occurring late after implantation of an iliofemoral prosthetic vascular graft. The Staphylococcus aureus infection was revealed by vascular purpura localized on the right leg 7 years after implantation of a vascular prosthesis. This case illustrates an uncommonly late clinical manifestation presenting as an acute infection 7 years after the primary operation. In this situation, the presentation differs from early infection, which generally occurs within the first four postoperative months. Diagnosis and treatment remain a difficult challenge because prosthetic graft infection is a potentially life-threatening complication. Morbidity and mortality rates are high. Here we detail specific aspects of the clinical and radiological presentation.