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Kirkham AM, Candeliere J, Stelfox HT, Nagpal SK, Dubois L, MacFadden DR, McIsaac DI, Roberts DJ. A Meta-Analysis to Derive Population-Based Quality Benchmarks of the Incidence of Surgical Site Infection after Lower Limb Revascularization Surgery. Ann Vasc Surg 2024; 104:81-92. [PMID: 37453466 DOI: 10.1016/j.avsg.2023.06.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/14/2023] [Accepted: 06/21/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND The reported incidence of surgical site infection (SSI) after lower limb revascularization surgery varies. We conducted a systematic review and meta-analysis of population-based studies reporting the incidence of SSI in adults who underwent these surgeries in high-income countries to derive SSI quality benchmarks. METHODS We searched MEDLINE, EMBASE, CENTRAL, and Evidence-Based Medicine Reviews (inception-to-April 28th, 2022) for population-based studies estimating the cumulative incidence of SSI among adults who underwent lower limb revascularization surgery for peripheral artery disease (PAD) in high-income countries. Two investigators independently screened abstracts and full-text articles, extracted data, and assessed risks of bias. We used random-effects models to pool data and GRADE to assess certainty. RESULTS Among 6,258 citations, we included 53 studies (n = 757,726 patients); 8 of which (n = 435,769 patients) reported nonoverlapping data that were meta-analyzed. The pooled cumulative incidence of any SSI was 6.0 in 100 patients [95% confidence interval (CI) = 4.3-8.0 in 100 patients; n = 8 studies; n = 435,769 patients; moderate certainty]. The cumulative incidence of Szilagyi grade I (cellulitis), grade II (subcutaneous tissue), and grade III (prosthetic graft) SSI was 6.5 in 100 patients (95% CI = 4.3-8.6 in 100 patients; n = 2 studies; n = 39,645 patients; low certainty), 2.1 in 100 patients (95% CI = 2.0-2.3 in 100 patients; n = 2 studies; low certainty), and 0.4 in 100 patients (95% CI = 0.4-0.4 in 100 patients; n = 1 study; n = 333,275 patients; low certainty), respectively. The pooled cumulative incidence of any early (in-hospital/≤30-days) and late (>30-days) SSI was 6.2 in 100 patients (95% CI = 4.4-8.0 in 100 patients; n = 7 studies; n = 431,273 patients; moderate certainty) and 3.7 in 100 patients (95% CI = 2.2-5.2 in 100 patients; n = 2 studies; n = 10,565 patients; low certainty), respectively. CONCLUSIONS This systematic review derived population-based benchmarks of the incidence of any SSI; Szilagyi I, II, and III SSI; and early and late SSI after lower limb revascularization surgery. These may be used by practicing surgeons and healthcare leaders/administrators to guide quality improvement efforts in the United States and perhaps other countries.
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Affiliation(s)
- Aidan M Kirkham
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada; School of Epidemiology & Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Jasmine Candeliere
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Henry T Stelfox
- The O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada; Departments of Critical Care Medicine, Medicine, and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Sudhir K Nagpal
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Luc Dubois
- Division of Vascular Surgery, Department of Surgery, Western University, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Faculty of Medicine, Western University, London, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Derek R MacFadden
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada; School of Epidemiology & Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Division of Infectious Disease, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Daniel I McIsaac
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada; School of Epidemiology & Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Departments of Anesthesiology and Pain Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Derek J Roberts
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada; School of Epidemiology & Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; The O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada.
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2
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Azad MA, Patel R. Practical Guidance for Clinical Microbiology Laboratories: Microbiologic diagnosis of implant-associated infections. Clin Microbiol Rev 2024; 37:e0010423. [PMID: 38506553 DOI: 10.1128/cmr.00104-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024] Open
Abstract
SUMMARYImplant-associated infections (IAIs) pose serious threats to patients and can be associated with significant morbidity and mortality. These infections may be difficult to diagnose due, in part, to biofilm formation on device surfaces, and because even when microbes are found, their clinical significance may be unclear. Despite recent advances in laboratory testing, IAIs remain a diagnostic challenge. From a therapeutic standpoint, many IAIs currently require device removal and prolonged courses of antimicrobial therapy to effect a cure. Therefore, making an accurate diagnosis, defining both the presence of infection and the involved microorganisms, is paramount. The sensitivity of standard microbial culture for IAI diagnosis varies depending on the type of IAI, the specimen analyzed, and the culture technique(s) used. Although IAI-specific culture-based diagnostics have been described, the challenge of culture-negative IAIs remains. Given this, molecular assays, including both nucleic acid amplification tests and next-generation sequencing-based assays, have been used. In this review, an overview of these challenging infections is presented, as well as an approach to their diagnosis from a microbiologic perspective.
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Affiliation(s)
- Marisa Ann Azad
- Division of Infectious Diseases, Department of Medicine, The Ottawa Hospital, Ottawa, Canada
- Ottawa Hospital Research Institute, Ottawa, Canada
| | - Robin Patel
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
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Ayyad M, Ayasa LA, Shbaita S, Qozat A, Tessarek J. Nonspecific Presentation of an Infected Aorto-Iliac Artery Stent Following Endovascular Revision and Stent Insertion. Vasc Endovascular Surg 2024; 58:436-442. [PMID: 37975794 PMCID: PMC10996291 DOI: 10.1177/15385744231217366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Over the last few decades, the use of covered stent grafts became increasingly popular; as it plays a pivotal role in the management of various atherosclerotic diseases that are rising in both incidence and prevalence. Subsequently, vascular stent infections, although rare, are becoming a well-recognized complication with possibly devastating consequences, owing to the difficulties associated with its diagnosis and treatment. This has prompted significant interest in the condition regarding its pathophysiology, modifiable and non-modifiable risk factors, diagnostic and therapeutic approaches, and the possible implementation of prophylactic measures. We herein present a case of a patient with an infected aortoiliac stent 4 weeks after endovascular revision with atherectomy and additional stent insertion. The patient initially developed nonspecific symptoms and later developed a life-threatening hemorrhage, which was urgently controlled using a percutaneously inserted covered stent at the infected site. Definitive treatment using extraanatomical bypass implantation and an explantation of the infected stents was performed with excellent clinical response.
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Affiliation(s)
- Mohammed Ayyad
- Faculty of Medicine, Al Quds University, Jerusalem, Palestine
| | - Laith A. Ayasa
- Faculty of Medicine, Al Quds University, Jerusalem, Palestine
| | - Sara Shbaita
- Faculty of Medicine, An Najah National University Nablus, Palestine
| | - Ahmad Qozat
- Vascular Surgery Department, Bonifatius Hospital, Lingen, Germany
| | - Jörg Tessarek
- Vascular Surgery Department, Bonifatius Hospital, Lingen, Germany
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Delcarro A, Coubeau L. Inferior vena cava reconstruction with non-fascial autologous peritoneum: Retrospective study and literature review. World J Surg 2024; 48:978-988. [PMID: 38502051 DOI: 10.1002/wjs.12127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 02/25/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND Inferior vena cava (IVC) resection is essential for complete (R0) excision of some malignancies. However, the optimal material for IVC reconstruction remains unclear. Our objective is to demonstrate the efficacy, safety, and advantages of using Non-Fascial Autologous Peritoneum (NFAP) for IVC reconstruction. To conduct a literature review of surgical strategies for tumors involving the IVC. METHODS We reviewed all IVC reconstructions performed at our institution between 2015 and 2023. Preoperative, operative, postoperative, and follow-up data were collected and analyzed. RESULTS A total of 33 consecutive IVC reconstructions were identified: seven direct sutures, eight venous homografts (VH), and 18 NFAP. With regard to NFAP, eight tubular (mean length, 12.5 cm) and 10 patch (mean length, 7.9 cm) IVC reconstructions were performed. Resection was R0 in 89% of the cases. Two patients had Clavien-Dindo grade I complications, 2 grade II, 2 grade III and 2 grade V complications. The only graft-related complication was a case of early partial thrombosis, which was conservatively treated. At a mean follow-up of 25.9 months, graft patency was 100%. There were seven recurrences and six deaths. Mean overall survival (OS) was 23.4 months and mean disease-free survival (DFS) was 14.4 months. According to our results, no statistically significant differences were found between NFAP and VH. CONCLUSIONS NFAP is a safe and effective alternative for partial or complete IVC reconstruction and has many advantages over other techniques, including its lack of cost, wide and ready availability, extreme handiness, and versatility. Further comparative studies are required to determine the optimal technique for IVC reconstruction.
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Affiliation(s)
| | - Laurent Coubeau
- Department of Abdominal Surgery and Transplantation, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
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Kirkham AM, Candeliere J, Mai T, Nagpal SK, Brandys TM, Dubois L, Shorr R, Stelfox HT, McIsaac DI, Roberts DJ. Risk Factors for Surgical Site Infection after Lower Limb Revascularisation Surgery: a Systematic Review and Meta-Analysis of Prognostic Studies. Eur J Vasc Endovasc Surg 2024; 67:455-467. [PMID: 37925099 DOI: 10.1016/j.ejvs.2023.10.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 09/27/2023] [Accepted: 10/30/2023] [Indexed: 11/06/2023]
Abstract
OBJECTIVE To systematically review and meta-analyse adjusted risk factors for surgical site infection (SSI) after lower limb revascularisation surgery. DATA SOURCES MEDLINE, Embase, Evidence Based Medicine Reviews, and the Cochrane Central Register of Controlled Trials (inception to 28 April 2022). REVIEW METHODS Systematic review and meta-analysis conducted according to PRISMA guidelines. After protocol registration, databases were searched. Studies reporting adjusted risk factors for SSI in adults who underwent lower limb revascularisation surgery for peripheral artery disease were included. Adjusted odds ratios (ORs) were pooled using random effects models. GRADE was used to assess certainty. RESULTS Among 6 377 citations identified, 50 studies (n = 271 125 patients) were included. The cumulative incidence of SSI was 12 (95% confidence interval [CI] 10 - 13) per 100 patients. Studies reported 139 potential SSI risk factors adjusted for a median of 12 (range 1 - 69) potential confounding factors. Risk factors that increased the pooled adjusted odds of SSI included: female sex (pooled OR 1.41, 95% CI 1.20 - 1.64; high certainty); dependent functional status (pooled OR 1.18, 95% CI 1.03 - 1.35; low certainty); being overweight (pooled OR 1.82, 95% CI 1.29 - 2.56; moderate certainty), obese (pooled OR 2.20, 95% CI 1.44 - 3.36; high certainty), or morbidly obese (pooled OR 1.65, 95% CI 1.08 - 2.52; moderate certainty); chronic obstructive pulmonary disease (pooled OR 1.42, 95% CI 1.17 - 1.71; high certainty); chronic limb threatening ischaemia (pooled OR 1.67, 95% CI 1.22 - 2.29; moderate certainty); chronic kidney disease (pooled OR 2.13, 95% CI 1.18 - 3.83; moderate certainty); intra-operative (pooled OR 1.23, 95% CI 1.02 - 1.49), peri-operative (pooled OR 1.92, 95% CI 1.27 - 2.90), or post-operative (pooled OR 2.21, 95% CI 1.44 - 3.39) blood transfusion (moderate certainty for all); urgent or emergency surgery (pooled OR 2.12, 95% CI 1.22 - 3.70; moderate certainty); vein bypass and or patch instead of endarterectomy alone (pooled OR 1.86, 95% CI 1.33 - 2.59; moderate certainty); an operation lasting ≥ 3 hours (pooled OR 1.86, 95% CI 1.33 - 2.59; moderate certainty) or ≥ 5 hours (pooled OR 1.60, 95% CI 1.18 - 2.17; moderate certainty); and early or unplanned re-operation (pooled OR 4.50, 95% CI 2.18 - 9.32; low certainty). CONCLUSION This systematic review identified evidence informed SSI risk factors following lower limb revascularisation surgery. These may be used to develop improved SSI risk prediction tools and to identify patients who may benefit from evidence informed SSI prevention strategies.
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Affiliation(s)
- Aidan M Kirkham
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Jasmine Candeliere
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Trinh Mai
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Sudhir K Nagpal
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Timothy M Brandys
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Luc Dubois
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Division of Vascular Surgery, Department of Surgery, Western University, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Faculty of Medicine, Western University, London, Ontario, Canada
| | - Risa Shorr
- Learning Services, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Henry T Stelfox
- The O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada; Departments of Critical Care Medicine, Medicine, and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Daniel I McIsaac
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Department of Anesthesiology and Pain Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Derek J Roberts
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada; The O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada.
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Daryapeyma A, Pettersson J, Blohmé L, Franzen Röhl E, Bartholdson E, Waldén M, Hultgren R. The Role of Antigranulocyte Scintigraphy in Diagnosis of Aortic Graft Infection and Evaluation of Treatment Outcome. Ann Vasc Surg 2024; 98:325-333. [PMID: 37536433 DOI: 10.1016/j.avsg.2023.06.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 06/22/2023] [Accepted: 06/22/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND The aim of this study was to assess the eventual added benefit of antigranulocyte monoclonal antibodies scintigraphy for the diagnostic imaging of aortic graft infection (AGI) and its role in evaluation of treatment outcome. METHODS A population-based, retrospective, register-based analysis was carried out of all patients with infected aortic grafts after treatment for aneurysmal or aortoiliac occlusive disease at Karolinska University Hospital, covering the greater Stockholm area during November 2012-December 2020. Cases were based on the definitions in the 2016 Management of Aortic Graft Infection Collaborations consensus. Using the in-hospital electronic patient registry (Take Care®) and the Swedish National Registry for Vascular Surgery (Swedvasc), 835 patients who had been treated for aortic aneurysms or aortoiliac occlusive disease were identified. The diagnostic arsenal of laboratory tests, computed tomography (CT), and clinical signs has been supplemented by antigranulocyte monoclonal antibodies (anti-G mAb) scintigraphy. Data were analyzed using SPSS Statistics. RESULTS Eighteen cases of AGI out of 835 operations incorporating aortic grafts during the period were identified. Fourteen patients (78%) were categorized as diagnosed AGI (AGI-D), and the remaining 4 (22%) were classified as suspected AGI (AGI-S). In the AGI-D group (n = 14), 10 patients (71%) had positive CTs and 4 (29%) had low-probability CTs. In the group of 10 positive CTs, 9 patients also had positive scintigraphy scans with only one negative scintigraphy scan. There were no negative scintigraphy scans without ongoing antibiotic treatment at the time of investigation. In 15 of 18 cases, a culprit agent was identified, either preoperatively or perioperatively. Thirteen of the 18 patients were treated solely by antibiotics, whereas 5 underwent surgical treatment in addition to antibiotic treatment. The outcome has been divided into 3 groups: infection-free (n = 6; 33%), lifelong antibiotic treatment (n = 7; 39%), and deceased (n = 5; 28%). CONCLUSIONS The imaging modalities in AGI diagnostics are a cornerstone of the investigative work-up, complemented by clinical signs and laboratory methods. The main advantage conveyed by anti-G mAb scintigraphy is in postoperative imaging and its ability to differentiate between infection and general postoperative changes in the areas of concern. We have identified 6 patients in our cohort in whom antibiotic therapy was discontinued after a negative anti-G mAb scintigraphy scan. Anti-G mAb scintigraphy may fulfill a unique need for diagnosis in suspected cases, evaluation of therapeutic efficacy in patients requiring long-term antibiotic treatment, and aiding in the decision to discontinue antibiotic therapy.
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Affiliation(s)
- Alireza Daryapeyma
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden.
| | - Jennifer Pettersson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Linus Blohmé
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Elisabeth Franzen Röhl
- Division of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Erika Bartholdson
- Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Mathias Waldén
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Radiology, Peripheral Angio and Interventional Radiology, Karolinska University Hospital, Stockholm, Sweden
| | - Rebecka Hultgren
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden
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Harduin LDO, Barroso TA, Guerra JB, Filippo MG, de Almeida LC, de Castro-Santos G, Oliveira FAC, Cavalcanti DET, Procopio RJ, Lima EC, Pinhati MES, dos Reis JMC, Moreira BD, Galhardo AM, Joviliano EE, de Araujo WJB, de Oliveira JCP. Guidelines on vascular access for hemodialysis from the Brazilian Society of Angiology and Vascular Surgery. J Vasc Bras 2023; 22:e20230052. [PMID: 38021275 PMCID: PMC10648056 DOI: 10.1590/1677-5449.202300522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 05/09/2023] [Indexed: 12/01/2023] Open
Abstract
Chronic kidney disease is a worldwide public health problem, and end-stage renal disease requires dialysis. Most patients requiring renal replacement therapy have to undergo hemodialysis. Therefore, vascular access is extremely important for the dialysis population, directly affecting the quality of life and the morbidity and mortality of this patient population. Since making, managing and salvaging of vascular accesses falls within the purview of the vascular surgeon, developing guideline to help specialists better manage vascular accesses for hemodialysis if of great importance. Thus, the objective of this guideline is to present a set of recommendations to guide decisions involved in the referral, evaluation, choice, surveillance and management of complications of vascular accesses for hemodialysis.
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Affiliation(s)
- Leonardo de Oliveira Harduin
- Universidade Estadual do Estado do Rio de Janeiro - UERJ, Departamento de Cirurgia Vascular, Niterói, RJ, Brasil.
| | | | | | - Marcio Gomes Filippo
- Universidade Federal do Rio de Janeiro - UFRJ, Departamento de Cirurgia, Rio de Janeiro, RJ, Brasil.
| | | | - Guilherme de Castro-Santos
- Universidade Federal de Minas Gerais - UFMG, Escola de Medicina, Departamento de Cirurgia, Belo Horizonte, MG, Brasil.
| | | | | | - Ricardo Jayme Procopio
- Universidade Federal de Minas Gerais - UFMG, Escola de Medicina, Departamento de Cirurgia, Belo Horizonte, MG, Brasil.
| | | | | | | | - Barbara D’Agnoluzzo Moreira
- Universidade Federal do Paraná - UFPR, Hospital de Clínicas, Serviço de Cirurgia Vascular, Curitiba, PR, Brasil.
| | | | - Edwaldo Edner Joviliano
- Universidade de São Paulo - USP, Faculdade de Medicina de Ribeirão Preto - FMRP, Departamento de Anatomia e Cirurgia, Ribeirão Preto, SP, Brasil.
| | - Walter Junior Boim de Araujo
- Universidade Federal do Paraná - UFPR, Hospital de Clínicas, Departamento de Angioradiologia e Cirurgia Endovascular, Curitiba, PR, Brasil.
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Lauri C, Campagna G, Aloisi F, Posa A, Iezzi R, Sirignano P, Taurino M, Signore A. How to combine CTA, 99mTc-WBC SPECT/CT, and [ 18F]FDG PET/CT in patients with suspected abdominal vascular endograft infections? Eur J Nucl Med Mol Imaging 2023; 50:3235-3250. [PMID: 37367965 PMCID: PMC10542742 DOI: 10.1007/s00259-023-06309-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 06/17/2023] [Indexed: 06/28/2023]
Abstract
PURPOSE We aimed at comparing 99mTc-HMPAO white blood cells (99mTc-WBC) scintigraphy, 18fluorine-fluorodeoxyglucose ([18F]FDG) positron emission tomography/computed tomography (PET/CT) and CT angiography (CTA) in patients with suspected abdominal vascular graft or endograft infection (VGEI). Moreover, we attempted to define a new visual score for interpreting [18F]FDG PET/CT scans aiming at increasing its specificity. METHODS We prospectively compared 99mTc-WBC SPECT/CT, [18F]FDG PET/CT, and CTA in 26 patients with suspected abdominal VGEI. WBC scans were performed and interpreted according to EANM recommendations. [18F]FDG PET/CT studies were assessed with both qualitative (Sah's scale and new visual score) and semi-quantitative analyses. CTA images were interpreted according to MAGIC criteria. Microbiology, histopathology or a clinical follow-up of at least 24 months were used to achieve final diagnosis. RESULTS Eleven out of 26 patients were infected. [18F]FDG PET/CT showed 100% sensitivity and NPV, with both scoring systems, thus representing an efficient tool to rule out the infection. The use of a more detailed scoring system provided statistically higher specificity compared to the previous Sah's scale (p = 0.049). 99mTc-WBC SPECT/CT provided statistically higher specificity and PPV than [18F]FDG PET/CT, regardless the interpretation criteria used and it can be, therefore, used in early post-surgical phases or to confirm or rule out a PET/CT finding. CONCLUSIONS After CTA, patients with suspected late VGEI should perform a [18F]FDG PET/CT given its high sensitivity and NPV. However, given its lower specificity, positive results should be confirmed with 99mTc-WBC scintigraphy. The use of a more detailed scoring system reduces the number of 99mTc-WBC scans needed after [18F]FDG PET/CT. Nevertheless, in suspected infections within 4 months from surgery, 99mTc-WBC SPECT/CT should be performed as second exam, due to its high accuracy in differentiating sterile inflammation from infection.
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Affiliation(s)
- Chiara Lauri
- Nuclear Medicine Unit, Department of Medical-Surgical Sciences and of Translational Medicine, Sant’Andrea Hospital, “Sapienza” University of Rome, 00161 Rome, Italy
| | - Giuseppe Campagna
- Nuclear Medicine Unit, Department of Medical-Surgical Sciences and of Translational Medicine, Sant’Andrea Hospital, “Sapienza” University of Rome, 00161 Rome, Italy
| | - Francesco Aloisi
- Vascular Surgery Unit, Department of Clinical and Molecular Medicine, Sant’Andrea Hospital, “Sapienza” University of Rome, 00161 Rome, Italy
| | - Alessandro Posa
- Dipartimento Di Diagnostica Per Immagini, Radioterapia Oncologica ed Ematologia – Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Roberto Iezzi
- Dipartimento Di Diagnostica Per Immagini, Radioterapia Oncologica ed Ematologia – Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
- Diagnostic and Interventional Radiology Unit, Gemelli Molise Hospital, Campobasso, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Pasqualino Sirignano
- Vascular Surgery Unit, Sant’Andrea Hospital, Department of General and Specialistic Surgery, Sapienza” University of Rome, 00161 Rome, Italy
| | - Maurizio Taurino
- Vascular Surgery Unit, Department of Clinical and Molecular Medicine, Sant’Andrea Hospital, “Sapienza” University of Rome, 00161 Rome, Italy
| | - Alberto Signore
- Nuclear Medicine Unit, Department of Medical-Surgical Sciences and of Translational Medicine, Sant’Andrea Hospital, “Sapienza” University of Rome, 00161 Rome, Italy
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Braams L, Vlaspolder G, Boiten K, Salomon E, Winter R, Saleem B, Wouthuyzen-Bakker M, van Oosten M. Sonication of Vascular Grafts and Endografts to Diagnose Vascular Graft Infection: a Head-To-Head Comparison with Conventional Culture and Its Clinical Impact. Microbiol Spectr 2023; 11:e0372222. [PMID: 36847571 PMCID: PMC10100911 DOI: 10.1128/spectrum.03722-22] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 02/09/2023] [Indexed: 03/01/2023] Open
Abstract
Vascular graft and endograft infection (VGEI) is a severe complication associated with high mortality and is often challenging to diagnose. For the definitive microbiological diagnosis, sonication of vascular grafts may increase the microbiological yield of these biofilm-associated infections. The objective of this study was to determine whether sonication of explanted vascular grafts and endografts results in a higher diagnostic accuracy than conventional culture methods and aids in clinical decision-making. A prospective diagnostic study was performed comparing conventional culture with sonication culture of explanted vascular grafts in patients treated for VGEI. Explanted (endo)grafts were cut in halves and were either subjected to sonication or conventional culture. Criteria based on the Management of Aortic Graft Infection Collaboration (MAGIC) case definition of VGEI were used for definitive diagnosis. The relevance of sonication cultures was assessed by expert opinion to determine the clinical impact on decision-making. Fifty-seven vascular (endo)graft samples from 36 patients (four reoperations; 40 episodes) treated for VGEI were included; 32 episodes were diagnosed with VGEI. Both methods showed a positive culture in 81% of the cases. However, sonication culture detected clinically relevant microorganisms that went unnoticed by conventional culturing in 9 out of 57 samples (16%, 8 episodes) and provided additional relevant information regarding growth densities in another 11 samples (19%, 10 episodes). Sonication of explanted vascular grafts and endografts improves the microbiological yield and aids in the clinical decision-making for patients with a suspected VGEI compared to conventional culture alone. IMPORTANCE Sonication culture of explanted vascular grafts was shown to be a noninferior method compared to conventional culturing in diagnosing vascular graft and endograft infection (VGEI). Moreover, sonication culture has probable additional value in microbiological characterization of VGEI by giving more detailed information on growth densities, especially when the conventional culture shows intermediate growth. In this prospective design, for the first time, a direct comparison is made between sonication culturing and conventional culturing in VGEI, while taking clinical interpretation into account. Therefore, this study is another step toward a more accurate microbiological diagnosis of VGEI, influencing clinical decision-making.
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Affiliation(s)
- Lisanne Braams
- Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Gro Vlaspolder
- Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Kathleen Boiten
- Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Elisa Salomon
- Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Rik Winter
- Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Ben Saleem
- Division of Vascular Surgery, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Marjan Wouthuyzen-Bakker
- Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Marleen van Oosten
- Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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Wahbah Makhoul G, Mustafa A, Ling J, Asogwa N, Elhosseiny S, Siddiqui FS, Khan S, Lafferty JC, Glaser A. Lactococcus endocarditis after Bentall procedure presenting with intracranial hemorrhage. IDCases 2023; 31:e01710. [PMID: 36845909 PMCID: PMC9945769 DOI: 10.1016/j.idcr.2023.e01710] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 02/04/2023] [Accepted: 02/11/2023] [Indexed: 02/15/2023] Open
Abstract
Background Endocarditis is more common in patients with cardiac prostheses. A Bentall procedure entails surgical replacement of the aortic valve, aortic root, and ascending aorta with re-implantation of coronary arteries into the graft. Case 65-year-old male with history of atrial fibrillation on rivaroxaban, bicuspid aortic valve, and ascending aortic aneurysm with a history of a Bentall procedure two years prior, presented with headache and dysarthria for one day. National Institutes of Health Stroke Scale was 3 and CT head showed 2.7 cm left frontal hematoma with extension into the subarachnoid space. Andexanet alfa was given for rivaroxaban reversal followed by cerebral angiogram which showed 5 mm intracranial inferior MCA aneurysm and embolization and coil placement was done. Blood cultures grew Lactococcus garvieae and transesophageal echocardiogram revealed aortic valve thickening and vegetation on the non-coronary cusp. He was subsequently treated with six weeks of IV ceftriaxone and Gentamycin. Conclusion With increasing use of bioprosthetic valves, the possibility of infective endocarditis with uncommon pathogens should be kept in mind. Lactococcus commonly affects native valves, however it can affect bioprosthetic valves and can present with mycotic aneurysms.
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Affiliation(s)
- Gennifer Wahbah Makhoul
- Department of Medicine, Staten Island University Hospital, Staten Island 10305, NY, USA
- Correspondence to: 475 Seaview Avenue, Staten Island 10305, NY, USA.
| | - Ahmad Mustafa
- Department of Medicine, Staten Island University Hospital, Staten Island 10305, NY, USA
| | - Joanne Ling
- Department of Medicine, Staten Island University Hospital, Staten Island 10305, NY, USA
| | - Nnedindu Asogwa
- Department of Medicine, Staten Island University Hospital, Staten Island 10305, NY, USA
| | - Sherif Elhosseiny
- Department of Cardiology, Staten Island University Hospital, Staten Island 10305, NY, USA
| | - Fasih Sami Siddiqui
- Department of Medicine, Staten Island University Hospital, Staten Island 10305, NY, USA
| | - Shahkar Khan
- Department of Medicine, Staten Island University Hospital, Staten Island 10305, NY, USA
| | - James C. Lafferty
- Department of Cardiology, Staten Island University Hospital, Staten Island 10305, NY, USA
| | - Allison Glaser
- Department of Infectious Diseases, Staten Island University Hospital, Staten Island 10305, NY, USA
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11
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Wouthuyzen-Bakker M, van Oosten M, Bierman W, Winter R, Glaudemans A, Slart R, Toren-Wielema M, Tielliu I, Zeebregts CJ, Prakken NHJ, de Vries JP, Saleem BR. Diagnosis and treatment of vascular graft and endograft infections: a structured clinical approach. Int J Infect Dis 2023; 126:22-27. [PMID: 36375692 DOI: 10.1016/j.ijid.2022.11.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 10/09/2022] [Accepted: 11/08/2022] [Indexed: 11/13/2022] Open
Abstract
A vascular graft or endograft infection (VGEI) is a severe complication that can occur after vascular graft or endograft surgery and is associated with high morbidity and mortality rates. A multidisciplinary approach, consisting of a team of vascular surgeons, infectious diseases specialists, medical microbiologists, radiologists, nuclear medicine specialists, and hospital pharmacists, is needed to adequately diagnose and treat VGEI. A structured diagnostic, antibiotic, and surgical treatment algorithm helps clinical decision making and ultimately aims to improve the clinical outcome of patients with a VGEI.
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Affiliation(s)
- Marjan Wouthuyzen-Bakker
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
| | - Marleen van Oosten
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Wouter Bierman
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Rik Winter
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Andor Glaudemans
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Riemer Slart
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Marlous Toren-Wielema
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Ignace Tielliu
- Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Clark J Zeebregts
- Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Niek H J Prakken
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Jean Paul de Vries
- Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Ben R Saleem
- Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Cristino MAB, Nakano LCU, Vasconcelos V, Correia RM, Flumignan RLG. Prevention of infection in aortic or aortoiliac peripheral arterial reconstruction. Hippokratia 2022. [DOI: 10.1002/14651858.cd015192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Mateus AB Cristino
- Department of Surgery, Division of Vascular and Endovascular Surgery; Universidade Federal de São Paulo; São Paulo Brazil
| | - Luis CU Nakano
- Department of Surgery, Division of Vascular and Endovascular Surgery; Universidade Federal de São Paulo; São Paulo Brazil
- Cochrane Brazil; Universidade Federal de São Paulo; São Paulo Brazil
| | - Vladimir Vasconcelos
- Department of Surgery, Division of Vascular and Endovascular Surgery; Universidade Federal de São Paulo; São Paulo Brazil
- Cochrane Brazil; Universidade Federal de São Paulo; São Paulo Brazil
| | - Rebeca M Correia
- Department of Surgery, Division of Vascular and Endovascular Surgery; Universidade Federal de São Paulo; São Paulo Brazil
| | - Ronald LG Flumignan
- Department of Surgery, Division of Vascular and Endovascular Surgery; Universidade Federal de São Paulo; São Paulo Brazil
- Cochrane Brazil; Universidade Federal de São Paulo; São Paulo Brazil
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Rahimi M, Adlouni M, Ahmed AI, Alnabelsi T, Chinnadurai P, Al-Mallah MH. Diagnostic accuracy of FDG PET for the identification of Vascular Graft Infection. Ann Vasc Surg 2022; 87:422-429. [PMID: 35760267 DOI: 10.1016/j.avsg.2022.05.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 05/13/2022] [Accepted: 05/17/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Fluorodeoxyglucose (FDG) positron emission tomography (FDG PET/CT) can be used to identify and localize infection in patients with vascular graft infections (VGI). We aimed to evaluate the diagnostic accuracy of 18F-FDG PET/CT by defining thresholds for standardized uptake value (SUV) and tissue-to-background ratio (TBR) that would accurately identify the presence of vascular graft infection. METHODS Patients with suspected VGI were prospectively recruited and underwent 18F-FDG PET/CT scans. Diagnosis was based on clinical, laboratory and radiologic findings, and blinded to the results of the PET/CT scan. Receiver operator characteristics (ROC) curve analysis was done to determine optimal thresholds for SUV and TBR. RESULTS Our final cohort consisted of 28 patients with suspected VGI (mean±SD age 67±10 years, 61% men), of which 15 patients (54%) had definitive VGI. The cohort included 61% prosthetics grafts and 39% stent-grafts. The type of graft included in this study were biologic (4%), Dacron (64%) and Polytetrafluoroethylene (32%). The location of the implanted grafts were aortic (54%) and peripheral arterial reconstruction (46%). The location of the peripheral graft was 77% in lower extremity and 23% in the upper extremity (arterio-venous grafts for dialysis access). Using ROC analysis, SUV max of 4.5, SUV mean of 3.7, and a TBR of 1.6 gave the best balance between sensitivity and specificity (93%/92%, 100%/92% and 93%/92% respectively). All thresholds had an area under the curve ≥0.93 and correct reclassification rate ≥93%. CONCLUSION Our data suggests that FDG PET/CT can be used to reliably and accurately diagnose VGI. The dual anatomic-physiologic information from FDG PET/CT can complement clinical diagnosis particularly in uncertain cases.
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Affiliation(s)
- Maham Rahimi
- Houston Methodist Debakey Heart & Vascular Center, Houston, TX
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Belati A, Novara R, Bavaro DF, Procopio A, Fico C, Diella L, Romanelli F, Stolfa S, Mosca A, Di Gennaro F, Saracino A. Thoracic aorta graft infection by avibactam-resistant KPC-producing K. pneumoniae treated with meropenem/vaborbactam: a case report and literature review. LE INFEZIONI IN MEDICINA 2022; 30:277-284. [PMID: 35693053 PMCID: PMC9177178 DOI: 10.53854/liim-3002-14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 04/21/2022] [Indexed: 06/15/2023]
Abstract
Meropenem/vaborbactam (M/V) is a new carbapenem-carbapenemase inhibitor combination drug active against extensively drug resistant Gram-negative pathogens. Studies about its efficacy and place in therapy are limited in "real-life" and no data are available for deep site infections, like vascular graft infections. We present a case of a patient successfully treated with M/V for a thoracic aorta graft infection, placed for a traumatic penetrating aortic ulcer, due to an extensively KPC-producing Klebsiella pneumoniae resistant to ceftazidime/ avibactam. Furthermore, we conducted a systematic literature review concerning vascular graft infections caused by carbapenem-resistant Klebsiella pneumoniae and the papers published until now about the use of M/V for the treatment of ceftazidime/avibactam-resistant K. pneumoniae. Meropenem/vaborbactam is a promising antibiotic for difficult-to-treat Gram-negative bacteria with limited therapeutic options. Only few reports have been published and more studies are needed to assess which is the best place in therapy of M/V.
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Affiliation(s)
- Alessandra Belati
- Clinic of Infectious Diseases, University of Bari, University Hospital Policlinico, Bari, Italy
| | - Roberta Novara
- Clinic of Infectious Diseases, University of Bari, University Hospital Policlinico, Bari, Italy
| | - Davide Fiore Bavaro
- Clinic of Infectious Diseases, University of Bari, University Hospital Policlinico, Bari, Italy
| | - Andrea Procopio
- Clinic of Infectious Diseases, University of Bari, University Hospital Policlinico, Bari, Italy
| | - Cecilia Fico
- Clinic of Infectious Diseases, University of Bari, University Hospital Policlinico, Bari, Italy
| | - Lucia Diella
- Clinic of Infectious Diseases, University of Bari, University Hospital Policlinico, Bari, Italy
| | - Federica Romanelli
- Microbiology and Virology Unit, University of Bari, University Hospital Policlinico, Bari, Italy
| | - Stefania Stolfa
- Microbiology and Virology Unit, University of Bari, University Hospital Policlinico, Bari, Italy
| | - Adriana Mosca
- Microbiology and Virology Unit, University of Bari, University Hospital Policlinico, Bari, Italy
| | - Francesco Di Gennaro
- Clinic of Infectious Diseases, University of Bari, University Hospital Policlinico, Bari, Italy
| | - Annalisa Saracino
- Clinic of Infectious Diseases, University of Bari, University Hospital Policlinico, Bari, Italy
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15
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Contemporary results with the biosynthetic glutaraldehyde denatured ovine collagen graft (Omniflow II) in lower extremity arterial revascularization in a septic context. Ann Vasc Surg 2022; 85:22-31. [PMID: 35460857 DOI: 10.1016/j.avsg.2022.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/28/2022] [Accepted: 04/03/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Prosthetic peripheral vascular graft infections are poorly evaluated, despite a grim prognosis with high mortality and major amputation rates. The vascular substitute of choice remains controversial when autologous veins are unavailable. The main objective of this study was to evaluate the mid-term results of a new alternative biosynthetic collagen graft (Omniflow II®) in an infected field in patients with unavailable or unsuitable autologous saphenous vein. METHODS This retrospective, observational, multicentric study included all consecutive patients in whom an Omniflow II® graft was used for infra-inguinal revascularization in the context of sepsis from January 2015 to January 2020. The primary endpoint was freedom from major amputation; secondary endpoints were 30-day mortality, perioperative morbidity, and estimated survival, patency, and freedom from reinfection estimated using the Kaplan-Meier method. RESULTS Twenty-nine patients (27 men, median age 69 years (IQR:60;76) were included. Fever was present in 58.6% of cases, a septic rupture in 17.9%, and a pseudo-aneurysm in 25.0%. The 30-day mortality rate was 3.4% (septic shock). The median follow-up reached 49 months. At 1 and 3 years, the estimated freedom from major amputation was 88.4% and 83.9%, survival was 96%, primary patency was 74.6% and 65.8%, secondary patency was 82.1% and 77.7% and reinfection free-survival was 85.6%. There were 7 occlusions (1 iliofemoral, 1 below-knee, and 5 above-knee bypasses), 3 explantations for persistent sepsis, 4 reinfections (all within the first 6 months which led to 1 death and 3 major amputations), and a total of 4 major amputations. The risk of major amputation increased with bypass reinfection (p=.004), occlusion (p=.005), and polymicrobial infection (p=.05). CONCLUSION In a septic context, the Omniflow II® bioprosthetic graft represents an acceptable vascular substitute in the absence of an autologous vein. It provides acceptable freedom from major amputation and reinfection considering the seriousness of this pathology. This usage remains outside the instructions for use, it is, therefore, essential to pursue longer-term studies in larger cohorts.
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Lauri C, Signore A, Glaudemans AWJM, Treglia G, Gheysens O, Slart RHJA, Iezzi R, Prakken NHJ, Debus ES, Honig S, Lejay A, Chakfé N. Evidence-based guideline of the European Association of Nuclear Medicine (EANM) on imaging infection in vascular grafts. Eur J Nucl Med Mol Imaging 2022; 49:3430-3451. [PMID: 35376992 PMCID: PMC9308572 DOI: 10.1007/s00259-022-05769-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 03/16/2022] [Indexed: 12/14/2022]
Abstract
Purpose Consensus on optimal imaging procedure for vascular graft/endograft infection (VGEI) is still lacking and the choice of a diagnostic test is often based on the experience of single centres. This document provides evidence-based recommendations aiming at defining which imaging modality may be preferred in different clinical settings and post-surgical time window. Methods This working group includes 6 nuclear medicine physicians appointed by the European Association of Nuclear Medicine, 4 vascular surgeons, and 2 radiologists. Vascular surgeons formulated 5 clinical questions that were converted into 10 statements and addressed through a systematic analysis of available literature by using PICOs (Population/problem–Intervention/Indicator–Comparator–Outcome) strategy. Each consensus statement was scored for level of evidence and for recommendation grade, according to the Oxford Centre for Evidence-based Medicine criteria. Results Sixty-six articles, published from January 2000 up to December 2021, were analysed and used for evidence-based recommendations. Conclusion Computed tomography angiography (CTA) is the first-line imaging modality in suspected VGEI but nuclear medicine modalities are often needed to confirm or exclude the infection. Positron emission tomography/computed tomography (PET/CT) with 2-deoxy-2-[18F]fluoro-D-glucose ([18F]FDG) has very high negative predictive value but it should be performed preferably at least 4 months after surgery to avoid false positive results. Radiolabelled white blood cell (WBC) scintigraphy, given its high diagnostic accuracy, can be performed at any time after surgery. Preamble The European Association of Nuclear Medicine (EANM) is a professional no-profit medical association that facilitates communication worldwide between individuals pursuing clinical and research excellence in nuclear medicine. The EANM was founded in 1985. EANM members are physicians, technologists, and scientists specializing in the research and practice of nuclear medicine. The EANM will periodically define new guidelines for nuclear medicine practice to help advance the science of nuclear medicine and to improve the quality of service to patients throughout the world. Existing practice guidelines will be reviewed for revision or renewal, as appropriate, on their fifth anniversary or sooner, if indicated. Each practice guideline, representing a policy statement by the EANM, has undergone a thorough consensus process in which it has been subjected to extensive review. The EANM recognizes that the safe and effective use of diagnostic nuclear medicine imaging requires specific training, skills, and techniques, as described in each document. Reproduction or modification of the published practice guideline by those entities not providing these services is not authorized. These guidelines are an educational tool designed to assist practitioners in providing appropriate care for patients. They are not inflexible rules or requirements of practice and are not intended, nor should they be used, to establish a legal standard of care. For these reasons and those set forth below, the EANM suggests caution against the use of the current consensus document in litigation in which the clinical decisions of a practitioner are called into question. The ultimate judgement regarding the propriety of any specific procedure or course of action must be made by the physician or medical physicist in the light of all the circumstances presented. Thus, there is no implication that an approach differing from the consensus document, standing alone, is below the standard of care. To the contrary, a conscientious practitioner may responsibly adopt a course of action different from that set forth in the consensus document when, in the reasonable judgement of the practitioner, such course of action is indicated by the condition of the patient, limitations of available resources, or advances in knowledge or technology subsequent to publication of the consensus document. The practice of medicine includes both the art and the science of the prevention, diagnosis, alleviation, and treatment of disease. The variety and complexity of human conditions make it impossible to always reach the most appropriate diagnosis or to predict with certainty a particular response to treatment. Therefore, it should be recognized that adherence to this consensus document will not ensure an accurate diagnosis or a successful outcome. All that should be expected is that the practitioner will follow a reasonable course of action based on current knowledge, available resources, and the needs of the patient, to deliver effective and safe medical care. The sole purpose of this consensus document is to assist practitioners in achieving this objective. Supplementary Information The online version contains supplementary material available at 10.1007/s00259-022-05769-x.
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PET imaging in cardiovascular infections. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00140-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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18
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Oliva A, Miele MC, Al Ismail D, Di Timoteo F, De Angelis M, Rosa L, Cutone A, Venditti M, Mascellino MT, Valenti P, Mastroianni CM. Challenges in the Microbiological Diagnosis of Implant-Associated Infections: A Summary of the Current Knowledge. Front Microbiol 2021; 12:750460. [PMID: 34777301 PMCID: PMC8586543 DOI: 10.3389/fmicb.2021.750460] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 10/04/2021] [Indexed: 12/14/2022] Open
Abstract
Implant-associated infections are characterized by microbial biofilm formation on implant surface, which renders the microbiological diagnosis challenging and requires, in the majority of cases, a complete device removal along with a prolonged antimicrobial therapy. Traditional cultures have shown unsatisfactory sensitivity and a significant advance in the field has been represented by both the application of the sonication technique for the detachment of live bacteria from biofilm and the implementation of metabolic and molecular assays. However, despite the recent progresses in the microbiological diagnosis have considerably reduced the rate of culture-negative infections, still their reported incidence is not negligible. Overall, several culture- and non-culture based methods have been developed for diagnosis optimization, which mostly relies on pre-operative and intra-operative (i.e., removed implants and surrounding tissues) samples. This review outlines the principal culture- and non-culture based methods for the diagnosis of the causative agents of implant-associated infections and gives an overview on their application in the clinical practice. Furthermore, advantages and disadvantages of each method are described.
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Affiliation(s)
- Alessandra Oliva
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Maria Claudia Miele
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Dania Al Ismail
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Federica Di Timoteo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Massimiliano De Angelis
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Luigi Rosa
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Antimo Cutone
- Department of Biosciences and Territory, University of Molise, Pesche, Italy
| | - Mario Venditti
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Maria Teresa Mascellino
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Piera Valenti
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
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Omental Free Flap Coverage for Extracavitary Vascular Bypass Graft Salvage. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3646. [PMID: 34235036 PMCID: PMC8245108 DOI: 10.1097/gox.0000000000003646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 04/13/2021] [Indexed: 12/02/2022]
Abstract
Background: Prosthetic vascular graft infection is a serious complication associated with significant morbidity and mortality often requiring graft excision and numerous additional operations. Pedicled flaps are often used for the coverage of exposed deep tissue or hardware for graft salvage. In the absence of pedicled options, the properties of omentum make it an excellent choice for free flap tissue coverage, particularly in cases involving implanted prostheses. Methods: A 63-year-old woman developed a mycotic right subclavian arterial aneurysm requiring ligation and extra-anatomic bypass grafting to restore right-sided intracranial and right upper extremity arterial perfusion. Subsequent wound breakdown and poor healing left the grafts exposed, resulting in contamination. Given the profound risks associated with graft excision in this patient, salvage was attempted with IV antibiotics, serial wound/graft washouts, and graft coverage with an omental free flap. Results: The patient tolerated the procedure well. The remainder of her hospital course was uneventful, and she was discharged home in good clinical condition. She will remain on long-term suppressive antibiotics per Infectious Disease recommendations. Conclusions: Contemporary literature reporting novel and effective applications of omental free flap coverage is rare. This report demonstrates that omental free flap coverage is safe and can provide healthy tissue to protect implanted grafts and even aid in the salvage of infected extra-anatomic bypass grafts.
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Leal BBJ, Wakabayashi N, Oyama K, Kamiya H, Braghirolli DI, Pranke P. Vascular Tissue Engineering: Polymers and Methodologies for Small Caliber Vascular Grafts. Front Cardiovasc Med 2021; 7:592361. [PMID: 33585576 PMCID: PMC7873993 DOI: 10.3389/fcvm.2020.592361] [Citation(s) in RCA: 75] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 12/09/2020] [Indexed: 12/24/2022] Open
Abstract
Cardiovascular disease is the most common cause of death in the world. In severe cases, replacement or revascularization using vascular grafts are the treatment options. While several synthetic vascular grafts are clinically used with common approval for medium to large-caliber vessels, autologous vascular grafts are the only options clinically approved for small-caliber revascularizations. Autologous grafts have, however, some limitations in quantity and quality, and cause an invasiveness to patients when harvested. Therefore, the development of small-caliber synthetic vascular grafts (<5 mm) has been urged. Since small-caliber synthetic grafts made from the same materials as middle and large-caliber grafts have poor patency rates due to thrombus formation and intimal hyperplasia within the graft, newly innovative methodologies with vascular tissue engineering such as electrospinning, decellularization, lyophilization, and 3D printing, and novel polymers have been developed. This review article represents topics on the methodologies used in the development of scaffold-based vascular grafts and the polymers used in vitro and in vivo.
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Affiliation(s)
- Bruna B J Leal
- Hematology and Stem Cell Laboratory, Faculty of Pharmacy, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil.,Post-graduate Program in Physiology, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil
| | - Naohiro Wakabayashi
- Division of Cardiac Surgery, Department of Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Kyohei Oyama
- Division of Cardiac Surgery, Department of Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Hiroyuki Kamiya
- Division of Cardiac Surgery, Department of Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Daikelly I Braghirolli
- Hematology and Stem Cell Laboratory, Faculty of Pharmacy, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil
| | - Patricia Pranke
- Hematology and Stem Cell Laboratory, Faculty of Pharmacy, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil.,Post-graduate Program in Physiology, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil.,Stem Cell Research Institute, Porto Alegre, Brazil
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21
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Coste A, Poinot M, Panaget S, Albert B, Kaladji A, Le Bars H, Bahaa N, Ali B, Piau C, Cattoir V, de Moreuil C, Revest M, Le Berre R. Use of rifampicin and graft removal are associated with better outcomes in prosthetic vascular graft infection. Infection 2021; 49:127-133. [PMID: 33389709 DOI: 10.1007/s15010-020-01551-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 10/30/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Prosthetic vascular graft infection (PVGI) is a very severe disease. We aimed to determine the factors associated with treatment failure. METHODS Patients admitted to two University Hospitals with PVGI were included in this retrospective study. PVGI was classified as possible, probable or proven according to an original set of diagnostic criteria. We defined treatment failure if one of the following events occurred within the first year after PVGI diagnosis: death and infection recurrence due to the same or another pathogen. RESULTS One hundred and twelve patients were diagnosed with possible (n = 26), probable (n = 22) and proven (n = 64) PVGI. Bacterial documentation was obtained for 81% of patients. The most frequently identified pathogen was Staphylococcus aureus (n = 39). Surgery was performed in 96 patients (86%). Antibiotics were administered for more than 6 weeks in 41% of patients. Treatment failure occurred in 30 patients (27.5%). The factors associated with a lower probability of treatment failure were total removal of the infected graft (OR = 0.2, 95% CI [0.1-0.6]), rifampicin administration (OR = 0.3 [0.1-0.9]) and possible PVGI according to the GRIP criteria (OR = 0.3 [0.1-0.9]). CONCLUSIONS Treatment failure occurred in 27.5% of patients with PVGI. Total removal of the infected graft and rifampicin administration were associated with better outcomes.
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Affiliation(s)
- Anne Coste
- Service de Médecine Interne, Vasculaire et Pneumologie, Hôpital La Cavale Blanche, CHRU Brest, Brest, France
| | - Mélanie Poinot
- Infectious Diseases and Intensive Care Unit, CHU Rennes, Rennes, France
| | - Sophie Panaget
- Service de Médecine Interne, Vasculaire et Pneumologie, Hôpital La Cavale Blanche, CHRU Brest, Brest, France
| | - Bénédicte Albert
- Service de Chirurgie Cardiaque Thoracique et Vasculaire, CHRU Brest, Brest, France
| | - Adrien Kaladji
- Centre of Cardiovascular and Vascular Surgery, CHU Rennes, Rennes, France.,University of Rennes, Inserm, UMR_1099, Rennes, France
| | - Hervé Le Bars
- Département de Bactériologie-Virologie, Hygiène et Parasitologie-Mycologie, CHRU Brest, Brest, France
| | - Nasr Bahaa
- Service de Chirurgie Cardiaque Thoracique et Vasculaire, CHRU Brest, Brest, France
| | - Badra Ali
- Service de Chirurgie Cardiaque Thoracique et Vasculaire, CHRU Brest, Brest, France
| | - Caroline Piau
- Department of Bacteriology, CHU Rennes, Rennes, France
| | - Vincent Cattoir
- Department of Bacteriology, CHU Rennes, Rennes, France.,University of Rennes, Inserm, BRM (Bacterial Regulatory RNAs and Medicine), UMR_1230, Rennes, France
| | - Claire de Moreuil
- Service de Médecine Interne, Vasculaire et Pneumologie, Hôpital La Cavale Blanche, CHRU Brest, Brest, France
| | - Matthieu Revest
- Infectious Diseases and Intensive Care Unit, CHU Rennes, Rennes, France. .,University of Rennes, Inserm, BRM (Bacterial Regulatory RNAs and Medicine), UMR_1230, Rennes, France. .,CIC-Inserm 1414, CHU Rennes, Rennes, France.
| | - Rozenn Le Berre
- Service de Médecine Interne, Vasculaire et Pneumologie, Hôpital La Cavale Blanche, CHRU Brest, Brest, France. .,Brest University, Inserm, UMR_1078, Brest, France.
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22
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Mukhamadeev IS, Oborin AA, Danilov VN. [Case of extra-anatomical prosthetic repair in local infection of a bifurcated aortofemoral graft]. ANGIOLOGIIA I SOSUDISTAIA KHIRURGIIA = ANGIOLOGY AND VASCULAR SURGERY 2021; 27:125-130. [PMID: 35050257 DOI: 10.33529/angio2021414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Presented in the article is a clinical case report regarding successful treatment of a patient with infection of a vascular graft after bifurcation aortofemoral bypass grafting by means of partial removal of the graft's branch with extra-anatomical graft-to-femur prosthetic repair through the iliac wing. The patient was admitted 6 months after bifurcation aortofemoral bypass grafting with a purulent and ligature fistula, discharge in the inguinal area. The findings of computed tomography showed no infection of the central anastomosis in the retroperitoneal space, with however periprosthetic infection in the area of the distal branch and severe comorbid background, thus not allowing complete removal of the prosthesis. A decision was made to perform operation in the scope of resection of the graft's branch, with extra-anatomical bypass grafting through a hole created in the iliac wing and debridement of the wound in the groin. In the postoperative period, no lower limb ischemia was observed, with blood circulation compensated completely. The patient was discharged in a satisfactory condition on POD 64 with no signs of either local or systemic infection.
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Affiliation(s)
- I S Mukhamadeev
- Division of Cardiovascular Surgery, Perm Regional Clinical Hospital, Perm, Russia
| | - A A Oborin
- Department of Surgery with a Course of Cardiovascular Surgery, Perm State Medical University named after Academician E.A. Wagner under the RF Ministry of Public Health, Perm, Russia
| | - V N Danilov
- Division of Cardiovascular Surgery, Perm Regional Clinical Hospital, Perm, Russia
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23
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Sivathapandi T, Amalachandran J, Elangovan I, Simon S, Patel A, Nikita. Genuine impact of 18F-fluorodeoxyglucose positron emission tomography with contrast-enhanced computed tomography in clinching the diagnosis and follow-up response assessment of vascular graft infections. World J Nucl Med 2020; 19:408-413. [PMID: 33623511 PMCID: PMC7875032 DOI: 10.4103/wjnm.wjnm_14_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/03/2020] [Accepted: 05/01/2020] [Indexed: 11/04/2022] Open
Abstract
Vascular graft infection (VGI) is a rare and severe complication after vascular surgery associated with significant morbidity and mortality, but the diagnosis is not always straightforward due to its variable and nonspecific clinical signs. Computed tomography (CT) scan is considered to be the diagnostic tool of choice for advanced VGI, but there is a high incidence of false-negative results, especially in low-grade infections. 18F-Fluorodeoxyglucose positron emission tomography with contrast-enhanced CT (18F-FDG PET-CT) imaging can serve as an effective alternative tool for assessment of suspected VGI and also provide accurate anatomic localization of the infective focus. Here, we describe three cases of VGI with various clinical presentations where the site of infection was diagnosed, confirmed, and documented with the help of 18F-FDG PET-CT imaging.
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Affiliation(s)
| | | | - Indirani Elangovan
- Department of Nuclear Medicine and PET-CT, Apollo Hospitals, Chennai, Tamil Nadu, India
| | - Shelley Simon
- Department of Nuclear Medicine and PET-CT, Apollo Hospitals, Chennai, Tamil Nadu, India
| | - Asra Patel
- Department of Nuclear Medicine and PET-CT, Apollo Hospitals, Chennai, Tamil Nadu, India
| | - Nikita
- Department of Nuclear Medicine and PET-CT, Apollo Hospitals, Chennai, Tamil Nadu, India
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24
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Groot Jebbink E, van Den Ham LH, van Woudenberg BBJ, Slart RHJA, Zeebregts CJ, Rijnders TJM, Lardenoije JWHP, Reijnen MMPJ. Physiological Appearance of Hybrid FDG-Positron Emission Tomography/Computed Tomography Imaging Following Uncomplicated Endovascular Aneurysm Sealing Using the Nellix Endoprosthesis. J Endovasc Ther 2020; 27:509-515. [PMID: 32295455 PMCID: PMC7288856 DOI: 10.1177/1526602820913888] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To investigate the physiological uptake of hybrid fluorine-18-fluorodeoxyglucose (FDG)-positron emission tomography/computed tomography (PET/CT) before and after an uncomplicated endovascular aneurysm sealing (EVAS) procedure as a possible tool to diagnose EVAS graft infection and differentiate from postimplantation syndrome. Materials and Methods: Eight consecutive male patients (median age 78 years) scheduled for elective EVAS were included in the prospective study (ClinicalTrials.gov identifier NCT02349100). FDG-PET/CT scans were performed in all patients before the procedure and 6 weeks after EVAS. The abdominal aorta was analyzed in 4 regions: suprarenal, infrarenal neck, aneurysm sac, and iliac. The following parameters were obtained for each region: standard uptake value (SUV), tissue to background ratio (TBR), and visual examination of FDG uptake to ascertain its distribution. Demographic data were obtained from medical files and scored based on reporting standards. Results: Visual examination showed no difference between pre- and postprocedure FDG uptake, which was homogenous. In the suprarenal region no significant pre- and postprocedure differences were observed for the SUV and TBR parameters. The infrarenal neck region showed a significant decrease in the SUV and no significant decrease in the TBR. The aneurysm sac and iliac regions both showed a significant decrease in SUV and TBR between the pre- and postprocedure scans. Conclusion: Physiological FDG uptake after EVAS was stable or decreased with regard to the preprocedure measurements. Future research is needed to assess the applicability and cutoff values of FDG-PET/CT scanning to detect endograft infection after EVAS.
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Affiliation(s)
- Erik Groot Jebbink
- Department of Surgery, Rijnstate Hospital, Arnhem, the Netherlands
- Multi-Modality Medical Imaging Group, Technical Medical Centre, University of Twente, Enschede, the Netherlands
| | | | | | - Riemer H. J. A. Slart
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, the Netherlands
- Biomedical Photonic Imaging Group, University of Twente, Enschede, the Netherlands
| | - Clark J. Zeebregts
- Department of Surgery, Division Vascular Surgery, University Medical
Center Groningen, University of Groningen, the Netherlands
| | - Ton J. M. Rijnders
- Department of Nuclear Medicine, Rijnstate Hospital, Arnhem, the Netherlands
| | | | - Michel M. P. J. Reijnen
- Department of Surgery, Rijnstate Hospital, Arnhem, the Netherlands
- Multi-Modality Medical Imaging Group, Technical Medical Centre, University of Twente, Enschede, the Netherlands
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25
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Lok CE, Huber TS, Lee T, Shenoy S, Yevzlin AS, Abreo K, Allon M, Asif A, Astor BC, Glickman MH, Graham J, Moist LM, Rajan DK, Roberts C, Vachharajani TJ, Valentini RP. KDOQI Clinical Practice Guideline for Vascular Access: 2019 Update. Am J Kidney Dis 2020; 75:S1-S164. [PMID: 32778223 DOI: 10.1053/j.ajkd.2019.12.001] [Citation(s) in RCA: 902] [Impact Index Per Article: 225.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 12/09/2019] [Indexed: 02/07/2023]
Abstract
The National Kidney Foundation's Kidney Disease Outcomes Quality Initiative (KDOQI) has provided evidence-based guidelines for hemodialysis vascular access since 1996. Since the last update in 2006, there has been a great accumulation of new evidence and sophistication in the guidelines process. The 2019 update to the KDOQI Clinical Practice Guideline for Vascular Access is a comprehensive document intended to assist multidisciplinary practitioners care for chronic kidney disease patients and their vascular access. New topics include the end-stage kidney disease "Life-Plan" and related concepts, guidance on vascular access choice, new targets for arteriovenous access (fistulas and grafts) and central venous catheters, management of specific complications, and renewed approaches to some older topics. Appraisal of the quality of the evidence was independently conducted by using a Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach, and interpretation and application followed the GRADE Evidence to Decision frameworks. As applicable, each guideline statement is accompanied by rationale/background information, a detailed justification, monitoring and evaluation guidance, implementation considerations, special discussions, and recommendations for future research.
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26
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Lapergola A, Felli E, Rebiere T, Mutter D, Pessaux P. Autologous peritoneal graft for venous vascular reconstruction after tumor resection in abdominal surgery: a systematic review. Updates Surg 2020; 72:605-615. [PMID: 32144647 DOI: 10.1007/s13304-020-00730-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 02/21/2020] [Indexed: 02/07/2023]
Abstract
Radical surgical resection (R0) is the only option to cure patients with borderline resectable or multivisceral intraabdominal malignancies involving major vessels. Autologous peritoneal flap has been described as a safe and versatile option for vascular reconstruction, but still limited experience exists regarding its use. An extensive literature review was performed to analyze results of vascular reconstruction with an autologous peritoneal graft. Fifteen reports were found for a total of 94 patients. No cases of arterial vascular reconstruction were found. Two different types of peritoneal patch have been described, backed (APFG, 30 patients) or not backed (ANFP, 64 patients) by posterior rectus sheath. A patch type of reconstruction was adopted in 70 patients (74.5%), while a tubular reconstruction in 24 (25.5%). Postoperative mortality was 5.3% (5 cases). Graft outcomes with very heterogeneous follow-ups (7 days-47 months) were available only in 85 patients (90.4%). Among them, a graft patency was documented in 80 patients (94.1%), while a stenotic graft was reported in 5 patients (5.9%). No differences in graft outcomes were observed between the patch and tubular groups (p = 0.103), nor between the ANFP and APFG groups (p = 0.625). In reported experiences, autologous peritoneal graft seems to represent a safe and versatile option for functional restoration of venous vascular anatomy after resection, especially in operations with high risk of contamination, trauma, liver transplantation and unplanned vascular resection. Unfortunately, the data available in the literature do not make it possible to draw any evidence-based conclusions on these considerations.
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Affiliation(s)
- Alfonso Lapergola
- HepatoBiliary and Pancreatic Surgery Unit, Department of Digestive and Endocrine Surgery, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France.,Institut de Recherche Contre les Cancers de l'Appareil Digestif (IRCAD), IHU-Mix Surg, 1 place de l'Hôpital, 67091, Strasbourg, France.,Unit of Surgical Oncology, Department of Surgery, "SS. Annunziata" Hospital, "G. D'Annunzio" University, Chieti, Italy
| | - Emanuele Felli
- HepatoBiliary and Pancreatic Surgery Unit, Department of Digestive and Endocrine Surgery, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France.,IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France.,Unité INSERM UMR_S1110, Institut de Recherche sur les Maladies Virales et hépatiques, Université de Strasbourg, Strasbourg, France
| | - Thomas Rebiere
- HepatoBiliary and Pancreatic Surgery Unit, Department of Digestive and Endocrine Surgery, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
| | - Didier Mutter
- HepatoBiliary and Pancreatic Surgery Unit, Department of Digestive and Endocrine Surgery, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France.,IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France.,Institut de Recherche Contre les Cancers de l'Appareil Digestif (IRCAD), IHU-Mix Surg, 1 place de l'Hôpital, 67091, Strasbourg, France
| | - Patrick Pessaux
- HepatoBiliary and Pancreatic Surgery Unit, Department of Digestive and Endocrine Surgery, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France. .,IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France. .,Institut de Recherche Contre les Cancers de l'Appareil Digestif (IRCAD), IHU-Mix Surg, 1 place de l'Hôpital, 67091, Strasbourg, France. .,Unité INSERM UMR_S1110, Institut de Recherche sur les Maladies Virales et hépatiques, Université de Strasbourg, Strasbourg, France.
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Chakfé N, Diener H, Lejay A, Assadian O, Berard X, Caillon J, Fourneau I, Glaudemans AWJM, Koncar I, Lindholt J, Melissano G, Saleem BR, Senneville E, Slart RHJA, Szeberin Z, Venermo M, Vermassen F, Wyss TR, de Borst GJ, Bastos Gonçalves F, Kakkos SK, Kolh P, Tulamo R, Vega de Ceniga M, von Allmen RS, van den Berg JC, Debus ES, Koelemay MJW, Linares-Palomino JP, Moneta GL, Ricco JB, Wanhainen A. Editor's Choice - European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Vascular Graft and Endograft Infections. Eur J Vasc Endovasc Surg 2020; 59:339-384. [PMID: 32035742 DOI: 10.1016/j.ejvs.2019.10.016] [Citation(s) in RCA: 266] [Impact Index Per Article: 66.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Panthier F, Warein E, Cochennec F, Desgranges P, Touma J. Early Onset of Acute Lower Limb Drug-eluting Stent Infection. Ann Vasc Surg 2019; 61:471.e3-471.e7. [PMID: 31394215 DOI: 10.1016/j.avsg.2019.05.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 05/10/2019] [Accepted: 05/12/2019] [Indexed: 10/26/2022]
Abstract
The present case describes acute and early infection of a superficial femoral artery drug-eluting stent (DES) in a 65-year-old patient 2 days after its implantation in outpatient clinic, with intense clinical presentation. The initial indication was Rutherford 3 peripheral artery disease. Radical treatment by means of stent explantation and femoro-femoral bypass using autogenous vein was performed. Both stent and blood cultures were positive for methicillin-sensitive Staphylococcus aureus. Informative imaging and intraoperative view are provided. Local evolution was satisfactory but endocarditis occurred secondarily. The pathophysiology of this first reported DES infection and the management of the infected vessel are discussed, in light of data derived from coronary literature and open vascular surgery.
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Affiliation(s)
- Frédéric Panthier
- Assistance Publique des Hôpitaux de Paris, Hôpital Henri Mondor, Service de Chirurgie Vasculaire, Créteil, France
| | - Edouard Warein
- Assistance Publique des Hôpitaux de Paris, Hôpital Henri Mondor, Service de Chirurgie Vasculaire, Créteil, France
| | - Frederic Cochennec
- Assistance Publique des Hôpitaux de Paris, Hôpital Henri Mondor, Service de Chirurgie Vasculaire, Créteil, France
| | - Pascal Desgranges
- Assistance Publique des Hôpitaux de Paris, Hôpital Henri Mondor, Service de Chirurgie Vasculaire, Créteil, France
| | - Joseph Touma
- Assistance Publique des Hôpitaux de Paris, Hôpital Henri Mondor, Service de Chirurgie Vasculaire, Créteil, France.
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29
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Sunde SK, Beske T, Gerke O, Clausen LL, Hess S. FDG-PET/CT as a diagnostic tool in vascular graft infection: a systematic review and meta-analysis. Clin Transl Imaging 2019. [DOI: 10.1007/s40336-019-00336-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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30
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Puges M, Bérard X, Ruiz JB, Debordeaux F, Desclaux A, Stecken L, Pereyre S, Hocquelet A, Bordenave L, Pinaquy JB, Cazanave C. Retrospective Study Comparing WBC scan and 18F-FDG PET/CT in Patients with Suspected Prosthetic Vascular Graft Infection. Eur J Vasc Endovasc Surg 2019; 57:876-884. [PMID: 31130421 DOI: 10.1016/j.ejvs.2018.12.032] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 12/21/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Prosthetic vascular graft infections (PVGIs) are associated with high mortality rates. To improve treatment outcome, an early and definite diagnosis is critical, and current diagnostic criteria are often insufficient. The accuracy of 2-deoxy-2-[fluorine-18]-fluoro-d-glucose positron emission tomography integrated with computed tomography (18F-FDG PET/CT) and white blood cell (WBC) scan for the diagnosis of PVGI were compared. METHODS A retrospective single centre study was conducted on patients undergoing WBC scan and 18F-FDG PET/CT for a suspected PVGI between April 2013 and June 2016 at the Bordeaux University Hospital, France. The diagnostic value of both imaging tests was assessed for all grafts, using receiver operating characteristic (ROC) curve analysis. Images were independently interpreted by two nuclear medicine physicians blinded to the patients' clinical and other imaging data. RESULTS Thirty-nine patients were included, of whom 15 had PVGI. Antibiotic treatment was started before nuclear imaging for 16 patients, including nine patients with a PVGI. The 96 grafts of these patients were analysed, and 19 were infected. The diagnostic value of the WBC scan was significantly higher than 18F-FDG PET/CT (ROC AUC = 0.902, 95% CI 0.824-0.980, and 0.759, CI 95% (0.659-0.858), respectively, p = .0071). Interobserver agreement was good for 18F-FDG PET/CT and excellent for WBC scan (kappa value of 0.76, 95% CI 0.62-0.9, and 0.97, 95% CI 0.92-1, respectively). Only one patient had a false negative 18F-FDG PET/CT result under antibiotic therapy. CONCLUSION The WBC scan has a better diagnostic value than 18F-FDG PET/CT for PVGI diagnosis.
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Affiliation(s)
- Mathilde Puges
- Infectious and Tropical Diseases Department, University Hospital of Bordeaux, Bordeaux, France; University of Bordeaux, Bordeaux, France.
| | - Xavier Bérard
- University of Bordeaux, Bordeaux, France; Vascular Surgery Department, University Hospital of Bordeaux, Bordeaux, France; CIC 1401, University Hospital of Bordeaux, Bordeaux, France
| | - Jean-Baptiste Ruiz
- Nuclear Medicine Department, University Hospital of Bordeaux, Bordeaux, France
| | - Frederic Debordeaux
- Nuclear Medicine Department, University Hospital of Bordeaux, Bordeaux, France
| | - Arnaud Desclaux
- Infectious and Tropical Diseases Department, University Hospital of Bordeaux, Bordeaux, France; University of Bordeaux, Bordeaux, France
| | - Laurent Stecken
- Anaesthetics Department, University Hospital of Bordeaux, Bordeaux, France
| | - Sabine Pereyre
- University of Bordeaux, Bordeaux, France; Bacteriology Department, University Hospital of Bordeaux, Bordeaux, France
| | - Arnaud Hocquelet
- Nuclear Medicine Department, University Hospital of Bordeaux, Bordeaux, France
| | - Laurence Bordenave
- University of Bordeaux, Bordeaux, France; CIC 1401, University Hospital of Bordeaux, Bordeaux, France; Nuclear Medicine Department, University Hospital of Bordeaux, Bordeaux, France
| | | | - Charles Cazanave
- Infectious and Tropical Diseases Department, University Hospital of Bordeaux, Bordeaux, France; University of Bordeaux, Bordeaux, France
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31
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Kim SJ, Lee SW, Jeong SY, Pak K, Kim K. A systematic review and meta-analysis of 18F-fluorodeoxyglucose positron emission tomography or positron emission tomography/computed tomography for detection of infected prosthetic vascular grafts. J Vasc Surg 2019; 70:307-313. [PMID: 30922755 DOI: 10.1016/j.jvs.2019.01.051] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 01/05/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The purpose of this investigation was to evaluate the diagnostic accuracy of 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) or PET/computed tomography (PET/CT) for the detection of vascular prosthetic graft infection (VPGI) using a diagnostic accuracy test. METHODS The MEDLINE/PubMed and Embase databases, from the earliest available date of indexing through March 31, 2018, were searched for results investigating the diagnostic accuracy of 18F-FDG PET or PET/CT for the detection of VPGI. We calculated the pooled sensitivities and specificities of included studies, calculated positive and negative likelihood ratios, and obtained summary receiver operating characteristic curves. RESULTS Across 10 studies (286 patients), the pooled sensitivity was 0.96 (95% confidence interval [CI], 0.89-0.98) without heterogeneity (I2 = 40.2; 95% CI, 0.0-84.4; P = .09), and pooled specificity was 0.74 (95% CI, 0.67-0.81) without heterogeneity (I2 = 39.9; 95% CI, 0.0-84.3; P = .09). Likelihood ratio syntheses showed an overall positive likelihood ratio of 3.7 (95% CI, 2.9-4.9) and negative likelihood ratio of 0.06 (95% CI, 0.02-0.15). The pooled diagnostic odds ratio was 63 (95% CI, 23-173). The hierarchical summary receiver operating characteristic curve showed the area under the curve to be 0.87 (95% CI, 0.83-0.89). CONCLUSIONS This study showed the high sensitivity and moderate specificity of 18F-FDG PET or PET/CT for the detection of VPGI. The clinical usefulness of 18F-FDG PET or PET/CT for detection of VPGI should be validated through further large multicenter studies.
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Affiliation(s)
- Seong-Jang Kim
- Department of Nuclear Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea; BioMedical Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea; Department of Nuclear Medicine, College of Medicine, Pusan National University, Yangsan, Korea.
| | - Sang-Woo Lee
- Department of Nuclear Medicine, School of Medicine, Kyungpook National University, Daegu, Korea; Department of Nuclear Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Shin Young Jeong
- Department of Nuclear Medicine, School of Medicine, Kyungpook National University, Daegu, Korea; Department of Nuclear Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Kyoungjune Pak
- Department of Nuclear Medicine, Pusan National University Hospital, Busan, Korea
| | - Keunyoung Kim
- Department of Nuclear Medicine, Pusan National University Hospital, Busan, Korea
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Comparison of Genus Specific PCR and Culture with or without Sonication for Microbiological Diagnosis of Vascular Graft Infection. Eur J Vasc Endovasc Surg 2018; 56:562-571. [PMID: 30076076 DOI: 10.1016/j.ejvs.2018.06.064] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 06/25/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Vascular graft infections (VGIs) are severe and require prolonged adequate antimicrobial therapy. However, up to 45% of conventional cultures are negative. Sonication and genus specific PCRs for microbiological diagnosis of VGI was evaluated. METHODS Samples were prospectively obtained from explanted vascular grafts in Bordeaux University Hospital. Conventional bacterial cultures with and without prior sonication of samples were performed. A genus specific PCR assay panel, targeting the most frequent bacteria involved in VGI (Staphylococcus, Streptococcus, Enterococcus, and Enterobacteriaceae), was also applied to sonicate fluids. The performance of these three diagnostic strategies was compared. RESULTS Forty-five patients (118 samples) were included between July 2014 and October 2015. Six patients had no infection and 39 had a VGI. Sensitivities of graft culture, sonicate fluid culture, and genus specific PCR were 85.7%, 89.7%, and 79.5%, respectively. Specificities were 100%, 100%, and 83.3%, respectively. Sonicate fluid culture was positive for five graft samples (from four patients) with negative culture without sonication. Four VGIs were detected by PCR only (3 patients had previously received antibiotics). For 15 patients with positive graft cultures, PCR identified at least one additional bacterium compared with culture, thus 30 additional bacteria for all included patients. By combining sonicate fluid culture and PCR, a microbiological diagnosis was obtained for all patients with VGI. CONCLUSIONS There was no statistical difference between performances of culture with and without sonication and genus specific PCR. However, combining sonicate fluid cultures and PCR may be the best strategy for microbiological diagnostic of VGI.
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Andercou O, Marian D, Olteanu G, Stancu B, Cucuruz B, Noppeney T. Complex treatment of vascular prostheses infections. Medicine (Baltimore) 2018; 97:e11350. [PMID: 29979414 PMCID: PMC6076048 DOI: 10.1097/md.0000000000011350] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Accepted: 06/08/2018] [Indexed: 01/29/2023] Open
Abstract
Infections after vascular reconstructions are very rare; however, when they occur, they are associated with a high risk of morbidity. In order to obtain the best results possible, the treatment needs to be initiated as early as possible, from the very first signs of infection, and it needs to be carried out in centers specializing in vascular surgery. The aim of the present study was to assess the incidence of infections in a single university center.This retrospective analysis over a 2-year period is based on the medical reports of hospitalized patients who were diagnosed with infection following revascularization.From 2013 to 2014, a number of 151 open reconstructive surgical procedures were performed. 15 patients suffered from infection (10%) of the vascular reconstruction. Of these patients, 40% have had an aorto-bifemoral bypass, 53%-a femoro-popliteal bypass, and 7% (n = 1)-an axillo-femoral bypass. According to the Samson classification, the patients were categorized as follows: group 2: 6 cases, group 3: 2 cases, group 4: 4 cases, and group 5: 3 cases. The most frequent bacteria found were methicillin-resistant Staphylococcus aureus (MRSA) (n = 6, 40%), followed by S aureus (n = 5, 33%). The treatment options were: application of antibiotics alone without any invasive treatment in 3 patients, local irrigation and debridement in 6 patients, complete explantation of the prosthesis with a new extra-anatomic bypass in 6 cases, and partial excision of the prosthesis, which was replaced and covered with muscle flap, in 3 cases. The amputation rate in our study was 18%, which corresponds to the rates published in the literature.The treatment of infections in vascular surgery needs to be complex and adapted to each individual patient, because infections being in a permanent dynamic state. The treatment needs to be performed in specialized centers that have large experience in vascular surgery, in order for the patient to have the best chances of survival and protection from amputation.
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Affiliation(s)
- Octavian Andercou
- Second Surgical Clinic, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca
| | - Dorin Marian
- Second Surgical Department, University of Medicine and Pharmacy, Targu Mures, Romania
| | - Gabriel Olteanu
- Second Surgical Clinic, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca
| | - Bogdan Stancu
- Second Surgical Clinic, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca
| | - Beatrix Cucuruz
- Center for Vascular Diseases and Department for Vascular Surgery Martha-Maria Hospital, Nuremberg, Germany
| | - Thomas Noppeney
- Center for Vascular Diseases and Department for Vascular Surgery Martha-Maria Hospital, Nuremberg, Germany
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Abstract
Non-invasive imaging of the aorta has undergone considerable advancements in recent times; largely driven by the technological advances in computed tomography (CT) and magnetic resonance imaging (MRI). This review article highlights these recent advancements and discusses the current role of different imaging tools in the management of aortic diseases.
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Affiliation(s)
- Vinit Baliyan
- Division of Cardiovascular Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Daniel Verdini
- Division of Cardiovascular Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Nandini M Meyersohn
- Division of Cardiovascular Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
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Hayder J, Chaouch MA, Amira N, Ben Mansour M, Majdoub H, Chaubet F, Maaroufi RM. Co-immobilization of chitosan and dermatan sulfate from Raja montagui skin on polyethylene terephthalate surfaces: Characterization and antibiofilm activity. INT J POLYM MATER PO 2018. [DOI: 10.1080/00914037.2017.1320664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Jihane Hayder
- University of Monastir, Laboratory of Genetics, Biodiversity and Bioresources Valorization (LR11ES41), High Institute of Biotechnology of Monastir, Monastir, Tunisia
| | - Mohamed Aymen Chaouch
- University of Monastir, Laboratory of interfaces and advanced materials (LIMA), Faculty of Sciences of Monastir, Monastir, Tunisia
| | - Noumi Amira
- University of Monastir, Laboratory of Contagious Diseases and Biologically Active Substances (LR99ES27), Faculty of Pharmacy, Monastir, Tunisia
| | - Mohamed Ben Mansour
- Galilee Institute, University of Paris 13, Paris-Sorbonne University, Laboratory for Vascular Translational Science, Villetaneuse, France
| | - Hatem Majdoub
- University of Monastir, Laboratory of interfaces and advanced materials (LIMA), Faculty of Sciences of Monastir, Monastir, Tunisia
| | - Frédéric Chaubet
- Galilee Institute, University of Paris 13, Paris-Sorbonne University, Laboratory for Vascular Translational Science, Villetaneuse, France
| | - Raoui Mounir Maaroufi
- University of Monastir, Laboratory of Genetics, Biodiversity and Bioresources Valorization (LR11ES41), High Institute of Biotechnology of Monastir, Monastir, Tunisia
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Sollini M, Berchiolli R, Delgado Bolton RC, Rossi A, Kirienko M, Boni R, Lazzeri E, Slart R, Erba PA. The "3M" Approach to Cardiovascular Infections: Multimodality, Multitracers, and Multidisciplinary. Semin Nucl Med 2018; 48:199-224. [PMID: 29626939 DOI: 10.1053/j.semnuclmed.2017.12.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Cardiovascular infections are associated with high morbidity and mortality. Early diagnosis is crucial for adequate patient management, as early treatment improves the prognosis. The diagnosis cannot be made on the basis of a single symptom, sign, or diagnostic test. Rather, the diagnosis requires a multidisciplinary discussion in addition to the integration of clinical signs, microbiology data, and imaging data. The application of multimodality imaging, including molecular imaging techniques, has improved the sensitivity to detect infections involving heart valves and vessels and implanted cardiovascular devices while also allowing for early detection of septic emboli and metastatic infections before these become clinically apparent. In this review, we describe data supporting the use of a Multimodality, Multitracer, and Multidisciplinary approach (the 3M approach) to cardiovascular infections. In particular, the role of white blood cell SPECT/CT and [18F]FDG PET/CT in most prevalent and clinically relevant cardiovascular infections will be discussed. In addition, the needs of advanced hybrid equipment, dedicated imaging acquisition protocols, specific expertise for image reading, and interpretation in this field are discussed, emphasizing the need for a specific reference framework within a Cardiovascular Multidisciplinary Team Approach to select the best test or combination of tests for each specific clinical situation.
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Affiliation(s)
- Martina Sollini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (Milan), Italy
| | - Raffaella Berchiolli
- Vascular Surgery Unit Department of Translational Research and Advanced Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Roberto C Delgado Bolton
- Department of Diagnostic Imaging and Nuclear Medicine, University Hospital San Pedro and Centre for Biomedical Research of La Rioja (CIBIR), Logronño, La Rioja, Spain
| | - Alexia Rossi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (Milan), Italy
| | - Margarita Kirienko
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (Milan), Italy
| | - Roberto Boni
- Nuclear Medicine Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Elena Lazzeri
- Regional Center of Nuclear Medicine, Department of Translational Research and Advanced Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Riemer Slart
- University Medical Center Groningen, Medical Imaging Center, University of Groningen, Groningen, The Netherlands; Faculty of Science and Technology, Biomedical Photonic Imaging, University of Twente, Enschede, The Netherlands
| | - Paola Anna Erba
- Regional Center of Nuclear Medicine, Department of Translational Research and Advanced Technologies in Medicine, University of Pisa, Pisa, Italy; University Medical Center Groningen, Medical Imaging Center, University of Groningen, Groningen, The Netherlands.
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Arnaiz de Las Revillas F, Fernandez-Sampedro M, Arnaiz-García AM, Gutierrez-Cuadra M, Armiñanzas C, Pulitani I, Ponton A, Tascon V, García I, Fariñas MC. Daptomycin treatment in Gram-positive vascular graft infections. Int J Infect Dis 2018; 68:69-73. [PMID: 29373845 DOI: 10.1016/j.ijid.2018.01.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 01/10/2018] [Accepted: 01/15/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Daptomycin is a bactericidal antibiotic approved for the treatment of skin and soft tissue infections and right-side endocarditis. However, there is a lack of published data outlining its usefulness in vascular graft infections (VGI). The aim of this study was to describe the clinical experience of daptomycin use in the treatment of VGI caused by Gram-positive bacteria. METHODS This was a retrospective cohort study of patients diagnosed with VGI receiving daptomycin at a tertiary care hospital during the period January 2010 to December 2012. RESULTS Of a total 1066 consecutive patients who had undergone vascular grafts (VG), 25 were diagnosed with VGI. Fifteen of these patients (11 prosthetic VG, three autologous VG, one both types) received daptomycin (median dose 6.7mg/kg/day, range 4.1-7.1mg/kg/day; median age 69 years, range 45-83 years; 80% male). The infected bypass was removed in 13 cases. The most common reason for selecting daptomycin was kidney failure (53%). The Gram-positive organisms isolated were coagulase-negative Staphylococcus (n=10), Staphylococcus aureus (n=3) (two methicillin-resistant S. aureus), Enterococcus faecium (n=2), and Enterococcus faecalis (n=1). The mean follow-up was 69 months (interquartile range 48-72 months). Ten patients (66.7%) achieved complete healing of the VGI. A recurrence of the infection was observed in 100% of patients in whom the bypass was not removed. Among patients who did not achieve complete healing, one needed a supracondylar amputation and one died as a consequence of infection. Five patients received treatment with rifampicin in addition to daptomycin and they were all cured. CONCLUSIONS The use of daptomycin and surgery for Gram-positive VGI was effective and well tolerated, and this may be a good alternative for the treatment of VGI in patients with peripheral arterial disease in whom renal insufficiency is common.
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Affiliation(s)
| | - Marta Fernandez-Sampedro
- Infectious Diseases Unit, Department of Internal Medicine, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
| | - Ana María Arnaiz-García
- Infectious Diseases Unit, Department of Internal Medicine, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
| | - Manuel Gutierrez-Cuadra
- Infectious Diseases Unit, Department of Internal Medicine, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
| | - Carlos Armiñanzas
- Infectious Diseases Unit, Department of Internal Medicine, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
| | - Ivana Pulitani
- Cardiovascular Surgery Service, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
| | - Alejandro Ponton
- Cardiovascular Surgery Service, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
| | - Valentin Tascon
- Cardiovascular Surgery Service, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
| | - Ivan García
- Cardiovascular Surgery Service, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
| | - María Carmen Fariñas
- Infectious Diseases Unit, Department of Internal Medicine, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
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Laparoscopic pancreaticoduodenectomy with reconstruction of the mesentericoportal vein with the parietal peritoneum and the falciform ligament. Surg Endosc 2018; 32:3256-3261. [DOI: 10.1007/s00464-018-6044-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Accepted: 01/03/2018] [Indexed: 01/09/2023]
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Machelart I, Greib C, Wirth G, Camou F, Issa N, Viallard JF, Pellegrin JL, Lazaro E. Graft infection after a Bentall procedure: A case series and systematic review of the literature. Diagn Microbiol Infect Dis 2017; 88:158-162. [PMID: 28330738 DOI: 10.1016/j.diagmicrobio.2017.03.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Revised: 02/24/2017] [Accepted: 03/03/2017] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The Bentall procedure is a cardiac surgery involving graft replacement of the aortic valve, aortic root and ascending aorta. Graft infection after Bentall's procedure (BGI) is infrequent but severe, and often difficult to diagnose and treat. PATIENTS AND METHODS A retrospective cohort study was performed using the Bordeaux endocarditis database of adult patients admitted to the Bordeaux University Medical Hospital for BGI between 2008 and 2014. Published case reports were identified in the literature. RESULTS We identified 10 BGI patients in the database and 13 in the literature. The majority of infections were late-onset (20/23) and occurred as a result of gram positive cocci bacterial infection (16/22). Detailed diagnoses of the described BGI were determined using echocardiography, computed tomography (CT) and positron emission tomography/CT (PET/CT). Labeled-leukocyte scintigraphy was not reported in any case. Prolonged antibiotic therapy and surgery were found to be the treatment of choice for BGI; however it was not always possible to perform a surgical intervention. Clinical relapses occurred even with a negative PET/CT, while PET/CT consistently positive for BGI occurred in the absence of clinical relapse. This suggests that the use of PET/CT for follow-up is questionable. CONCLUSION Diagnosis of BGI is difficult, due to the combination of clinical, biological, and radiological observations obtained through transesophageal echocardiography and CT. PET/CT is an alternative method to diagnosis BGI, but its impact on clinical management remains unclear. Current data suggests that if surgical replacement of the prosthesis is not possible, patients should be treated with prolonged antibiotic therapy.
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Affiliation(s)
- I Machelart
- Department of Internal Medicine and Infectious Diseases, Haut-Lévêque Hospital, Pessac, France
| | - C Greib
- Department of Internal Medicine and Infectious Diseases, Haut-Lévêque Hospital, Pessac, France
| | - G Wirth
- Department of Infectious Diseases, Pellegrin Hospital, Bordeaux, France
| | - F Camou
- Medical Intensive Care Unit, Saint André Hospital, Bordeaux, France
| | - N Issa
- Medical Intensive Care Unit, Saint André Hospital, Bordeaux, France
| | - J F Viallard
- Department of Internal Medicine and Infectious Diseases, Haut-Lévêque Hospital, Pessac, France
| | - J L Pellegrin
- Department of Internal Medicine and Infectious Diseases, Haut-Lévêque Hospital, Pessac, France
| | - E Lazaro
- Department of Internal Medicine and Infectious Diseases, Haut-Lévêque Hospital, Pessac, France
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Megaloikonomos PD, Antoniadou T, Dimopoulos L, Liontos M, Igoumenou V, Panagopoulos GN, Giannitsioti E, Lazaris A, Mavrogenis AF. Spondylitis transmitted from infected aortic grafts: a review. J Bone Jt Infect 2017; 2:96-103. [PMID: 28540144 PMCID: PMC5441139 DOI: 10.7150/jbji.17703] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Graft infection following aortic aneurysms repair is an uncommon but devastating complication; its incidence ranges from <1% to 6% (mean 4%), with an associated perioperative and overall mortality of 12% and 17.5-20%, respectively. The most common causative organisms are Staphylococcus aureus and Escherichia coli; causative bacteria typically arise from the skin or gastrointestinal tract. The pathogenetic mechanisms of aortic graft infections are mainly breaks in sterile technique during its implantation, superinfection during bacteremia from a variety of sources, severe intraperitoneal or retroperitoneal inflammation, inoculation of bacteria during postoperative percutaneous interventions to manage various types of endoleaks, and external injury of the vascular graft. Mechanical forces in direct relation to the device were implicated in fistula formation in 35% of cases of graft infection. Partial rupture and graft migration leading to gradual erosion of the bowel wall and aortoenteric fistulas have been reported in 30.8% of cases. Rarely, infection via continuous tissues may affect the spine, resulting in spondylitis. Even though graft explantation and surgical debridement is usually the preferred course of action, comorbidities and increased perioperative risk may preclude patients from surgery and endorse a conservative approach as the treatment of choice. In contrast, conservative treatment is the treatment of choice for spondylitis; surgery may be indicated in approximately 8.5% of patients with neural compression or excessive spinal infection. To enhance the literature, we searched the related literature for published studies on continuous spondylitis from infected endovascular grafts aiming to summarize the pathogenesis and diagnosis, and to discuss the treatment and outcome of the patients with these rare and complex infections.
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Affiliation(s)
- Panayiotis D Megaloikonomos
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, ATTIKON University Hospital, Athens, Greece
| | - Thekla Antoniadou
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, ATTIKON University Hospital, Athens, Greece
| | - Leonidas Dimopoulos
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, ATTIKON University Hospital, Athens, Greece
| | - Marcos Liontos
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, ATTIKON University Hospital, Athens, Greece
| | - Vasilios Igoumenou
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, ATTIKON University Hospital, Athens, Greece
| | - Georgios N Panagopoulos
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, ATTIKON University Hospital, Athens, Greece
| | - Efthymia Giannitsioti
- Fourth Department of Internal Medicine, National and Kapodistrian University of Athens, School of Medicine, ATTIKON University Hospital, Athens, Greece
| | - Andreas Lazaris
- Department of Vascular Surgery, National and Kapodistrian University of Athens, School of Medicine, ATTIKON University Hospital, Athens, Greece
| | - Andreas F Mavrogenis
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, ATTIKON University Hospital, Athens, Greece
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Van de Vyver H, Bovenkamp PR, Hoerr V, Schwegmann K, Tuchscherr L, Niemann S, Kursawe L, Grosse C, Moter A, Hansen U, Neugebauer U, Kuhlmann MT, Peters G, Hermann S, Löffler B. A Novel Mouse Model of Staphylococcus aureus Vascular Graft Infection: Noninvasive Imaging of Biofilm Development in Vivo. THE AMERICAN JOURNAL OF PATHOLOGY 2017; 187:268-279. [PMID: 28088288 DOI: 10.1016/j.ajpath.2016.10.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 09/20/2016] [Accepted: 10/04/2016] [Indexed: 10/20/2022]
Abstract
Staphylococcus aureus causes very serious infections of vascular grafts. Knowledge of the molecular mechanisms of this disease is largely lacking because of the absence of representable models. Therefore, the aim of this study was to set up a mouse model of vascular graft infections that closely mimics the human situation. A catheter was inserted into the right carotid artery of mice, which acted as a vascular graft. Mice were infected i.v. using 8 different S. aureus strains, and development of the infection was followed up. Although all strains had varying abilities to form biofilm in vitro and different levels of virulence in mice, they all caused biofilm formation on the grafts. This graft infection was monitored using magnetic resonance imaging (MRI) and 18F-fluordeoxyglucose positron emission tomography (FDG-PET). MRI allowed the quantification of blood flow through the arteries, which was decreased in the catheter after infection. FDG-PET revealed high inflammation levels at the site of the catheter after infection. This model closely resembles the situation in patients, which is characterized by a tight interplay between pathogen and host, and can therefore be used for the testing of novel treatment, diagnosis, and prevention strategies. In addition, combining MRI and PET with microscopic techniques provides an appropriate way to characterize the course of these infections and to precisely analyze biofilm development.
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Affiliation(s)
- Hélène Van de Vyver
- Institute of Medical Microbiology, University Hospital Muenster, Muenster, Germany.
| | - Philipp R Bovenkamp
- Department of Clinical Radiology, University Hospital Muenster, Muenster, Germany
| | - Verena Hoerr
- Department of Clinical Radiology, University Hospital Muenster, Muenster, Germany; Institute of Medical Microbiology, Jena University Hospital, Jena, Germany
| | - Katrin Schwegmann
- European Institute for Molecular Imaging, University Hospital Muenster, Muenster, Germany
| | - Lorena Tuchscherr
- Institute of Medical Microbiology, Jena University Hospital, Jena, Germany
| | - Silke Niemann
- Institute of Medical Microbiology, University Hospital Muenster, Muenster, Germany
| | - Laura Kursawe
- Biofilmcenter, German Heart Institute Berlin, Berlin, Germany
| | - Christina Grosse
- Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany; Leibniz Institute of Photonic Technology, Jena, Germany
| | - Annette Moter
- Biofilmcenter, German Heart Institute Berlin, Berlin, Germany
| | - Uwe Hansen
- Institute of Experimental Musculoskeletal Medicine, University Hospital Muenster, Muenster, Germany
| | - Ute Neugebauer
- Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany; Leibniz Institute of Photonic Technology, Jena, Germany; Institute of Physical Chemistry, University of Jena, Jena, Germany
| | - Michael T Kuhlmann
- European Institute for Molecular Imaging, University Hospital Muenster, Muenster, Germany
| | - Georg Peters
- Institute of Medical Microbiology, University Hospital Muenster, Muenster, Germany; Cells-in-Motion Cluster of Excellence (EXC 1003 - CiM), University of Münster, Münster, Germany
| | - Sven Hermann
- European Institute for Molecular Imaging, University Hospital Muenster, Muenster, Germany
| | - Bettina Löffler
- Institute of Medical Microbiology, Jena University Hospital, Jena, Germany
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Textural features of 18F-fluorodeoxyglucose positron emission tomography scanning in diagnosing aortic prosthetic graft infection. Eur J Nucl Med Mol Imaging 2016; 44:886-894. [PMID: 28013350 DOI: 10.1007/s00259-016-3599-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 12/09/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND The clinical problem in suspected aortoiliac graft infection (AGI) is to obtain proof of infection. Although 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography scanning (PET) has been suggested to play a pivotal role, an evidence-based interpretation is lacking. The objective of this retrospective study was to examine the feasibility and utility of 18F-FDG uptake heterogeneity characterized by textural features to diagnose AGI. METHODS Thirty patients with a history of aortic graft reconstruction who underwent 18F-FDG PET/CT scanning were included. Sixteen patients were suspected to have an AGI (group I). AGI was considered proven only in the case of a positive bacterial culture. Positive cultures were found in 10 of the 16 patients (group Ia), and in the other six patients, cultures remained negative (group Ib). A control group was formed of 14 patients undergoing 18F-FDG PET for other reasons (group II). PET images were assessed using conventional maximal standardized uptake value (SUVmax), tissue-to-background ratio (TBR), and visual grading scale (VGS). Additionally, 64 different 18F-FDG PET based textural features were applied to characterize 18F-FDG uptake heterogeneity. To select candidate predictors, univariable logistic regression analysis was performed (α = 0.16). The accuracy was satisfactory in case of an AUC > 0.8. RESULTS The feature selection process yielded the textural features named variance (AUC = 0.88), high grey level zone emphasis (AUC = 0.87), small zone low grey level emphasis (AUC = 0.80), and small zone high grey level emphasis (AUC = 0.81) most optimal for distinguishing between groups I and II. SUVmax, TBR, and VGS were also able to distinguish between these groups with AUCs of 0.87, 0.78, and 0.90, respectively. The textural feature named short run high grey level emphasis was able to distinguish group Ia from Ib (AUC = 0.83), while for the same task the TBR and VGS were not found to be predictive. SUVmax was found predictive in distinguishing these groups, but showed an unsatisfactory accuracy (AUC = 0.75). CONCLUSION Textural analysis to characterize 18F-FDG uptake heterogeneity is feasible and shows promising results in diagnosing AGI, but requires additional external validation and refinement before it can be implemented in the clinical decision-making process.
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Successful Endovascular Repair of a Penetrating Aortic Ulcer in Bacterial Aortitis. Ann Vasc Surg 2016; 35:205.e13-7. [PMID: 27236095 DOI: 10.1016/j.avsg.2016.01.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 01/07/2016] [Accepted: 01/09/2016] [Indexed: 11/23/2022]
Abstract
Infective aortitis (IA) and penetrating aortic ulcer (PAU) impending for rupture represent 2 hostile life-threatening conditions. Simultaneous presentations of these rare entities can be considered an exception. The pleomorphic clinical presentation and the multifactorial etiology require a multidisciplinary approach to reach a correct diagnosis and an urgent treatment. We report the case of a 65-year-old patient presented with acute abdominal pain and septic shock secondary to a bacterial aortitis and penetrating ulcer of abdominal aorta. Unfit for surgery due to severe comorbidities, he was treated by means of a tubular endograft and long-term antibiotic therapy. A rapid improvement of clinical conditions was observed during the subsequent hospital stay. Complete regression of aortic involvement was demonstrated after 1 year. In conclusion, for selected patients affected by IA and PAU an endovascular approach associated to long-term antibiotic therapy may be safe and effective.
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An unusual case of fistula formation and thrombosis between arteriovenous graft and a native vein. Kidney Res Clin Pract 2016; 35:59-62. [PMID: 27069860 PMCID: PMC4811979 DOI: 10.1016/j.krcp.2015.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 06/19/2015] [Accepted: 07/09/2015] [Indexed: 12/03/2022] Open
Abstract
Arteriovenous graft for hemodialysis vascular access is a widely used technique with many advantages. However, it has crucial complications with graft thrombosis and infection. We recently experienced an unusual case of arteriovenous graft complication involving graft thrombosis related to fistula formation between the graft and the natural vein with infection. We diagnosed this condition using Doppler ultrasound and computed tomography angiography. Successful surgical treatment including partial graft excision and creation of a secondary arteriovenous fistula using an inadvertently dilated cephalic vein was performed. The dialysis unit staff should keep this condition in mind and try to prevent this complication.
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Wissanji T, Fouard O, Herman D, Hermans P, Vindevogel C. Management and Prevention of Percutaneous Iliac Stent Infection: A Case Report. Ann Vasc Surg 2016; 32:131.e1-5. [DOI: 10.1016/j.avsg.2015.10.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 10/25/2015] [Accepted: 10/29/2015] [Indexed: 10/22/2022]
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Operative and perioperative management of infected arteriovenous grafts. J Vasc Access 2016; 18:13-21. [DOI: 10.5301/jva.5000613] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2016] [Indexed: 11/20/2022] Open
Abstract
Vascular graft infections are a particularly troublesome complication for dialysis patients, many of whom are in an already immunocompromised state. The objective of this review is to detail the risk factors, etiology, diagnosis, perioperative and operative management of vascular graft infections.
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Juxtarenal Modular Aortic Stent Graft Infection Caused by Staphylococcus aureus. Case Rep Vasc Med 2016; 2016:7597265. [PMID: 26904354 PMCID: PMC4745350 DOI: 10.1155/2016/7597265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Accepted: 01/06/2016] [Indexed: 11/17/2022] Open
Abstract
Introduction. We are presenting a case report of an infected modular abdominal stent graft. Case Presentation. A 67-year-old male patient three years after Cook's modular abdominal aortic aneurysm (AAA) graft implantation for juxtarenal AAA with an implantation of a stent extension into the right common iliac artery for type Ib endoleak. The patient was admitted into our center in severe condition with suspected retroperitoneal bleeding. Computed tomography angiography (CTAG) confirmed retroperitoneal bleeding in the right common iliac artery. An urgent surgical revision was indicated; destructed arterial wall around the stent extension in the right common iliac artery was discovered. Due to the severe state of health of the patient, a resection of the infected stent and affected arterial wall was performed, followed by an iliac-femoral crossover bypass. The patient was transported to the intensive care unit with hepatic and renal failure, with maximal catecholamine support. Combined antibiotic treatment was started. The patient died five hours after the procedure. The cause of death was multiorgan failure caused by sepsis. Hemocultures and perioperative microbiological cultures showed the infection agent to be Staphylococcus aureus methicillin sensitive. Conclusion. Stent graft infection is a rare complication. Treatment is associated with high mortality and morbidity.
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Kilic A, Arnaoutakis DJ, Reifsnyder T, Black JH, Abularrage CJ, Perler BA, Lum YW. Management of infected vascular grafts. Vasc Med 2015; 21:53-60. [PMID: 26584886 DOI: 10.1177/1358863x15612574] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Infections of vascular grafts are associated with significant mortality and morbidity risk and cost an estimated $640 million annually in the United States. Clinical presentation varies by time elapsed from implantation and by surgical site. A thorough history and physical examination in conjunction with a variety of imaging modalities is often essential to diagnosis. For infected aortic grafts, there are several options for treatment, including graft excision with extra-anatomic bypass, in situ reconstruction, or reconstruction with the neo-aortoiliac system. The management of infected endovascular aortic grafts is similar. For infected peripheral bypasses, graft preservation techniques can be utilized, but in cases where it is not possible, graft removal and revascularization through uninfected tissue planes is necessary. Infected dialysis access can be surgically treated by complete or subtotal graft excision. Diagnosis, general management, and surgical approaches to infected vascular grafts are discussed in this review.
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Affiliation(s)
- Arman Kilic
- Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | | | | | - James H Black
- Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | | | - Bruce A Perler
- Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Ying Wei Lum
- Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
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Parietal Peritoneum as an Autologous Substitute for Venous Reconstruction in Hepatopancreatobiliary Surgery. Ann Surg 2015; 262:366-71. [PMID: 25243564 DOI: 10.1097/sla.0000000000000959] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To evaluate the parietal peritoneum (PP) as an autologous substitute for venous reconstruction during hepatopancreatobiliary (HPB) surgery. BACKGROUND Venous resection during liver or pancreatic resection may require a rapidly available substitute especially when the need for venous resection is unforeseen. METHODS The PP was used as an autologous substitute during complex liver and pancreatic resections. Postoperative anticoagulation was standard and venous patency was assessed by routine computed tomographic scans. RESULTS Thirty patients underwent vascular resection during pancreatic (n = 18) or liver (n = 12) resection, mainly for malignant tumors (n = 29). Venous resection was an emergency procedure in 4 patients due to prolonged vascular occlusion. The PP, with a mean length of 22 mm (15-70), was quickly harvested and used as a lateral (n = 28) or a tubular (n = 2) substitute for reconstruction of the mesentericoportal vein (n = 24), vena cava (n = 3), or hepatic vein (n = 3). Severe morbidity included Clavien grade-III complications in 4 (13%) patients but there was no PP-related or hemorrhagic complications. Histological vascular invasion was present in 18 (62%) patients, and all had an R0 resection (100%). After a mean follow-up of 14 (7-33) months, all venous reconstructions were patent except for 1 tubular graft (97%). CONCLUSIONS A PP can be safely used as a lateral patch for venous reconstruction during HPB surgery; this could help reduce reluctance to perform vascular resection when oncologically required. Clinical trials identification: NCT02121886.
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