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Efficient neutrophil migration to infection sites plays a vital role in the body's defense against bacterial infections and natural immune responses. Neutrophils have a short lifespan and cannot be mass‐cultured in vitro. Therefore, developing more stable artificial neutrophils (AN) in a controllable manner has become a research focus. However, existing AN lack chemotaxis, which is the ability to migrate toward high‐signal‐concentration positions in a dynamic blood‐ flow environment. Supplying AN with chemotaxis is key to designing AN that are more similar to natural neutrophils in terms of morphology and function. In this study, micrometer‐sized, spherical, biocompatible AN are developed. These AN consist of zeolitic imidazolate framework‐8 nanoparticles encapsulating two enzymes, coacervate droplet frameworks, and outer phospholipid bilayers carrying enzymes. The AN exhibit responsiveness to elevated hydrogen peroxide levels at inflammation sites, actively chemotaxing toward these sites along concentration gradients. They also demonstrate effective combat against Staphylococcus aureus infections. The capabilities of the AN are further validated through in vitro experiments and in vivo evaluations using vascular graft infection models. This study replicates natural neutrophils in terms of chemical composition, functionality, and physiological impact. It introduces new ideas for advancing the development of advanced artificial cells. [ABSTRACT FROM AUTHOR]

Background: Vascular graft infection is a very complex disease. Although complete excision of the infected grafts with extra-anatomic bypass or in situ reconstruction is a general treatment strategy, some concerns including reinfection in the new graft remain. Case Report: An 88 year-old man presented to the hospital with abdominal swelling and bleeding. The patient had undergone revascularization for aorto-iliac occlusive disease twice in the past. The first procedure had been performed 15 years previously, with right ilio-femoral bypass grafting for right iliac artery occlusion and stent implantation for left iliac artery stenosis. The second procedure had been performed 10 years previously, with aorta-to-left femoral and left-to-right femoro-femoral bypass grafting because the terminal aorta, the first ilio-femoral bypass graft, and the stent of the left iliac artery had been occluded. The patient was diagnosed with vascular graft infection, and endovascular therapy was selected as the revascularization method prior to graft excision. It was successfully performed using various devices and techniques, followed by graft excision without critical limb ischemia. Conclusion: This case demonstrates that endovascular therapy prior to graft excision can be an alternative revascularization method for vascular graft infection after bypass surgery for aorto-iliac occlusive disease. [ABSTRACT FROM AUTHOR]

Implant-related infections may need suppressive antibiotic therapy (SAT). We describe a SAT strategy using dalbavancin with therapeutic drug monitoring (TDM). This is a retrospective bicentric study of patients with implant-related infection who received dalbavancin SAT between January 2021 and September 2023. Fifteen patients were included. Median number of injections was 4 (IQR: 2–7). Median time between two reinjections was 57 days (IQR 28–82). Dalbavancin plasma concentrations were above 4 mg/L for 97.9% of dosages (93/95) and above 8 mg/L for 85% (81/95). These results support the use of dalbavancin SAT for implant-related infections. [ABSTRACT FROM AUTHOR]

Purpose: We aimed to assess risk factors of candida-related Vascular Graft Infections (VGIs). Methods: We did a case–control study (1:4) matched by age and year of infection, nested in a cohort of patient with a history of VGIs. Cases were defined by a positive culture for Candida spp. in biological samples and controls were defined by a positive culture for bacterial strains only in biological samples. Risk factors for Candida-related VGIs were investigated using multivariate logistic regression. Mortality were compared using survival analysis. Results: 16 Candida-related VGIs were matched to 64 bacterial-related VGIs. The two groups were comparable regarding medical history and clinical presentation. Candida-related VGIs were associated with bacterial strains in 88% (14/16). Gas/fluid-containing collection on abdominal CT scan and the presence of an aortic endoprosthesis were risk factors for Candidaspp.-related VGIs [RRa 10.43 [1.81–60.21] p = 0.009 RRa and 6.46 [1.17–35.73] p = 0.03, respectively]. Candida-related VGIs were associated with a higher mortality when compared to bacterial-related VGIs (p = 0.002). Conclusions: Candida-related VGIs are severe. Early markers of Candidaspp. infection are needed to improve their outcome. The suspicion of aortic endoprosthesis infection may necessitate probabilistic treatment with antifungal agents. [ABSTRACT FROM AUTHOR]

Abstract Efficient neutrophil migration to infection sites plays a vital role in the body's defense against bacterial infections and natural immune responses. Neutrophils have a short lifespan and cannot be mass‐cultured in vitro. Therefore, developing more stable artificial neutrophils (AN) in a controllable manner has become a research focus. However, existing AN lack chemotaxis, which is the ability to migrate toward high‐signal‐concentration positions in a dynamic blood‐ flow environment. Supplying AN with chemotaxis is key to designing AN that are more similar to natural neutrophils in terms of morphology and function. In this study, micrometer‐sized, spherical, biocompatible AN are developed. These AN consist of zeolitic imidazolate framework‐8 nanoparticles encapsulating two enzymes, coacervate droplet frameworks, and outer phospholipid bilayers carrying enzymes. The AN exhibit responsiveness to elevated hydrogen peroxide levels at inflammation sites, actively chemotaxing toward these sites along concentration gradients. They also demonstrate effective combat against Staphylococcus aureus infections. The capabilities of the AN are further validated through in vitro experiments and in vivo evaluations using vascular graft infection models. This study replicates natural neutrophils in terms of chemical composition, functionality, and physiological impact. It introduces new ideas for advancing the development of advanced artificial cells.

Introduction Vascular graft infections (VGIs) are challenging and potentially life-threatening complications following femoropopliteal bypasses. The treatments of choice in peripheral VGIs are antimicrobial therapy, surgical excision, and in-situ reconstruction with an autologous superficial vein. An extraanatomical homograft bypass and antimicrobial therapy could be resolutive in patients presenting with recurrent VGIs and unavailable autologous veins.Case Report We present the case of a 74-year-old Caucasian man with a history of a below-the-knee (BTK) right femoropopliteal bypass using polytetrafluoroethylene (PTFE) for chronic peripheral artery disease (Rutherford Grade 3). He presented at the emergency department with septic arthritis of the right knee involving the previous PTFE femoropopliteal bypass. The graft was excised, and an insitu saphenous vein BTK femoropopliteal bypass was performed. Due to multiple recurrences of graft infection of the proximal anastomosis, an extra-anatomical cryopreserved arterial homograft reconstruction from the external iliac artery to the profunda femoral artery was necessary as a definitive treatment. At three years follow-up the patient is alive, with patency of both vascular reconstructions.Conclusion Despite aggressive treatment, managing vascular graft infections can be challenging, typically requiring a blend of surgical and medical interventions. Patient-specific surgical approaches, such as graft removal, infected tissue debridement andextra-anatomical reconstruction with biological grafts is crucial. In those patients with unavailable autologous veins, consideration could be given to a cryopreserved homograft due to its resistance against infections.

Hybrid thoracic endovascular aortic repair (TEVAR) has been proved to be an effective and reliable treatment option for aortic arch diseases requiring extension of the proximal landing zone. However, hybrid TEVAR was associated with potential risk of post-operative complications, including cerebral infarction, endoleaks and paraplegia. Here we reported a rare case of bypass graft infection complicated with mitral valve aneurysm and perforation following landing zone 2 hybrid TEVAR procedure, who presented with symptoms of fever, major bleeding and anastomotic pseudoaneurysm and received emergency bypass graft removal and stent implantation with acceptable short and midterm follow-up results.

Histoplasma vascular graft infection (VGI) is rarely reported, with only a handful of instances documented in the existing literature. Reporting Histoplasma VGI cases is important as they demonstrate previous treatment strategies and their outcomes. In this paper, we report a case of disseminated histoplasmosis with ascending aortic graft infection. Conservative therapy was attempted initially but failed, and our patient eventually required surgical graft explantation. Our case demonstrates the challenges in diagnosing and managing VGI caused by Histoplasma capsulatum.

Key Clinical Message After a Bentall surgery, there is a small chance of developing a serious complication called vascular graft infection. 18F‐FDG PET/CT, a new and accurate diagnostic tool, can help detect it early, especially if the symptoms are unusual. Abstract A 14‐year‐old boy who had undergone Bentall surgery 1 year prior presented with symptoms of fever, chills, loss of appetite, and weight loss over the course of a month. The initial Bentall surgery was performed due to an aneurysm of the thoracic aorta, along with severe aortic valve insufficiency and moderate aortic valve stenosis. The patient was referred to the PET/CT department for evaluation of possible endarteritis or infection of Dacron graft, which had been reported in trans‐esophageal echocardiography as suspicious findings. Despite normal blood tests, blood cultures, and other imaging modalities, the 18F‐FDG PET/CT confirmed the diagnosis of vascular graft infection. This diagnostic tool allowed for timely and appropriate treatment and prevention of possible complications.

Abstract Background Diagnosis of aortic graft infections (AGI) is challenging. Here, we report a case of AGI with splenomegaly and splenic infarction. Case presentation A 46-year-old man who underwent total arch replacement for Stanford type A acute aortic dissection one year prior presented to our department with fever, night sweat, and a 20-kg weight loss over several months. Contrast-enhanced computed tomography (CT) revealed splenic infarction with splenomegaly, fluid collection, and thrombus around the stent graft. Positron emission tomography-CT (PET-CT) revealed abnormal 18F-fluorodeoxyglucose uptake in the stent graft and spleen. Transesophageal echocardiography revealed no vegetations. The patient was diagnosed with an AGI and underwent graft replacement. Blood and tissue cultures in the stent graft yielded Enterococcus faecalis. After the surgery, the patient was successfully treated with antibiotics. Conclusions Splenic infarction and splenomegaly are the clinical findings of endocarditis but are rare in graft infection. These findings could be helpful to diagnose graft infections, which is often challenging.

Key Clinical Message: After a Bentall surgery, there is a small chance of developing a serious complication called vascular graft infection. 18F‐FDG PET/CT, a new and accurate diagnostic tool, can help detect it early, especially if the symptoms are unusual. A 14‐year‐old boy who had undergone Bentall surgery 1 year prior presented with symptoms of fever, chills, loss of appetite, and weight loss over the course of a month. The initial Bentall surgery was performed due to an aneurysm of the thoracic aorta, along with severe aortic valve insufficiency and moderate aortic valve stenosis. The patient was referred to the PET/CT department for evaluation of possible endarteritis or infection of Dacron graft, which had been reported in trans‐esophageal echocardiography as suspicious findings. Despite normal blood tests, blood cultures, and other imaging modalities, the 18F‐FDG PET/CT confirmed the diagnosis of vascular graft infection. This diagnostic tool allowed for timely and appropriate treatment and prevention of possible complications. [ABSTRACT FROM AUTHOR]

Cardiovascular infections are the most severe and potentially lethal among the persistent focalized Coxiella burnetii infections. While aortic infections on aneurysms or prostheses are well-known, with specific complications (risk of fatal rupture), new non-aortic vascular infections are increasingly being described thanks to the emerging use of 18-fluorodeoxyglucose positron emission tomography (18F-FDG PET-scan). Here, we describe an infection of a femoro-popliteal bypass that would not have been diagnosed without the use of PET-scan. It is well-known that vascular prosthetic material is a site favorable for bacterial persistence, but the description of unusual anatomical sites, outside the heart or aorta, should raise the clinicians' awareness and generalize the indications for PET-scan, with careful inclusion of the upper and lower limbs (not included in PET-scan for cancer), particularly in the presence of vascular prostheses. Future studies will be needed to precisely determine their optimal management. [ABSTRACT FROM AUTHOR]

Vascular graft infections are a severe complication in vascular surgery, with a high morbidity and mortality. Prevention and treatment involve the use of antibiotic- or antiseptic-impregnated artificial vascular grafts, but currently, there are no commercially available infection-proof small-diameter vascular grafts (SDVGs). In this work we investigated the antimicrobic activity of two SDVGs prototypes loaded with tobramycin and produced via the electrospinning of drug-doped PLGA (polylactide-co-glycolide) solutions. Differences in rheological and conductivity properties of the polymer solutions resulted in non-identical fibre morphology that deeply influenced the hydration profile and consequently the in vitro cumulative drug release, which was investigated by using a spectrofluorimetric technique. Using DDSolver Excel add-in, modelling of the drug release kinetic was performed to evaluate the release mechanism involved: Prototype 1 showed a sustained and diffusive driven drug release, which allowed for the complete elution of tobramycin within 2 weeks, whereas Prototype 2 resulted in a more extended drug release controlled by both diffusion and matrix relaxation. Time-kill assays performed on S. aureus and E. coli highlighted the influence of burst drug release on the decay rate of bacterial populations, with Prototype 1 being more efficient on both microorganisms. Nevertheless, both prototypes showed good antimicrobic activity over the 5 days of in vitro testing. [ABSTRACT FROM AUTHOR]

Introduction: First described in 1937, Q fever remains a relatively new disease, with much to be learned about its presentation and diagnosis. Due to its role in the development of aortic aneurysms and vascular graft infections, its implications in the vascular domain have become increasingly reported. This is a report of two cases of vascular complications associated with Coxiella burnetii infection, and the challenges in managing their unique presentations. Reports: Case 1: A 70 year old man with a prosthetic aortobiiliac graft and past Q fever infection presented with acute sepsis. Abdominal computed tomography (CT) showed soft tissue thickening and stranding around the graft, and locules of gas within the vessel. Pelvic magnetic resonance imaging (MRI) revealed a chain of abscesses within the right gluteal region, of which aspirate grew Prevotella oris and Escherichia coli. Open explanation of the aortic graft and replacement by superficial femoral vein was performed. Tissue culture confirmed a polymicrobial infection, and PCR of the aortic wall and pre-aortic lymph node was positive for Q fever. He was treated for recrudescent Q fever infection with a good outcome and recovery. Case 2: A 73 year old man had an incidental abdominal aortic aneurysm (AAA) identified at the time of Q fever diagnosis. Following an incomplete course of doxycycline and hydroxychloroquine, the aneurysm rapidly progressed, leading to presentation with right flank pain. Fluorodeoxyglucose (FDG) positron emission tomography (PET) showed multiple foci of uptake within the aneurysm wall. Open AAA repair with a polyester graft was performed, with AAA tissue positive for Q fever on PCR. The operation was successful, with the patient continuing clearance therapy at time of writing. Discussion: Q fever infection poses serious implications for patients with vascular grafts and AAAs, and thus, should be considered in the differential diagnosis of mycotic aortic aneurysms and in aortic graft infections.

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.

Background: Diagnosis of aortic graft infections (AGI) is challenging. Here, we report a case of AGI with splenomegaly and splenic infarction. Case presentation: A 46-year-old man who underwent total arch replacement for Stanford type A acute aortic dissection one year prior presented to our department with fever, night sweat, and a 20-kg weight loss over several months. Contrast-enhanced computed tomography (CT) revealed splenic infarction with splenomegaly, fluid collection, and thrombus around the stent graft. Positron emission tomography-CT (PET-CT) revealed abnormal 18F-fluorodeoxyglucose uptake in the stent graft and spleen. Transesophageal echocardiography revealed no vegetations. The patient was diagnosed with an AGI and underwent graft replacement. Blood and tissue cultures in the stent graft yielded Enterococcus faecalis. After the surgery, the patient was successfully treated with antibiotics. Conclusions: Splenic infarction and splenomegaly are the clinical findings of endocarditis but are rare in graft infection. These findings could be helpful to diagnose graft infections, which is often challenging. [ABSTRACT FROM AUTHOR]

Purpose: After endovascular aneurysm repair (EVAR), an increased [18F]FDG uptake may be observed at PET/CT, being common to both vascular graft/endograft infection (VGEI) and sterile post-surgical inflammation. Increased non-specific metabolic activity, due to foreign body reaction, can persist for several years after surgery, thus complicating the interpretation of PET/CT studies. In this paper, we aimed to assess [18F]FDG distribution at different time-points after the implant of abdominal Endurant® endografts in patients without suspicion of infection. Methods: We retrospectively evaluated [18F]FDG/CT in 16 oncological patients who underwent abdominal aortic aneurysm exclusion with Endurant® grafts. Patients had no clinical suspicion of infection and were followed up for at least 24 months after scan. [18F]FDG PET/CT scans were interpreted using both visual and semi-quantitative analyses. Results: The time between the EVAR procedure and [18F]FDG PET/CT ranged between 1 and 36 months. All grafts showed mild and diffuse [18F]FDG uptake without a focal pattern. Mean values of SUVmax were 2.63 ± 0.48 (95% CI 2.38–2.88); for SUVmean 1.90 ± 0.33 (95% CI 1.72–2.08); for T/B ratios 1.43 ± 0.41 (95% CI 1.21–1.65). SUVmax and SUVmean were not correlated to the time elapsed from the procedure, but we observed a declining trend in T/B ratio over time. Conclusions: Endovascular implant of Endurant® grafts does not cause a significant inflammatory reaction. The evidence of faint and diffuse [18F]FDG uptake along the graft can reliably exclude an infection, even in early post-procedural phases. Therefore, in patients with a low probability of VGEI, [18F]FDG PET/CT can also be performed immediately after EVAR. [ABSTRACT FROM AUTHOR]

• Vascular graft or endograft infection (VGEI) is associated with high morbidity and mortality rates. • VGEI patients should be managed within a multidisciplinary team. • A structural diagnostic and treatment algorithm for VGEI is mandatory. 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. [ABSTRACT FROM AUTHOR]

Introduction: High suspicion for infective endocarditis is driven by fever and positive blood cultures in the absence of an alternative focus of infection. This case underlines the importance of exploring other more obvious sources of bacteremia to avoid unnecessary tests and delays in diagnosis. In cases of inconclusive echocardiography results, imaging should be repeated. Case report: 59-year-old patient with diabetes and hypertension was admitted for sepsis, unilateral leg pain and plantar rash. Medical history includes aortobifemoral reparation of infrarenal aortic aneurysm 19 years ago and recurrent leg abscesses with prolonged periods of antimicrobial and probiotic therapy. Blood cultures found Lactobacillus rhamnosus and Candida glabrata. Positive blood cultures and clear Janeway lesions (Figure 1) indicated transesophageal echocardiography (TEE) which showed competent aortic valve with small hyperechogenic lesion (7mm X 6 mm) on base of left coronary cusp (Figure 2). TEE was repeated after 2 weeks of effective antimicrobial therapy, showing no change of suspected valvular lesion. Patient clinically improved and repeated blood cultures were negative. Further workup (including FDG-PET/CT) found intensive tracer uptake in the region of implanted aortic prosthesis. The surgeon opted for prolonged course of antimicrobial therapy. Unfortunately, only 4 days after completion of therapy the patient was septic with positive blood cultures. The operation was inevitable and aortointestinal fistula, graft infection and thrombosis were found. Partial graft replacement and bowel reconstruction were conducted. Conclusion: Even in patients with highly specific findings for endocarditis like skin lesions and positive blood cultures, workup and therapy should be clinically guided. Bizarre blood culture isolates in our patient are easily explained when we know complete course of disease. [ABSTRACT FROM AUTHOR]

Angioinvasive aspergillosis is a fungal infection that rarely involves vascular grafts. This case illustrates a patient with a history of aortic arch Dacron graft reconstruction presenting with acute bilateral lower extremity ischemia. The patient underwent emergent open thromboembolectomy. The intraluminal contents had an atypical appearance for thromboembolism, and histologic examination was consistent with aspergillosis. Cardiac computed tomography and transesophageal echocardiography showed an aortic arch graft vegetation. Aortic graft excision and reconstruction were performed for control of the fungal source. Investigation into the etiology of thromboembolism should include consideration for septic emboli in patients with indwelling vascular grafts. When suspected, graft excision should be considered for definitive management.

Lawsonella clevelandensis is a fastidious Gram-positive, partially acid-fast, anaerobic, catalase positive bacterium that has been reported to be a rare cause of abdominal, breast, spinal, and liver abscesses. Here, three L. clevelandensis vascular graft infections (VGIs) and cardiac infections are reported.

Vascular graft infections (VGI) pose a significant challenge in vascular surgery, characterized by substantial morbidity and mortality. This review delves into the epidemiology, pathogenesis, microbiology, risk factors, and clinical presentation of VGI. It highlights diagnostic criteria and methodologies, including imaging techniques and laboratory tests. Comprehensive management strategies, involving antimicrobial therapy, surgical intervention, and preventive measures, are discussed. Emphasis is placed on the multidisciplinary approach required for effective treatment, alongside emerging trends in VGI microbiology and innovative therapeutic options. This review article aims to provide a detailed understanding of VGI for improved clinical outcomes., Competing Interests: Disclosures Declaration of artificial intelligence (AI) and AI-assisted technologies in the writing process: During the preparation of this work, the authors used Chatgpt /AI language model in order to improve readability and language of the material, since English is not the first language of the primary authors., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Graft infections of supra-aortic bypasses are rare, but often life-threatening. Guidelines for treatment of graft infections recommend systemic antibiotics and complete graft removal, followed by in-situ or extra-anatomic revascularisation., Methods: Based on case report, literature search was performed on Medline, Google Scholar and Web of Science databases, focussing on infected supra-aortic bypass reconstructions. Inclusion criterium was prosthetic graft infection, excluding stent and carotid patch infections., Results: A 68-year old man with clinically infected subclavian-subclavian bypass with interposition bypass to left carotid bifurcation, presented at emergency department with manifestation of sepsis. A total graft removal and an extra-anatomical prosthetic reconstruction was created, from right common carotid artery to left carotid bifurcation. Defect of prior left subclavian anastomosis was primarily closed, on right subclavian anastomosis per-operative acute bleeding occured, which was controlled by covered stent through right brachial artery. Literature review identified 16 cases. Different approaches ranging from open repair with autologous (six) or allogenic (two) material, to hybrid techniques (eight) have been described. No re-infections were reported. When comparing different types of approaches, no differences are found concerning overall complications., Conclusion: Complete graft removal with extra-anatomical reconstruction is challenging, but crucial in supra-aortic graft infections. Preservation of parts of vascular prosthesis depends on case-by-case basis, according to infection site and general condition of the patient. But due to rarity, only case reports are available, so no strong recommendations can be formulated. International registries should be initiated to share experiences and provide data for decent analysis of short, mid and long term outcomes.

Aerococcus urinae, a gram-positive, catalase-negative coccus, has emerged as a notable pathogen in clinical microbiology. It is traditionally associated with urinary tract infections in elderly males with underlying urologic conditions. Recently, A. urinae has been implicated in severe invasive infections outside the genitourinary tract including infective endocarditis, vertebral osteomyelitis, peritonitis, lymphadenitis, and discitis. We present the case of 84-year-old male with a history of aortic graft replacement who presented with five days of fever and fatigue. Blood and urine cultures grew gram-positive cocci, identified as A. urinae. Thoracoabdominal contrast-enhanced CT revealed a slightly increased soft tissue shadowing around the prosthetic stent in the ascending aorta, indicating a possible aortic stent-graft infection. Gallium-67 scintigraphy demonstrated inflammation around the prosthetic stent in the ascending aorta consistent with an aortic stent-graft infection. The patient and family opted for conservative treatment and despite a six-week inpatient course of ampicillin, followed by oral amoxicillin, the patient died one week after discharge. This is the first published case of A. urinae causing an aortic stent-graft infection. Clinicians should remain cognizant of the disseminated source of infection in cases of A. urinae bacteremia., Competing Interests: Conflict of interest statement All authors have no conflicts of interest to declare., (Copyright © 2024 Japanese Society of Chemotherapy, Japanese Association for Infectious Diseases, and Japanese Society for Infection Prevention and Control. Published by Elsevier Ltd. All rights reserved.)

Cardiovascular infections are the most severe and potentially lethal among the persistent focalized Coxiella burnetii infections. While aortic infections on aneurysms or prostheses are well-known, with specific complications (risk of fatal rupture), new non-aortic vascular infections are increasingly being described thanks to the emerging use of 18-fluorodeoxyglucose positron emission tomography (18F-FDG PET-scan). Here, we describe an infection of a femoro-popliteal bypass that would not have been diagnosed without the use of PET-scan. It is well-known that vascular prosthetic material is a site favorable for bacterial persistence, but the description of unusual anatomical sites, outside the heart or aorta, should raise the clinicians’ awareness and generalize the indications for PET-scan, with careful inclusion of the upper and lower limbs (not included in PET-scan for cancer), particularly in the presence of vascular prostheses. Future studies will be needed to precisely determine their optimal management.

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. [ABSTRACT FROM AUTHOR]

Objectives: To report the midterm outcomes of treating prosthetic peripheral and aortic graft infections using a biosynthetic collagen prosthesis in a tertiary vascular center. Methods: A retrospective analysis of all patients with prosthetic peripheral and aortic graft infections who underwent in situ reconstruction using a biosynthetic collagen prosthesis between March 2015 and November 2020 was conducted. Perioperative and midterm outcomes were analyzed. Results: A biosynthetic collagen prosthesis was used in 19 patients (14 males, median age 66 years) to reconstruct the femoral artery (n = 6), iliac artery (n = 1), and infrarenal aorta (n = 12). All patients were treated for a prosthetic vascular graft infection. The median follow-up period was 26.6 months (range 1–66 months). The 30-day graft failure rate was 15.7% (n = 3), leading to a major amputation in one patient (5.3%). All grafts were occluded aortofemoral reconstructions in patients with occluded superficial femoral artery and were treated by immediate thrombectomy. The 30-day mortality rate was 5.3% (n = 1), and survival after 3 years was 63.2%. The reinfection rate was 5.3% (n = 1). At 13.6 months, the occlusion of a femoral graft was detected in 5.3% (n = 1) and was treated with a new interposition graft. We observed no graft rupture or degeneration during follow-up. Conclusions: Although results of in situ repair with autologous vein seem to be superior with little or none reinfection and low number of occlusions, biosynthetic collagen prostheses show acceptable midterm outcomes in terms of graft occlusion and mortality after prosthetic peripheral and aortic graft infections. Similar to other xenogenous materials, the reinfection rate is low with this prosthesis. With regard to immediate availability and easy handling, the use of a biosynthetic collagen prosthesis might be favorable compared to other replacement materials while treating prosthetic graft infections. [ABSTRACT FROM AUTHOR]

Haemophilus parainfluenzae is a gram-negative coccobacillus that is a part of the normal flora in the human upper airway and sometimes causes infective endocarditis. We present a case of a 68-year-old Japanese man who had vascular graft infection caused by H. parainfluenzae 4 years after surgery for chronic aortic dissection. [ABSTRACT FROM AUTHOR]

Heart infections are not limited to infectious endocarditis. In fact, prosthetic vascular graft infections are among the most severe complications associated with vascular and cardiac surgery. The risk of developing an infection on prosthetic material is estimated to be ~5%. The mortality rate associated with the infection is estimated to be ~10-25% within 30 days of infection and 50% after 1 year. The present article describes a case of a methicillin-sensitive Staphylococcus aureus (MSSA) infection on the prosthetic material following a heart Fontan procedure. To the best of our knowledge, only one other case of extracardiac prosthesis-related infection following Fontan surgery has been reported to date in adults. Prosthetic vascular graft infections (PVGIs) are a rare complication of heart surgery. However, PVGIs can seldomly occur and are burdened by a decreased survival rate. Therefore, physicians need to promptly suspect and recognize such cases. Further studies are required however, in order to determine the feasibility and long-term survival rates of a conservative therapeutic approach. [ABSTRACT FROM AUTHOR]

Background Vascular graft infection (VGI) remains a severe disease with high mortality and relapse rates. We performed a retrospective single-center cohort study to highlight factors associated with long-term all-cause mortality in patients with vascular graft infection. Methods All patients hospitalized in our facility over 10 years for VGI were included. VGI was defined by the presence of a vascular graft or an aortic stent graft (stent or fabric), associated with 2 criteria among clinical, biological, imaging, or microbiological elements in favor of VGI. The primary outcome was all-cause mortality. Empirical antibiotic therapy was considered as appropriate when all involved pathogens were susceptible in vitro to the antibiotics used. The surgical strategy was defined as nonoptimal when the graft was not removed in a late-onset surgery (>3 months) or no surgery was performed. Results One hundred forty-six patients were included. Empirical antibiotic therapy was administered in 98 (67%) patients and considered appropriate in 55 (56%) patients. Surgery was performed in 136 patients (96%) and considered as optimal in 106 (73%) patients. In multivariable analysis, appropriate empirical antibiotic therapy was associated with a lower probability of mortality (hazard ratio, 0.47 [95% confidence interval,.30–.79]; P  = .002). Long-term survival did not differ according to whether the surgical strategy was considered optimal or not (log-rank = 0.66). Conclusions Appropriate empirical antibiotic therapy is a cornerstone of the management of VGI. Whenever possible, antibiotics must be associated with optimal surgical management. However, surgery could potentially be avoided in comorbid patients who are treated with appropriate antibiotics. [ABSTRACT FROM AUTHOR]

Purpose: After endovascular aneurysm repair (EVAR), an increased [18F]FDG uptake may be observed at PET/CT, being common to both vascular graft/endograft infection (VGEI) and sterile post-surgical inflammation. Increased non-specific metabolic activity, due to foreign body reaction, can persist for several years after surgery, thus complicating the interpretation of PET/CT studies. In this paper, we aimed to assess [18F]FDG distribution at different time-points after the implant of abdominal Endurant® endografts in patients without suspicion of infection. Methods: We retrospectively evaluated [18F]FDG/CT in 16 oncological patients who underwent abdominal aortic aneurysm exclusion with Endurant® grafts. Patients had no clinical suspicion of infection and were followed up for at least 24 months after scan. [18F]FDG PET/CT scans were interpreted using both visual and semi-quantitative analyses. Results: The time between the EVAR procedure and [18F]FDG PET/CT ranged between 1 and 36 months. All grafts showed mild and diffuse [18F]FDG uptake without a focal pattern. Mean values of SUVmax were 2.63 ± 0.48 (95% CI 2.38–2.88); for SUVmean 1.90 ± 0.33 (95% CI 1.72–2.08); for T/B ratios 1.43 ± 0.41 (95% CI 1.21–1.65). SUVmax and SUVmean were not correlated to the time elapsed from the procedure, but we observed a declining trend in T/B ratio over time. Conclusions: Endovascular implant of Endurant® grafts does not cause a significant inflammatory reaction. The evidence of faint and diffuse [18F]FDG uptake along the graft can reliably exclude an infection, even in early post-procedural phases. Therefore, in patients with a low probability of VGEI, [18F]FDG PET/CT can also be performed immediately after EVAR.

Vascular graft infection with its morbidity and mortality has tormented the world of vascular reconstruction overlong. India despite carrying a sizable burden of patients requiring vascular reconstruction has minimal research on the subject. We attempted to chronicle clinical profiles, symptom variability, risk factors, prophylactic measures, and various therapeutic options extended to patients with vascular graft infection, in this medical record-based case series analysis, of a decade (years 2010–2020), of patients presenting with vascular graft infections. Statistical comparison was done with chi-square and Fisher's exact probability test. A total of 70 patients presented with vascular graft infection, 92.9% men and 7.1% women (mean age of 58 SD 11.8 years). Diabetes and coronary artery disease were the commonest comorbid conditions (24.7% each). The most common site of infection was the groin, and femoropopliteal bypass graft was the most infected segment (48.5%). The average time interval from index surgery to presentation with infection was 308 days. Early graft infection was seen in 60% patients, with extra-cavitary graft infections manifesting earlier than others. Local symptoms with discharging sinuses and cellulitis were common clinical presentations. Staphylococcus aureus was the commonest organism isolated (31.4%). A total of 58.5% patients underwent graft explantation and 40% were managed conservatively. Incidence of infection in patients who underwent immediate post-operative re-intervention was statistically significant when compared with Bunt's classification (P value < 0.05). The distribution of incidence of post-operative infection differed significantly across various sites and the type of graft material used (P value < 0.05). Prosthetic vascular grafts provide unparalleled benefit to a patient in maintenance of life and limb. Our Indian experience of a decade when summed up reflects that extra-cavitary graft infections express early and anatomical predisposition of the groin makes femoropopliteal segment the worst affected in VGI. Remote infections and re-interventions are hidden caveats of VGI. Apt to say that "Aegrescit medendo"—"the cure is worse than the disease"—holds good for vascular graft infections. [ABSTRACT FROM AUTHOR]

Histoplasma vascular graft infection (VGI) is rarely reported, with only a handful of instances documented in the existing literature. Reporting Histoplasma VGI cases is important as they demonstrate previous treatment strategies and their outcomes. In this paper, we report a case of disseminated histoplasmosis with ascending aortic graft infection. Conservative therapy was attempted initially but failed, and our patient eventually required surgical graft explantation. Our case demonstrates the challenges in diagnosing and managing VGI caused by Histoplasma capsulatum ., (© 2024 The Authors.)

Introduction: Vascular graft infection is a life threatening situation with significant morbidity and mortality. Bacterial graft infection can lead to false aneurysms, bleeding and sepsis. There are a lot of risky situations where grafts can become infected. It is therefore highly desirable to have a vascular graft that is resistant to infection. In this retrospective clinical study, a silver-impregnated vascular graft was evaluated in various indications. Methods: Our study included a total of 71 patients who received a silver-impregnated vascular graft during the period from 2013 to 2018. Patients had an aortoiliac localization of vascular graft in 61 cases (86%), and a peripheral localization on the lower limbs in 10 cases (14%). Indications for the use of these special vascular grafts were trophic lesions or gangrene in the lower limbs in 24 cases (34%), suspicious mycotic abdominal aortic aneurysm (mAAA) in 4 cases (5.5%), salmonela aortitis or aneurysms in 4 cases (5.5%), infection of the previous vascular graft in 11 cases (15.5%), other infections in 12 cases (17%), AAA rupture in 10 cases (14%) and other reasons (pre-transplant condition, multiple trauma, graft-enteric fistula) in 6 cases (8.5%). Thirty-day mortality, morbidity, the need for reintervention and amputation, primary and secondary graft patency, and finally the presence of a proven vascular graft infection were evaluated. Results: The 30-day mortality was 19.7%, and morbidity was 42.2%. The primary patency of the vascular graft was 91.5%. Reoperation was necessary in 10 cases (14%) and amputation was necessary in 10 cases (14%). The median length of hospital stay was 13 days and the mean follow-up period was 48 ± 9 months. During the follow-up period, six patients (8.5%) died from reasons unrelated to surgery or without any relation to the vascular graft. Secondary patency after one year was 88%. Infection of the silver graft was observed in three patients (4.2%). Conclusions: Based on our results, the silver graft is a very suitable alternative for solving infectious, or potentially infectious, situations in vascular surgery. In particular, in urgent or acute cases, a silver graft is often the only option.

Infective endocarditis (IE) is a life-threatening disease with stable prevalence despite prophylactic, diagnostic, and therapeutic advances. In parallel to the growing number of cardiac devices implanted, the number of patients developing IE on prosthetic valves and cardiac implanted electronic device (CIED) is increasing at a rapid pace. The diagnosis of IE is particularly challenging, and currently relies on the Duke-Li modified classification, which include clinical, microbiological, and imaging criteria. While echocardiography remains the first line imaging technique, especially in native valve endocarditis, the incremental value of two nuclear imaging techniques, 18F-fluorodeoxyglucose positron emission tomography with computed tomography (18F-FDG-PET/CT) and white blood cells single photon emission tomography with computed tomography (WBC-SPECT), has emerged for the management of prosthetic valve and CIED IE. In this review, we will summarize the procedures for image acquisition, discuss the role of 18F-FDG-PET/CT and WBC-SPECT imaging in different clinical situations of IE, and review the respective diagnostic performance of these nuclear imaging techniques and their integration into the diagnostic algorithm for patients with a suspicion of IE.

We aim to describe and report on a novel graft preservation technique using a human gelatin thrombin matrix with rifampin for the treatment of vascular graft infections. Eight patients with vascular graft infections were included, one with bilateral infections, for a total of nine cases from January 2016 through June 2021. All the patients underwent wound exploration and placement of human gelatin thrombin matrix with rifampin. No deaths or allergic reactions had been reported at the 30-day follow-up, with only one major amputation. The graft and limb salvage rates were 77.8% at the 1-year follow-up. The mean time to a major amputation was 122 days, and the mean time to graft excision was 30 days., Competing Interests: None., (© 2023 The Author(s).)

Infections account for relevant morbidity and mortality, especially if the cardiovascular system is affected. Clinical manifestations are often unspecific, resulting in a challenging diagnostic work-up. The use of molecular imaging methods, namely [ 18 F]FDG PET and leukocyte scintigraphy, is increasingly recognized in recently published international guidelines. However, these 2 established methods focus on the host's immune response to the pathogen and are therefore virtually unable to differentiate infection from inflammation. Targeting the microorganism responsible for the infection directly with novel imaging agents is a promising strategy to overcome these limitations. In this review, we discuss clinically approved [ 18 F]FDG PET with its advantages and limitations in cardiovascular infections, followed by new PET-based approaches for the detection of cardiovascular infections by bacteria-specific molecular imaging methods. A multitude of different targeting options has already been preclinically evaluated, but most still lack clinical translation. We give an overview not only on promising tracer candidates for noninvasive molecular imaging of infections but also on issues hampering clinical translation., (© 2023 by the Society of Nuclear Medicine and Molecular Imaging.)

In situ reconstruction (ISR) with autologous veins is the preferred method in infectious native aortic aneurysms (INAAs) or vascular (endo)graft infection (VGEI). However, access to biological substitutes can prove difficult and lacks versatility. This study evaluates survival and freedom from reinfection after ISR of INAA/VGEI using the antimicrobial Intergard Synergy graft combining silver and triclosan. From February 2014 to April 2020, 86 antimicrobial grafts were implanted for aortic infection. The diagnosis of INAA/VGEI and reinfection was established based on the Management of Aortic Graft Infection Collaboration criteria. Survival was analyzed using the Kaplan-Meier method and log-rank P values. The antimicrobial graft was implanted in 32 cases of INAA, 28 of VGI, and 26 of VEI. The median age was 69.0 (interquartile range: 62.0; 74.0), with a history of coronary artery disease (n = 21; 24.4%), chronic kidney disease (n = 11; 12.8%), cancer (n = 21; 24.4%), and immunosuppression (n = 27; 31.4%). Imaging showed infiltration (n = 14; 16.3%), air (n = 10; 11.6%), and rupture (n = 16; 18.6% including 22 aortoenteric fistulae [AEnF]). Symptoms included fever (n = 37; 43.0%), shock (n = 11; 12.8%), and pain (n = 47; 54.7%). Repair was undertaken through a midline laparotomy in 75 cases (87.2%) and coeliac cross-clamping in 19 (22.1%), suprarenal in 26 (30.2%), plus celiac trunk (n = 3), mesenteric (n = 5), renal (n = 13), or hypogastric (n = 4) artery reconstruction, and omental flap coverage (n = 41; 48.8%). For AEnF, the gastrointestinal tract was repaired using direct suture (n = 14; 16.3%) or resection anastomosis (n = 8; 9.3%). Causative organisms were identified in 74 patients (86.0%), with polymicrobial infection in 32 (37.2%) and fungal coinfection in 7 (8.1%). Thirty-day and in-hospital mortality were 14.0% and 22.1% (n = 12 and 19, respectively, 3 INAA [9.4%], 7 VGI [25.0%], and 9 VEI [34.6%]). Seventy patients (81.4%) had a postoperative complication, 44 (51.2%) of whom returned to the operative room. The 1- and 2-year survival rates were 74.0% (95% confidence interval [CI]: 63.3-82.1) and 69.8% (95% CI: 58.5-78.5), respectively. Survival was significantly better for INAA vs VGEI (P =.01) and worse for AEnF (P =.001). Freedom from reinfection was 97.2% (95% CI: 89.2-99.3) and 95.0% (95% CI: 84.8-98.4) with six reinfections (7.0%) requiring two radiological/six surgical drainage and two graft removals. Primary patency was 88.0% (95% CI: 78.1-93.6) and 79.9% (95% CI: 67.3-88.1) with no significant difference between INAA and VGEI (P =.16). ISR of INAA or VGEI with the antimicrobial graft showed encouraging early mortality, comparable to the rates found in femoral vein (9%-16%) and arterial allograft (8%-28%) studies, as well as mid-term reinfection. The highest in-hospital mortality was noted for VEI including nearly 50% of AEnF. [ABSTRACT FROM AUTHOR]

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.

Introduction: Vascular graft infection is a life threatening situation with significant morbidity and mortality. Bacterial graft infection can lead to false aneurysms, bleeding and sepsis. There are a lot of risky situations where grafts can become infected. It is therefore highly desirable to have a vascular graft that is resistant to infection. In this retrospective clinical study, a silver-impregnated vascular graft was evaluated in various indications. Methods: Our study included a total of 71 patients who received a silver-impregnated vascular graft during the period from 2013 to 2018. Patients had an aortoiliac localization of vascular graft in 61 cases (86%), and a peripheral localization on the lower limbs in 10 cases (14%). Indications for the use of these special vascular grafts were trophic lesions or gangrene in the lower limbs in 24 cases (34%), suspicious mycotic abdominal aortic aneurysm (mAAA) in 4 cases (5.5%), salmonela aortitis or aneurysms in 4 cases (5.5%), infection of the previous vascular graft in 11 cases (15.5%), other infections in 12 cases (17%), AAA rupture in 10 cases (14%) and other reasons (pre-transplant condition, multiple trauma, graft-enteric fistula) in 6 cases (8.5%). Thirty-day mortality, morbidity, the need for reintervention and amputation, primary and secondary graft patency, and finally the presence of a proven vascular graft infection were evaluated. Results: The 30-day mortality was 19.7%, and morbidity was 42.2%. The primary patency of the vascular graft was 91.5%. Reoperation was necessary in 10 cases (14%) and amputation was necessary in 10 cases (14%). The median length of hospital stay was 13 days and the mean follow-up period was 48 ± 9 months. During the follow-up period, six patients (8.5%) died from reasons unrelated to surgery or without any relation to the vascular graft. Secondary patency after one year was 88%. Infection of the silver graft was observed in three patients (4.2%). Conclusions: Based on our results, the silver graft is a very suitable alternative for solving infectious, or potentially infectious, situations in vascular surgery. In particular, in urgent or acute cases, a silver graft is often the only option. [ABSTRACT FROM AUTHOR]

Infective endocarditis (IE) is a life-threatening disease with stable prevalence despite prophylactic, diagnostic, and therapeutic advances. In parallel to the growing number of cardiac devices implanted, the number of patients developing IE on prosthetic valves and cardiac implanted electronic device (CIED) is increasing at a rapid pace. The diagnosis of IE is particularly challenging, and currently relies on the Duke-Li modified classification, which include clinical, microbiological, and imaging criteria. While echocardiography remains the first line imaging technique, especially in native valve endocarditis, the incremental value of two nuclear imaging techniques, 18F-fluorodeoxyglucose positron emission tomography with computed tomography (18F-FDG-PET/CT) and white blood cells single photon emission tomography with computed tomography (WBC-SPECT), has emerged for the management of prosthetic valve and CIED IE. In this review, we will summarize the procedures for image acquisition, discuss the role of 18F-FDG-PET/CT and WBC-SPECT imaging in different clinical situations of IE, and review the respective diagnostic performance of these nuclear imaging techniques and their integration into the diagnostic algorithm for patients with a suspicion of IE. [ABSTRACT FROM AUTHOR]

Introduction: Vascular graft infection is a rare but serious complication in vascular surgery, associated with high morbidity and mortality. Early diagnosis of vascular graft infection is important for proper and timely surgical and antibiotic treatment that improves the outcome. The tactic and techniques of surgical treatment of vascular graft infection have changed over the last two decades, and this trend can also be observed in our retrospective study., Methods: We evaluated a group of patients with prosthetic vascular reconstructions performed at the Department of Surgery, University Hospital in Pilsen in the period of 2003-2021 using retrospective analysis. In the analyzed 19-year period, 23 infected vascular grafts were managed out of a total of 2090 performed peripheral bypasses, and 27 infected vascular grafts were managed out of a total set of 1940 central reconstructions., Results: The incidence of peripheral vascular graft infections at our Department of Surgery in the period of 2003-2021 reached 1.1% with the early mortality rate of 8.7%; 1.4% central vascular graft infections occurred in the same time period with 33% early mortality., Conclusion: The results of our retrospective study are comparable virtually in all parameters with the experience of other departments. Consistently, our department switched to in situ replacements for explanted vascular grafts and we can confirm good experience with silver impregnated grafts.