Search

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.

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.

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.

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.)

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.

Objective: This in vitro study investigates the antimicrobial efficacy of impregnation of commercially available aortic endografts (EG) with rifampicin (RIF) and nanocolloidal silver. Methods: Endografts were flushed with 50 mL of RIF 600 mg, 70 mL of a silver-based aqueous solution (AG), or 50 mL of phosphate-buffered saline (PBS) over 15 minutes. Endografts were then retrieved from the sheath and cut in 1 × 1 cm sized graft units (n = 80 of each impregnation), which were then incubated for 1 hour separately with inoculates containing 106 or 103 bacteria per milliliter (bact/mL) of each of the following bacteria: Staphylococcus epidermidis, Escherichia coli, multisensitive Staphylococcus aureus, and Pseudomonas aeruginosa. After sonication of the graft units, bacterial counts were measured by plating out twice the sonication solution on Mueller-Hinton plates. Results: RIF showed a statistically significant decrease of colony forming units per milliliter for all four bacterial strains in both concentrations compared with PBS and AG, except for 103 bact/mL of E coli. AG showed a significant decrease of colony forming units per milliliter compared with PBS only for 106 bact/mL of E coli and was statistically significantly inferior to RIF for all four bacterial strains in both concentrations with the exception of E coli at a concentration of 103 bact/mL. Conclusions: This in vitro study demonstrated infectivity resistance of aortic EG after flushing with RIF. Moreover, the feasibility of flushing aortic EG with a new silver-based agent could be demonstrated, but without statistically significant antimicrobial efficacy compared with native EG. : Clinical Relevance: Because the number of elective and emergency endovascular procedures on the thoracic and abdominal aorta is continuously increasing, endograft infections in both locations are also more frequently observed. The necessity and use of antimicrobial-impregnated EG in the prophylaxis or treatment of endograft infections has so far neither been discussed in the literature nor addressed in existing guidelines. This is the first study investigating the influence of antiseptic impregnations of commercially available aortic EG on in vitro contamination with bacteria commonly causing vascular graft infections. Owing to proven infectivity resistance, flushing EG with RIF could, despite known limitations, lead to a modification of established therapeutic principles in patients at high risk for aortic graft infections.

Q fever, a zoonotic infection caused by Coxiella burnetii, can present with a wide spectrum of clinical manifestations. The organism is typically transmitted from sheep, goats, or cattle to humans via contaminated aerosols. On average, 1–5% of patients with acute Q fever will develop chronic infection months to decades after their primary infections. We report a case of a chronic vascular graft infection due to Coxiella burnetii in a 61-year-old man without direct exposure to animals who presented with recurrent fever. Indium-111-labeled white blood cell scan with single-emission positron computed tomography demonstrated findings suggesting a graft infection. C. burnetii phase I and phase II IgG antibody titers were > 1:32,768 and polymerase chain reaction performed on the explanted graft was positive for C. burnetii. Q fever should be considered in the differential diagnosis of vascular infections in patients who have a pre-existing lesion such as an aneurysm, or vascular prosthesis even in the absence of a history of direct animal exposure.

Prosthetic vascular graft infection is devastating and frequently fatal. Cure requires removal of the graft and reperfusion by placement of a new graft. However, no evidence based guidelines exist for management where removal of the graft is not possible. We describe a patient who lived in a state of chronic infection suppression through outpatient parenteral antimicrobial therapy (OPAT) over a period of 32 months, and outline the challenges experienced and strategies used to suppress infection in the face of escalating antimicrobial resistance. To date there have been very few reports of OPAT used in the palliative context and this case illustrates the microbiological issues that can arise and the importance of the full OPAT multi-disciplinary team in managing these issues and optimising the patient's quality and length of life.

Introduction: 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., Methods: 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., Results: 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)., Conclusions: 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., (Copyright © 2022 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)

Background: The empiric antibiotic regimen started after deep cultures and explantation of the graft mostly do not cover antifungals. We retrospectively studied the outcome of candida compared to non-candida VGI and assessed whether these results could justify the addition of antifungals to the empiric antibiotics in the early postoperative period., Methods: All patients treated for infected aorto(ilio)femoral graft with excision and reconstruction at the vascular department of University Hospitals Leuven between January 2010 and 2017 (n = 56) were studied retrospectively. Patients were allocated to the candida group (n = 10) or non-candida group (n = 46) according to the presence of Candida in deep culture isolates., Results: All-cause mortality was significantly higher in the candida group compared to the non-candida group. All-cause 30-day mortality was 40% and 13% for both groups respectively (P = 0.066). At 5 years this was 90% and 46% respectively (P = 0.014). In the candida group 6 patients (60%) had to be revised in the operating room due to bleeding, compared to 5 patients (11%) in the non-candida group (P = 0.002).  Two patients (20%) and 5 patients (11%) had to be readmitted to the ICU, respectively., Conclusion: Survival of candida related VGI is significantly worse, especially in the first 5 postoperative months. This could justify the addition of an antifungal to the early empiric postoperative antibiotic cocktail, especially in patients with an aorto-enteric fistula. A cost-benefit analysis could be useful to evaluate the yield., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background: In Canada, tissue distribution is managed by provincial entities. In 2014, Hema-Quebec established a cryopreserved vascular tissue bank accessible to all Canadian hospitals. The objectives of this report were to review the first 5 years of activity of Hema-Quebec's vascular bank and to briefly assess the competitiveness of its products., Methods: Deceased donors, ages 15 to 60, were screened for common blood-borne diseases. Grafts were treated in a triple-antibiotic solution at 35°C before preservation at -100°C. Hema-Quebec's vascular graft records were analyzed from 2014 to 2019 inclusively., Results: The average donor age was 35 years old and 78% of donors were men. Overall, 63% of harvested grafts cleared the quality management system. Positive microbial cultures and morphologic defects were the major reasons for graft discard. As such, a total of 60 grafts were delivered between 2016 and 2019 to 8 hospital centers. Moreover, the bank achieved a mean activity increase of 55% per year and Hema-Quebec's homografts were 48% less costly compared with similar homographs from for-profit organizations., Conclusions: Our findings demonstrate that Hema-Quebec has established a viable cryopreserved vascular tissue bank with steady increase in activity and an acceptable graft discard rates and pricing. Based on our findings, we recommend that efforts should be directed to expand the tissue bank graft distribution outside the province of Quebec., (Copyright © 2021 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)

Objective: Different graft materials have been proposed for in situ reconstruction in the setting of vascular graft infection (VGI). We analyzed the long-term outcomes after in situ aortoiliac reconstruction with cryopreserved allografts., Methods: We performed a retrospective analysis of patients who had undergone in situ aortoiliac reconstruction with cryopreserved arterial allografts for VGI from 2000 to 2015. The end points were the perioperative and long-term mortality and graft-related complications, including stenosis, occlusion, pseudoaneurysm, and reinfection., Results: A total of 33 patients (91% male) with a median age of 67 years (range, 53-83 years) had undergone in situ aortoiliac reconstruction with cryopreserved allografts. The 30-day mortality was 6% (n = 2); both deaths were related to the allograft (one early allograft-enteric fistula and one graft rupture). Another two patients had experienced early (≤30 days) graft-related events (one allograft-enteric fistula and one graft limb occlusion), for an early graft-related complication rate of 12% (n = 4). Of the 31 discharged patients, 13 (42%) had died after a median of 47 months (range, 2-97 months). The median follow-up for the 18 remaining patients was 96 months (range, 10-146 months). The estimated survival at 1, 3, and 5 years was 88%, 81%, and 66%, respectively. Nine patients (29%) had experienced at least one of the following graft-related events during follow-up, including graft stenosis requiring intervention in five (16%), graft occlusion in four (13%), pseudoaneurysm in three (10%), and reinfection in two patients (6%). The estimated freedom from any first graft-related event at 1, 3, and 5 years was 78%, 71%, and 62%, respectively. The estimated primary patency and primary assisted patency at 1 and 3 years was 87% and 79%, and 90% and 83%, respectively., Conclusions: In situ aortoiliac reconstruction with cryopreserved allografts to treat VGI was associated with relevant perioperative graft-related complications. Although the reinfection rate was acceptable, other graft-related complications were frequent in the long term, in particular, graft occlusion and stenosis., (Copyright © 2020 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)

Objective: Vascular graft and endograft infection (VGEI) has high morbidity and mortality rates. Diagnosis is complicated because symptoms vary and can be nonspecific. A meta-analysis identified 18 F-fluoro-d-deoxyglucose positron emission tomography-computed tomography ( 18 F-FDG PET/CT) as the most valuable tool for diagnosis of VGEI and favorable to computed tomography as the current standard. However, the availability and varied use of several interpretation methods, without consensus on which interpretation method is best, complicate clinical use. The aim of this study was to evaluate the diagnostic performance of different interpretation methods of 18 F-FDG PET/CT in diagnosis of VGEI., Methods: A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data sources included PubMed/MEDLINE, Embase, and Cochrane Library. A meta-analysis was conducted on the different interpretation methods for 18 F-FDG PET/CT in diagnosis of VGEI, including visual FDG uptake intensity, visual FDG uptake pattern, and quantitative maximum standardized uptake (SUVmax)., Results: Of 613 articles, 13 were included (10 prospective and 3 retrospective articles). The FDG uptake pattern method (I 2  = 26.2%) showed negligible heterogeneity, whereas the FDG uptake intensity (I 2  = 42.2%) and SUVmax (I 2  = 42.1%) methods showed moderate heterogeneity. The pooled sensitivity for FDG uptake intensity was 0.90 (95% confidence interval [CI], 0.79-0.96); for uptake pattern, 0.94 (95% CI, 0.89-0.97); and for SUVmax, 0.95 (95% CI, 0.76-0.99). The pooled specificity for FDG uptake intensity was 0.59 (95% CI, 0.38-0.78); for FDG uptake pattern, 0.81 (95% CI, 0.71-0.88); and for SUVmax, 0.77 (95% CI, 0.63-0.87). The uptake pattern interpretation method demonstrated the best positive and negative post-test probability, 82% and 10%, respectively., Conclusions: This meta-analysis identified the FDG uptake pattern as the most accurate assessment method of 18 F-FDG PET/CT for diagnosis of VGEI. The optimal SUVmax cutoff, depending on the vendor, demonstrated strong sensitivity and moderate specificity., (Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.)

Objectives: Infection of the vascular graft represents one of the most threatening complications after aortic repair. It is rare and associated with high morbidity and mortality rates. The aim of this study was to present short-term outcomes after surgical treatment of infected aortic grafts after endovascular and open repair of abdominal aortic aneurysms (AAAs)., Methods: Data of all patients affected by aortic graft infection after aneurysm repair who underwent an explantation of a conventional or endovascular aortic graft between January 2008 and December 2016 were retrospectively reviewed. All patients underwent in situ reconstruction using a rifampicin soaked synthetic graft. The primary endpoint of this study was 30 day mortality; secondary endpoints were major post-operative complications., Results: Twenty-six patients were included in the cohort, 16 with an infected endograft (iEVAR) and 10 patients with an infected conventional graft (iOAR). Thirty-day mortality was 23.1% overall, 37.5% for iEVAR and 0% (p = .027) for iOAR. Post-operative major complications occurred in eight (50%) patients from the iEVAR group and in four (40%) patients from the iOAR group (p = .619). The supravisceral clamping rate was higher in patients with infected iEVAR (93.8 vs. 20%, p = .001), furthermore a greater incidence of post-operative acute kidney injury was observed (50 vs. 0%, p = .009)., Conclusions: Explantation of the graft and in situ reconstruction for aortic graft infection is accepted as the therapy of choice. However, re-operation for iEVAR is related to significantly higher mortality and morbidity rates. The need for suprarenal aortic clamping seems to be a possible explanation for worse outcomes in iEVAR., (Copyright © 2018 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.)

Background: Vascular graft infection (VGI), a serious complication in vascular surgery, has a high morbidity and mortality rate. The diagnosis is complicated by non-specific symptoms and challenged by the variable accuracy of different imaging techniques. The objective of this study was to determine the diagnostic value of various imaging techniques to diagnose VGI., Methods: A systematic review was conducted according to the PRISMA guidelines. Data sources included PubMed/Medline, Embase, and Cochrane from January 1997 until October 2017. Observational cohort studies were included. A meta-analysis was conducted on several imaging modalities: computed tomography with or without angiography (CT(A)), 18 F-fluoro-d-deoxyglucose positron emission tomography with or without low dose or contrast enhanced CT (FDG-PET(/CT)), and white blood cell scintigraphy with or without single photon emission computed tomography combined with low dose CT (WBC (SPECT/CT))., Results: Of 4259 papers, 14 articles were included, containing eight prospective and six retrospective articles. CTA (I 2 7.4%), FDG-PET (I 2 36.5%), and FDG-PET/CT (I 2 36.6%) showed negligible to moderate heterogeneity, while WBC scintigraphy ± SPECT/CT (I 2 78.6%) showed considerable heterogeneity. Pooled sensitivity for CTA was 0.67 (95% CI 0.57-0.75), in contrast to FDG-PET of 0.94 (95% CI 0.88-0.98), FDG-PET/CT of 0.95 (95% CI 0.87-0.99), WBC scintigraphy of 0.90 (95% CI 0.85-0.94), and WBC scintigraphy with SPECT/CT of 0.99 (95% CI 0.92-1.00). The pooled specificities were for CTA 0.63 (95% CI 0.48-0.76), FDG-PET 0.70 (95% CI 0.59-0.79), FDG-PET/CT 0.80 (95% CI 0.69-0.89), WBC scintigraphy 0.88 (95% CI 0.81-1.94), and WBC scintigraphy SPECT/CT 0.82 (95% CI 0.57-0.96). Pre- and post-test results showed that WBC SPECT/CT favours FDG-PET/CT, with a positive post-test probability of 96% versus 83%., Conclusion: This meta-analysis suggests the diagnostic performance of WBC scintigraphy combined with SPECT/CT is the greatest in diagnosing VGI. However, it is a time consuming technique and not always available. Therefore FDG-PET/CT may be favourable as the initial imaging technique. The use of solitary CTA in diagnosing VGI seems to be obsolete., (Copyright © 2018 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.)

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., (Copyright © 2018 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.)

Objective/background: Vascular graft infection is a serious and challenging complication. In situations when neither traditional radical surgery nor conservative negative pressure wound therapy (VAC) alone, are considered feasible or safe, for example due to bleeding, adverse anatomy, or severe comorbidity, a novel hybrid procedure was developed. The EndoVAC technique consists of (i) relining of the infected reconstruction with a stent graft; (ii) surgical revision (without clamping the reconstruction); and (iii) VAC therapy, to permit granulation and secondary delayed healing, and long-term antibiotic treatment. The aim of the study is to report long-term follow up data of this new treatment modality., Methods: From November 2007 to June 2015, 17 EndoVAC procedures were performed in 16 patients (eight men, aged 16-91 years): six infected carotid patches after carotid endarterectomy, three infected neck deviations, two infected femoro-popliteal bypasses, three infected patches after femoral thrombo-endarterectomy, and two infected vascular accesses. Surveillance was performed routinely every 3-6 months and included clinical examination, hematologic tests, duplex ultrasonography, and imaging techniques, including 18F-fluorodeoxyglucose positron emission tomography/computed tomography., Results: Primary technical success rate was 100%. Antibiotics were prescribed for a median of 3 months (range 1-20 months). The median duration of VAC treatment was 14 days (range 9-57 days). Complications included early, transient stroke (n = 1), temporary hypoglossal palsy (n = 1), and late, asymptomatic occluded bypasses (n = 2), stent graft thrombosis (n = 1), and moderate carotid stenosis (n = 1). After a median of 5 years (range 1-90 months) of follow up, all patients had healed graft infections with no recurrence was observed. Eight patients died as a result of severe comorbidities, unrelated to the infection or hybrid procedure, 1 month-7 years after treatment., Conclusion: The EndoVAC technique is an alternative, less invasive, option for treatment of infected vascular reconstructions in selected cases, when neither traditional radical surgery, nor conservative simple negative pressure wound therapy are considered feasible or safe. The exact indications for this alternative hybrid treatment need to be established., (Copyright © 2016 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.)