This document discusses graft infection, including its incidence, classification, pathogenesis, diagnosis, and surgical treatment/outcomes. Graft infections can be classified based on their relationship to postoperative wounds or extent of graft involvement. Diagnosis involves imaging like CT scans and lab tests/cultures. Treatment goals are to eradicate infection while maintaining blood flow, and options depend on clinical factors and infection extent. Surgical treatment and outcomes are discussed.
my aortic surgery presentation in Solo as an introduction for general practitioner and cardiology resident
Cover the basic diagram of surgical procedures of aorta.
definitely not for surgeon.
my aortic surgery presentation in Solo as an introduction for general practitioner and cardiology resident
Cover the basic diagram of surgical procedures of aorta.
definitely not for surgeon.
Principles of angioplasty -Endovascular Management of Peripheral Vascular Dis...Saurabh Joshi
This presentation covers the principles of peripheral angioplasty with and explanation of the TASC stratification and selection of appropriate management according to current guidelines. Endovascular management of peripheral vascular disease.
Vascular Injuries and Principles of ManagementVascular Surgery Workshop 2018
Joel Arudchelvam,MBBS (Col), MD (Sur), MRCS (Eng),Consultant Vascular and Transplant Surgeon Teaching Hospital Anuradhapura.
Causes, Mechanism of injury, Arterial Level injuries, Signs of vessel injury -Hard signs,Soft sign, Principles of management
Principles of angioplasty -Endovascular Management of Peripheral Vascular Dis...Saurabh Joshi
This presentation covers the principles of peripheral angioplasty with and explanation of the TASC stratification and selection of appropriate management according to current guidelines. Endovascular management of peripheral vascular disease.
Vascular Injuries and Principles of ManagementVascular Surgery Workshop 2018
Joel Arudchelvam,MBBS (Col), MD (Sur), MRCS (Eng),Consultant Vascular and Transplant Surgeon Teaching Hospital Anuradhapura.
Causes, Mechanism of injury, Arterial Level injuries, Signs of vessel injury -Hard signs,Soft sign, Principles of management
A discussion on the risk factors, classification and clinical presentation of surgical site infection. Also elucidates the overview of management approach to SSI.
Comparative Study Of Pterygium Excision With Conjunctival Autograft,Wet Amnio...Dr. Jagannath Boramani
Presenter: Dr. Pavitra K. Patel, Co-authors: Dr. Sachin Daigavane,Dr. Mala Kamble, Department of Ophthalmology, Jawarharlal Nehru Medical College & Acharya Vinoba Bhave Rural Hospital, Sawangi, Wardha.
Hospital Aquired Infections with special consideration to surgical site infections...also case presentation in the begining followed by literature review
Surgical site Infection during Internship in medical college.pptxrautkrisna
Infections that occur in the wound created by an invasive surgical procedure are generally referred to as surgical site infections (SSIs). SSIs are one of the most important causes of healthcare-associated infections (HCAIs). A prevalence survey undertaken in 2006 suggested that approximately 8% of patients in hospital in the UK have an HCAI. SSIs accounted for 14% of these infections and nearly 5% of patients who had undergone a surgical procedure were found to have developed an SSI. However, prevalence studies tend to underestimate SSI because many of these infections occur after the patient has been discharged from hospital. SSIs are associated with considerable morbidity and it has been reported that over one-third of postoperative deaths are related, at least in part, to SSI. However, it is important to recognise that SSIs can range from a relatively trivial wound discharge with no other complications to a life-threatening condition. Other clinical outcomes of SSIs include poor scars that are cosmetically unacceptable, such as those that are spreading, hypertrophic or keloid, persistent pain and itching, restriction of movement, particularly when over joints, and a significant impact on emotional wellbeing. SSI can double the length of time a patient stays in hospital and thereby increase the costs of health care. Additional costs attributable to SSI of between 814 and 6626 have been reported depending on the type of surgery and the severity of the infection. The main additional costs are related to re-operation, extra nursing care and interventions, and drug treatment costs. The indirect costs, due to loss of productivity, patient dissatisfaction and litigation, and reduced quality of life, have been studied less extensively.Infections that occur in the wound created by an invasive surgical procedure are generally referred to as surgical site infections (SSIs). SSIs are one of the most important causes of healthcare-associated infections (HCAIs). A prevalence survey undertaken in 2006 suggested that approximately 8% of patients in hospital in the UK have an HCAI. SSIs accounted for 14% of these infections and nearly 5% of patients who had undergone a surgical procedure were found to have developed an SSI. However, prevalence studies tend to underestimate SSI because many of these infections occur after the patient has been discharged from hospital. SSIs are associated with considerable morbidity and it has been reported that over one-third of postoperative deaths are related, at least in part, to SSI. However, it is important to recognise that SSIs can range from a relatively trivial wound discharge with no other complications to a life-threatening condition. Other clinical outcomes of SSIs include poor scars that are cosmetically unacceptable, such as those that are spreading, hypertrophic or keloid, persistent pain and itching, restriction of movement, particularly when over joints, and a significant impact on emotional wllbeing
A proposal for classifying peristomal skin disorders: results of a multicente...Mario Antonini
The challenges of caring for abdominal ostomy disorders have grown over the years. Because the literature shows no evidence of a tool to classify peristomal skin disorders, a study group comprised of seven enterostomal therapy nurses and four surgeons sought to provide an objective, reproducible, standardized classification instrument. A prospective, observational study was conducted
among eight ostomy centers across Italy. The 339 patient participants (272 men, 67 women, average age 63 [25 to 85] years) were divided into two groups according to onset of complications (less than or greater than 1 year); 800 digital photographs were taken to enhance observation and blood samples were drawn for additional data. From the data obtained, a classification scheme was created
and subsequently tested using four non-study group experts. The resulting instrument facilitated lesion interpretation and detection, including topography. Thus far, this is the first validated classification attempt not based on assessments of lesions attributable to entirely different etiopathogenetic factors. Further research to refine the tool and to correlate the additional data obtained from blood samples with the classification system is underway.
Despite the routine use of prophylactic systemic antibiotics, surgical-site infection continues to be associated with significant morbidity and cost after colorectal sur- gery. The gentamicin–collagen sponge, an implantable topical antibiotic agent, is approved for surgical implantation in 54 countries. Since 1985, more than 1 million patients have been treated with the sponges.
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
2. REFERENCE
Textbook
1. Rutherford's Vascular Surgery and
Endovascular Therapy 9th edition , Chapter 47,
589-601.e
2. Vascular and Endovascular Surgery: A
Companion to Specialist Surgical Practice, 6th
Edition , Chapter 7, 83-101.e
3. REFERENCE
Journal
- European Journal of Vascular &
Endovascular Surgery RSS :
Volume 56, Issue 5 , 2018-11-
1, Pages i-767
- Infectious Disease Clinics of North
America : Current Issue , 2018-12-1,
Volume 32, Issue 4
4. • Orton, D. F., et al. (2000). "Aortic prosthetic graft infections: radiologic manifestations and
implications for management." Radiographics 20(4): 977-993.
• Folmer, E. I. R., et al. (2018). "Diagnostic Imaging in Vascular Graft Infection: A Systematic Review and
Meta-Analysis." European Journal of Vascular and Endovascular Surgery.
• Fatima, J., et al. (2013). "Treatment strategies and outcomes in patients with infected aortic
endografts." Journal of vascular surgery 58(2): 371-379.
REFERENCE
6. VASCULAR GRAFT SEPSIS
Definition: Sepsis involving all or part of a vascular conduit, vascular patch or
endovascular prosthesis
• Prosthetic vascular grafts
• Endovascular prosthesis (aortic or peripheral)
• Autologous vascular grafts / patches (rare)
7. INCIDENCE
• A population-based study from the Mayo Clinic estimated :
incidence of infection 5%
• Early (<30-day) graft infection 1%
• during an emergency procedure (ruptured AAA, acute arterial ischemia)
• prosthesis to the femoral artery
• placed in a subcutaneous tunnel (axillofemoral or cross-femoral bypass
13. CELLULAR AND BIOMOLECULAR EVENTS
Biomaterial-associated infection fundamental
steps
Adhesion of bact to graft/stent surface
Formation of microcolonies within biofilm
Activation host defense
Inflammatory response involve perigraft tissue ,
anastomosis
14.
15. CLINICAL SOURCES OF INFECTION
Perioperative contamination
Seeding of biomaterial by bacteremia
Mechanical erosion into bowel / genitourinary / skin
Involvement in contiguous infectious process
Impair host defense
16. 1.PERIOPERATIVE CONTAMINATION
Direct route during implantation ( break aseptic technique)
Through surgical wound
( healing complication: cellulitis , dermal necrosis , lymphocele /
gaping)
(C/S s.epidermidis 50-70% thrombosed graft , > 80% anastomosis
aneurysm)
Hematogenous/lymphatic from remote site
17. 2.BACTEREMIA
Uncommon but important mechanism
IV Bact 107 within days implantation 100% infection
Parenteral antibiotic significant decrease risk of graft colonization
from bacteremia
Vulnerability graft to infection is beyond 1 yr
Prosthesis heal , incorporated into surrounding tissue bact
colonization decrease
18. 3.MECHANICAL EROSION
GEE/GEF develop as result of
pulsatile movement of aortic
graft against bowel without
adequate intervening
retroperitoneal soft tissue
Incidence GEE/GEF after
aortic grafting : 0.4-2%
GEF : Graft enteric fistula GEE : Graft enteric erosion
19. 4.INVOLVEMENT BY CONTIGUOUS
INFECTIOUS PROCESS
An adjacent infection
Aortofemoral limb infection associated with diverticulitis
Peripheral graft infection secondary to an infected lymphocele
24. Avoid prolonged pre-op hos stay
Shower , scrub with antibacterial
soap night before
Control remote infection
Remove hair immediate before
operation
Protect vas graft contact with skin
by use of iodine-impregnated
plastic drapes
PREVENTION PRINCIPLE
25. Avoid concomitant GI procedure
Prophylactic antibiotic 30-60 min before
Longer (>24hr) duration of periprocedural antibiotic
Control MRSA : disposable gowns , gloves , masks
PREVENTION PRINCIPLE
26. ANTIBIOTIC PROPHYLAXIS IN ADULTS UNDERGOING
VASCULAR PROCEDURES
• 1st Vascular intervention (ATB for
24hrs)
• Cefalexin 1-2 g iv 30 min before
procedure
and repeat q 8 hrs
• Cefuroxime 1.5 g iv q 12 hrs
• Single dose before procedure involving a
prior access-site prosthesis (2nd intervention)
• Cefalexin 1-2 g iv 30 min before procedure
and repeat q 8 hrs
• Cefuroxime 1.5 g iv q 12 hrs
• Re-op involving an existing
prosthesis graft/ patch
• Vancomycin 1 g iv 30-60 min
before incision and continued q
12 hrs for 24-48 hrs
High MRSA risk : Vancomycin 1 g iv before
procedure
Alternative for penicillin , Cephalosporin or Vancomycin
allergy
1. Daptomycin 4 mg/kg and repeat dose 24 hrs
2. Levofloxacin 500 mg iv and repeat dose 24 hrs
3. Clindamycin 900 mg iv and repeat dose 450-900 mg q 8
28. • FOR PREVENT GRAFT COLONIZATION AND TRANSIENT BACTEREMIA :
ATB is recommended if intervention ( dental work , colonoscope ,
cystoscope) performed within 3 mo after implantation of prosthesis
graft
• Amoxy 2 g oral 1 hr before or Clindamycin 600 mg
PROPHYLACTIC ANTIBIOTICS
29. OPERATIVE CONCERN
Meticulous sterile technique
Avoid bacteria contact of vas devices
Careful handling tissues
Hemostatic technique
Closure groin in multiple layers to eliminate
dead space
Skin reapproximate without tension
minimize dermal ischemia / necrosis
33. PRE-OPERATIVE GRAFT IMAGING
Confirm perigraft inflammation
Dilineate the extent of graft sepsis
Angiographic imaging is used to plan a strategy for revascularization in
presence of distal ischemia , occlusive disease , graft thrombosis
Combination anatomic and functional imaging is fairly accurate:
Navigational tool to plan operative strategies
Imaging-guided fluid aspirate
Peri-graft fluid / Peri-graft gas
Anastomosis leak
Partial vs. total graft
involvement
GEE/GEF
Sensitivity 80-100%
Specificity 50-90%
36. CT SCAN/ CTA
CT preferred initial imaging
best separates luminal
graft, arterial, venous
structures and perigraft tissues
37. DIAGNOSTIC CRITERIA
CT scan / CTA
• loss of normal tissue planes (fat density) of retroperitoneal
or subcutaneous perigraft structures (indicative of
inflammation)
• collections of fluid or gas (>3 mo after implantation)
around the graft
• false aneurysm formation
• hydronephrosis, and adjacent vertebral or bony
osteomyelitis
Orton, D. F., et al. (2000). "Aortic prosthetic graft infections: radiologic manifestations and implications for management." Radiographics 20(4):
38. Figure A , CT scan showing perigraft fluid with
air(arrow)
Figure B : CT scan showing thickened perigraft tissue
(large arrow) and air within the graft and perigraft tissue
(small arrow)
39. Figure C : CT scan showing left limb of aortobifemoral bypass
(vertical arrow) surrounded by a large false aneurysm with a small
blush of contrast (small arrow). The false aneurysm communicates
with a large abscess (*) extending from the retroperitoneum into the
left lateral abdominal wall. Note air within the abscess (large arrow).
Figure D, CT scan of the right leg showing
complex abscess containing air at the
infrageniculate level (long arrow).
40. 2.ULTRASONOGRAPHY
• Initial imaging study for extracavitary (P1, P2, P3) graft
infections
• Color duplex scanning : differentiate a perigraft fluid
from
• Anastomotic pseudoaneurysm
• Hematoma
• soft tissue masses
42. 4. FUNCTIONAL WBC SCANNING
• To demonstrate abnormal accumulation of leukocytes in
perigraft tissue
• The accuracy of indium 111–labeled WBC scans 80-90%
in detecting graft infection
• Not useful during early postoperative course (3 - 6 mos)
because of uptake in the healing, inflamed perigraft tissue
44. 6. ARTERIOGRAPHY
• To define inflow and outflow targets for new bypass in
the presence of occlusive disease or graft thrombosis
45. CT-GUIDED ASPIRATION VS OPERATIVE
• CT guided : to differentiate uninfected seroma from
abscess formation ( false negative )
• The definitive diagnostic test for suspected graft
infection is operative exploration, especially with equivocal
anatomic imaging and suspected GEE/GEF
• Broth culture of graft material : only reliable method identifying
bacteria and selecting appropriate antibiotic therapy
46. CULTURE TECHNIQUES
• Standard swab cultures directly from the graft
surfaces and perigraft fluid are usually sufficient
• Surface swabs may not recover less virulent
pathogens that do not invade perigraft tissues
48. SURGICAL TREATMENT AND OUTCOMES
Goals of treatment
1.Eradicate septic process
2.Maintenance of normal
arterial perfusion
Selection criteria for specific
treatment modalities are based
primarily on
1. clinical findings
2. extent of graft
involvement
49.
50. TREATMENT ALGORITHMS NEED TO BE PATIENT-SPECIFIC BASED
ON CLINICAL FEATURES, EXTENT OF GRAFT INVOLVEMENT AND
BACTERIOLOGY
3
Graft preservation technique
2
Graft excision Only
1
-Total Graft excision & Extra-
anatomical/ Remote bypass grafting
-Graft excision (Total/Partial) & In-situ
graft replacement
53. Better results with early infection vs. late infection
Better results with PTFE vs. Dacron grafts
Segmental non-anastomotic graft involvement
Any organism (caution with pseudomonas / MRSA)
1.GRAFT PRESERVATION
** Graft sepsis antibiotic protocol: 6 weeks
54. 2. GRAFT EXCISION
ONLY
• Occluded septic prosthetic
graft
• No need for
revascularization
• Any organism
• Culture-directed antibiotics
for 7 – 10 day
55. 3.GRAFT EXCISION AND EXTRA-
ANATOMICAL BYPASS
• Graft excision alone : arterial
collaterals adequate not to develop
CLI
• Intra-op decision : temporary bypass
occlusion
1.Persistence pulsatile pedal
pulse
AND
2.Ankle pressure >40 mmHg
Delayed revascularization is OK
56. TIME OF LIMB REVASCULARIZATION
- Simultaneous
• Unstable patient
• Haemorrhage
• Severe graft sepsis
• GEE / GEF
& a widely patent, functioning graft
- Staged : axillofemoral PTFE bypass 1-2 days then excision graft
• Stable patients
• No haemorrhage
• Reasonably collateralized, will tolerate interval ischaemia
57. OUTCOME
• Limb loss in infected aortofemoral > aortoiliac
reconstruction
• Unilateral axillofemoral to profunda or SFA patency
94% at 6 mo
• Axillopopliteal bypass patency 42% at 6 mo
58. 3.IN SITU GRAFT
REPLACEMENT
• Aortic and / or peripheral
grafts
• No GEE / GEF
• Staph epidermidis or
culture negative organisms
• No perigraft pus
• Biofilm infection
• Segmental or total graft
involvement
59. ANTIBIOTIC-TREATED PROSTHETIC
GRAFTS
• In situ prosthetic with PTFE or polyester recurrent
infection 10-20%
• > 50% of late extracavitary graft infections met these
criteria + treated in situ PTFE reinfection rate < 5%.
60. SELECTION CRITERIA FOR IN SITU WITH
PROSTHETIC GRAFT
Clinical
1. Months to years after implantation
2. No systemic signs
Anatomical
1. Limited local
inflammation
2. Perigraft cavity with
absence of graft
incorporation
3. Weakening of
anastomosis
Microbiology
1. Perigraft fluid : Gram
stain negative
2. Perigraft fluid : Culture
no growth
3. Graft biofilm culture :
coag - staph
63. ENDOVASCULAR DEVICE INFECTION
• The incidence infection endoluminal devices is lower than
prosthetic grafts during open surgical procedures
• Both arterial stents and stent-grafts show decreasing
susceptibility by 1-4 wks to bacteremic as a result of
protective pseudointimal healing
64. • Definitive treatment of stent and stent-graft infections,
including aortoenteric erosions explantation of
device and ex situ bypass or in situ
ENDOVASCULAR DEVICE INFECTION
65. THORACIC AORTIC AND SUPRA-AORTIC
BRANCH PROSTHETIC INFECTIONS
• Graft excision and extra-anatomic bypass are not
possible for most cases of ascending, transverse arch,
or descending thoracic aortic graft infection
• Mortality : 10-20% in major tertiary centers,
recurrent/residual infection 20%
66. CONCLUSION
• Graft infection : Prophylaxis is better than
treatment
• Principle of treatment
1.Accurate diagnosis
2.Antibiotic
3.Intervension : Graft preservation , In
situ , Ex situ
1. Rutherford's Vascular Surgery and Endovascular Therapy, Chapter 74,
This diagram show pathogenesis of graft infection
Graft surface colonization and produced arterial growth
Arterial anastomosis arteritisPerigraft tissue pneutrophil chemotaxis , decreased phagocytosis , complememt activation
MOST COMMOND MICRO-ORGANISM -> Staph aureus and Staph epidermidis
S. epidermidis or gram-negative bacteria have increased in frequency. Graft infections associated with negative culture results are caused by
S. epidermidis or other coagulase-negative staphylococci and by Candida species.
Gram negative : The incidence of anastomotic dehiscence and arterial rupture is high because of the ability of the organisms to produce destructive endotoxins (elastase and alkaline protease) that compromise the structural integrity of the vessel wall.
After implantation of a prosthetic graft, patients should be informed of the potential risk
for graft colonization and infection from transient bacteremia, especially after dental work,colonoscopy, or cystoscopy.
Antibiotic prophylaxis is recommended if these procedures are performed within 3 months of the vascular operation
Diagnostic criteria
loss of normal tissue planes (fat density) of retroperitoneal or subcutaneous perigraft structures (indicative of inflammation)
collections of fluid or gas (>3 mo after implantation) around the graft
false aneurysm formation
hydronephrosis, and adjacent vertebral or bony osteomyelitis