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Vascular Graft Infections

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Mechanisms of Vascular Disease

Abstract

The introduction of prosthetic grafts has revolutionised the management of vascular disease but graft infection, although uncommon, remains a dreaded complication with significant morbidity and mortality.

The exact aetiology of vascular graft infections is not completely understood but likely to be multifactorial dependent on the causative microorganism and associated virulence or the microorganism’s ability to contribute to biofilm formation. Despite significant advances made in the understanding of biofilms, no single therapy for the eradication of biofilm has been completely successful. Investigations for graft infections not infrequently involve multiple diagnostic modalities to determine causative micro-organism/s and extent of infection.

Ideally all attempts should be made to prevent graft infection but once established the treatment is dependent on patient clinical presentation, extent of graft involvement, site of prosthetic graft, initial indication for prosthesis, revascularisation options and microbiology of infecting organisms. Procedures may be undertaken as single-staged or multi-staged accounting for the above variables. These may involve open surgical and/or endovascular therapies with short and/or long-term antibiotic therapy.

The future management of vascular graft infections will be reliant on a better understanding of the interaction between the micro-organism, the prosthesis and the immune system. This will allow a more directed approach towards prevention and treatment.

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Further Reading

  • Haidar GM, Hicks TD, Strosberg DS, El-Sayed HF, Davies MG. “In situ” endografting in the treatment of arterial and graft infections. J Vasc Surg. 2017;65:1824–9.

    PubMed  Google Scholar 

  • Kahl BC, Becker K, Löfflerb B. Clinical significance and pathogenesis of staphylococcal small colony variants in persistent infections. Clin Microbiol Rev. 2016;29:401–27.

    CAS  PubMed  PubMed Central  Google Scholar 

  • Langenberg CM, Kluytmans JA, De Groot HG, Ho GW, Veen EJ, Buimer MG, et al. Surgical site and graft infections in endovascular and open abdominal aortic aneurysm surgery. Surg Infect. 2018;19:424–9.

    Google Scholar 

  • Li HL, Chan YC, Cheng SW. Current evidence on management of aortic stent-graft infection: a systematic review and meta-analysis. Ann Vasc Surg. 2018;51:306–13.

    PubMed  Google Scholar 

  • Rabin N, Zheng Y, Opoku-Temeng C, Du Y, Bonsu E, Sintim HO. Biofilm formation mechanisms and targets for developing antibiofilm agents. Future Med Chem. 2015;7:493–512.

    CAS  PubMed  Google Scholar 

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  1. Department of Vascular Surgery, Westmead Hospital, Westmead, NSW, Australia

    Mauro Vicaretti

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  1. Discipline of Surgery, The University of Adelaide, Adelaide, SA, Australia

    Robert Fitridge

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Vicaretti, M. (2020). Vascular Graft Infections. In: Fitridge, R. (eds) Mechanisms of Vascular Disease. Springer, Cham. https://doi.org/10.1007/978-3-030-43683-4_29

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