Vascular graft infections: diagnostic and therapeutic problems.

Aortic graft infection is one of the most serious complication of vascular surgery. While the incidence of such infections has declined over the years , it continues to be associated with high mortality and high rates of limb loss. Graft implanted in the inguinal area have a higher rate of infection than those that lie entirely within the abdomen. Infection of the intraabdo minal extremities of vascular grafts is most frequently associated with pro stheto-enteric fistula. Diagnosis and treatment: Despite the many available sophisticated imaging t echniques diagnosis remains difficult, particularly with intra-abdominal gr afts because of nonspecific clinical and imaging findings. A variety of app roaches to aortic graft infection have been proposed and optimal treatment usually requires an association of systemic antibiotic administration with surgery. Removal of the entire infected graft is often necessary for cure a nd there are only few situations in which conservative treatment is accepta ble. A careful identification of the infecting microorganisms and in vitro susceptibility testing are essential for successful therapy. Prevention : Prevention consists in a strict adherence to principles of ase psis and the use of prophylactic antibiotics in vascular surgery. The use o f antibiotics-bound knitted grafts has been recently proposed.