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”MANAGEMENT OF INFECTED VASCULAR GRAFT”

”MANAGEMENT OF INFECTED VASCULAR GRAFT”. JONATHAN GHOSH Consultant Vascular & Endovascular Surgeon. 2 May 2012. INCIDENCE. CAROTID <1% INFRAINGUINAL 5-8% AXILLOFEMORAL 8% AORTA 2-3% (  rupture or groin involvement)

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”MANAGEMENT OF INFECTED VASCULAR GRAFT”

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  1. ”MANAGEMENT OF INFECTED VASCULAR GRAFT” JONATHAN GHOSH Consultant Vascular & Endovascular Surgeon 2 May 2012

  2. INCIDENCE CAROTID <1% INFRAINGUINAL 5-8% AXILLOFEMORAL 8% AORTA 2-3% ( rupture or groin involvement) 24% subcutaneous (Szilagyi II) infections  graft infection 22% death / amputation Source: Joint Vascular Research Group

  3. MANAGEMENT PREVENTION 4 PRINCIPLES CONTROL HAEMORRAGE (RISK) ERADICATE INFECTION OPTIMISE DISTAL PERFUSION MINIMISE MORBIDITY / MORTALITY

  4. AORTIC GRAFT INFECTION PRESENTATION:

  5. AORTIC GRAFT INFECTION ACUTE CHRONIC Discomfort Malaise Weight loss Anorexia Anaemia PRESENTATION: Aortoenteric fistula Abscess / Sinus Septicaemia Graft thrombosis Septic emboli

  6. INFECTED STENT Gas around metal strut STRUT OF STENT PENETRATING THROUGH DUODENUM

  7. AORTIC GRAFT INFECTION MICROBIOLOGY

  8. AORTIC GRAFT INFECTION MICROBIOLOGY Staphylococcus epidermis Staphylococcus aureus Escherichia coli Enterococcus Non-haemolytic streptococcus Pseudomonas Proteus MRSA Culture negative 20% Poly / Atypical 10%+ 60%

  9. AORTIC GRAFT INFECTION INVESTIGATION

  10. GAS BUBBLES

  11. PERIGRAFT COLLECTION

  12. PSEUDO ANEURYSM

  13. AORTIC GRAFT INFECTION OPTIONS:

  14. AORTIC GRAFT INFECTION OPTIONS: NON INTERVENTIONAL – NON-CURATIVE ENDOVASCULAR - TEMPORISING SURGERY – DEFINITIVE BUT RISK TOTAL V PARTIAL GRAFT EXCISION GRAFT REPLACEMENT V EXTRA-ANATOMICAL BYPASS DEEP VEIN V CRYOGRAFT V PROSPHETIC MORTALITY: 10-20(+)% 30 DAYS; 37(+)% 1 YEAR

  15. DUODENAL EROSION

  16. PROSTHETIC INFRA-INGUINAL PRESENTATION

  17. PROSTHETIC INFRA-INGUINAL PRESENTATION ABSCESS WOUND DISCHARGE EARLY AMPUTATION RE-OPERATION LIMB DETERIORATION MEDIAN TIME FROM BYPASS TO INFECTION: 3 MONTHS

  18. DUPLEX

  19. PROSTHETIC INFRA-INGUINAL OPTIONS

  20. PROSTHETIC INFRA-INGUINAL OPTIONS GRAFT PRESERVATION IRRIGATION AND VACUUM ASSITED CLOSURE MUSCLE FLAP GRAFT EXPLANT +/- REPLACEMENT (VEIN / CRYOGRAFT) …ALL WITH LONG TERM ANTIBIOTICS

  21. GRAFT PRESERVATION VACUUM ASSISTED CLOSURE SUCCESSFUL 80% UP TO 20% BLEED IF ANASTOMOSIS EXPOSED LOW RECURRENCE REPORTED

  22. GRAFT PRESERVATION 1 WEEK 3 WEEKS 4 WEEKS

  23. OVERVIEW PREVENTION BETTER THAN CURE DEFINITIVE TREATMENT IS DEBRIDEMENT – NOT ALWAYS ACHIEVABLE GRAFT PRESERVATION IN PERIPHERY – WITH CAUTION

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