Vascular graft infections and role of PET/CT in patients with persistent bacteraemia

Abstract

Prosthetic vascular graft infection although a rare complication of vascular reconstruction surgery; has been associated with significant morbidity and mortality. The author presents two patients with prosthetic aortic graft presenting as fever and methicillin sensitive Staphylococcus aureus bacteraemia without any other localising sign of infection. Both patients had a history of postoperative wound infection after their graft placement. Patients remained persistently bacteraemic on appropriate antimicrobial therapy making the clinician suspicious of a vascular graft infection. A [18 F] fluoro-2-deoxy-d glucose positron emission tomography associated to CT scan was used to identify the prosthetic vascular graft infection and since both patients were high-risk surgical candidates, a conservative medical approach was used. They were treated with 6 weeks of nafcillin and rifampin, followed by long-term doxycycline for suppression. This highlights the importance of considering vascular graft infection in patients with recurrent and persistent bacteraemia despite adequate therapy.

Figure 1

Increased [18 F] fluoro-2-deoxy-D-glucose activity consistent with infection in the distal aortic arch and the descending aorta intravascular graft (case 1).

Figure 2

Increased [18 F] fluoro-2-deoxy-D-glucose activity consistent with infection of the prosthetic graft of the ascending aorta (case 2).