Periferal Artery Disease: Vascular Graft Infection

Introduction Vascular graft infections are serious complications, which often require various surgical interventions [1]. It can present as systemic signs of infection or graft thrombosis, pseudoaneurysm formation [2]. Case Presentation A 78-year-old patient with lower extremities pain. CTA findings indicated atherosclerotic aorta, main pelvic and leg arteries, stenoses of the right AFC, AP, occlusions of the right AFS, AIE and the left AFS. Findings suggested PAD and required a PTA with stenting of the right AIE, which was successful. A femostop was placed on the groin. A spreading hematoma was observed, therefore an ultrasound examination was performed. It revealed an active extravasation from the puncture site which required surgery – suturing and pseudoaneurysm removal of the right AFC. The lower extremities pain that recurred a day after the procedure revealed a thrombosis of the stent and it led to a prosthetic femoral popliteal bypass in the right leg. Unfortunately the groin surgical wound was not healing properly and became purulent. A decision was made to remove the infected prosthesis and perform a right AIE-AP extraanatomical bypass with a donor vein. After microbiology test results revealed an active growth of Morganella morganii, the patient received a course of Ciprofloxacin. The patient was discharged without evidence of disease progression or infection. Discussion Vascular graft infection can occur through direct contamination during surgery or bacteremia, sepsis [3]. It usually presents as erythema, purulent drainage, fever [4]. To diagnose an infection there are laboratory, microbiology tests, CTA [5]. Treatment includes broad-spectrum antibiotics, graft removal and replacement, revascularization [5, 6]. To prevent graft infection, it is recommended to use autologous vein grafts, early treatment of infection, management of other diseases [7]. Conclusions Given the risks associated with untreated PAD, graft infection and overall life quality of the patient, the best course of treatment for more complex cases remains early infection management, surgical interventions, such as angioplasty, stenting or prosthesis.