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14 Cards in this Set
- Front
- Back
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What single factor has the greatest influence on the risk of prosthetic graft infection?
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Anatomic location has the greatest influence on the risk of prosthetic graft infection:
intra-abdominal: <1% thoracic: 1-2% groin: 2-4% Fem-pop/ax-fem: 7-9% |
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What other factors increase the risk of prosthetic graft infection?
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Presence of groin incision and wound infection are risk factors for prosthetic graft wound infection.
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What decreases the risk of prosthetic graft infection?
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Administration of pre-operative antibiotics (IV) has been shown to decrease prosthetic graft wound infection.
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What are the most common organisms isolated from infected prosthetic grafts?
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Most common isolates:
Staph epidermidis Staph aureus E. coli When there is enteric fistula then GNRs are the common isolates |
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What are the two proposed mechanisms for prosthetic graft infection?
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Two mechanism of prosthetic graft infection:
1. bacterial contamination at implantation 2. hematogenous/lymphogenous spread from a remote site |
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What is the definition of early and late graft infection? Which organisms are are isolated from early and late graft infection?
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Early infection occurs within 4 months of implantation and are associated with virulent organisms, S. aureus and GNRs.
Late infections occur after 4 months of implantation and are associated with less virulent orgamisms, S. epidermidis |
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How does graft location influence the timing and presentation of prosthetic graft infection?
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Extracavitary prosthetic grafts (fem-fem, fem-pop, ax-fem) usually present early (< 4 months) with cellulitis, induration, and inflammation.
Intracavitary prosthetic grafts (aorto-iliac, aorto-fem, ilio-fem) present late with focal wound infection, focal fluid collection, draining sinus, rarely present with systemic symptoms |
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What is the source of bleeding when there is graft erosion into the bowel? What is the source of bleeding when there is aorto-enteric fistula?
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When there is graft erosion into the bowel the source bleeding are the edges of the bowel wall. When there is an aorto-enteric fistula the source of bleeding is the aorto-prosthetic suture line.
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Describe the prosthetic graft infection classification system.
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Prosthetic graft infection classification system:
Group 1: infection extends no deeper than the dermis Group 2: Infection extends to the subcutaneous tissue but does not come into contact with the graft Group 3: Infection of the body of the graft but not at the anastomosis Group 4: Infection at the anastomosis without bleding or bacteremia Group 5: Infection at the anastomosis with bleeding and/or bacteremia |
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What are the ways in which intracavitary prosthetic graft infections are diagnosed?
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Ways to diagnose prosthetic graft infection:
CT MRI Endoscopy for aorto-enteric fistula Indium or technetium labeled WBC scan PET |
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What findings on CT scan are consistent with intracavitary prosthetic graft infection?
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CT findings associated with intracavitary prosthetic graft infection:
perigraft fluid perigraft soft tissue changes ectopic gas pseudoaneurysm focal bowel wall thickening |
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What is your treatment of choice for aortic prosthetic graft infection?
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treatment:
IV antibiotics resuscitation Two-stage operative plan: Ax-fem with ePTFE and fem-fem with cryopreserved SFV other conduits: saphenous vein, native SFV, endarterectomized SFA |
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For treatment of infected prosthetic graft, when performing an ax-fem bypass the profunda or SFA must be approached lateral to the __________.
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For treatment of infected prosthetic graft, when performing an ax-fem bypass the profunda or SFA must be approached lateral to the sartorius muscle, preventing contact with the infected space of the femoral triangle.
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What are the five surgical approached for the treament of infected aortic prosthetic graft?
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Surgical approaches to infected aortic prosthetic graft:
1. Extra-anatomic bypass followed by prosthetic graft excision 2. In situ prosthetic graft replacement with 6-8 weeks of IV antibiotics 3. In situ arterial allograft 4. In situ venous autograft with SFV (NAIS) 5. In situ venous allograft with cryopreserved SFV |
