Synopsis
Identify vascular graft infection and infected aneurysm before rupture, select urgent vascular imaging and achieve anatomical source control alongside prolonged culture-directed antimicrobial treatment.
- Ask about every arterial graft, stent, bypass and endovascular repair, including implantation date, groin wound problems and recent bacteraemia.
- Vascular graft infection may present months or years later with fever, weight loss, vague pain, recurrent bloodstream infection or a draining sinus.
- CT angiography is the urgent anatomical investigation for suspected aneurysm, perigraft complication, rupture or fistula.
- Take several peripheral blood-culture sets before antibiotics when stable and send multiple deep operative specimens rather than superficial sinus swabs.
- FDG PET-CT or labelled-leucocyte imaging can support diagnosis of indolent graft infection when cross-sectional findings are equivocal.
- Definitive treatment usually requires removal or exclusion of infected material, debridement and reconstruction planned by an experienced vascular service.
- Endovascular stenting may control life-threatening bleeding as a bridge but can leave infection behind and needs a definitive follow-up plan.
- Antibiotic selection and duration depend on organism, anatomy, removal completeness, new graft material, allergy and renal function.
Key red flags
Sentinel haematemesis or melaena in a patient with an aortic graft can precede catastrophic aorto-enteric haemorrhage.
Sudden severe chest, back, abdominal or groin pain with hypotension suggests aneurysm or anastomotic rupture.
Expanding pulsatile swelling, wound bleeding or exposed graft needs immediate vascular review without bedside probing.
Persistent Staphylococcus aureus or Salmonella bacteraemia with focal aortic pain demands vascular imaging.
Gas, enlarging perigraft fluid, pseudoaneurysm or loss of tissue planes on CT supports deep infection and mechanical failure.
New limb ischaemia, mesenteric symptoms or neurological deficit may reflect embolisation, thrombosis or compromised reconstruction.
Persistent focal chest, back or abdominal pain with fever or bacteraemia suggests infected aneurysm or perigraft inflammation and warrants urgent CTA.
Pain, erythema, swelling, discharge, lymph leak, bleeding or a sinus over a femoral graft may communicate directly with prosthetic material.
Repeated isolation of the same organism after apparently adequate therapy suggests a colonised graft, infected aneurysm or occult fistula.
A self-limited sentinel gastrointestinal bleed, sepsis or polymicrobial blood culture in an aortic-graft recipient is a surgical emergency warning.
Investigation priorities
Define aneurysm morphology, perigraft fluid or gas, pseudoaneurysm, fistula, thrombosis, branch perfusion and rupture.
Management branches
Shock, sentinel or active gastrointestinal bleeding, abrupt severe pain or graft-site haemorrhage is present.
- Call vascular surgery and activate major-haemorrhage support immediately; use ABCDE, large-bore access, crossmatch and balanced blood-component resuscitation.
- Obtain cultures quickly and give broad intravenous therapy active against likely skin and enteric organisms under the local emergency protocol.
- Proceed to urgent CT angiography if sufficiently stable, but do not delay operative or endovascular haemorrhage control for exhaustive investigation.
- Document whether endovascular treatment is definitive or a bridge, because retained infected tissue requires prolonged therapy and reassessment.
There is chronic pain, sinus, constitutional illness, unexplained inflammation or recurrent bacteraemia without immediate rupture.
- Clarify graft type, operative reports, wound history and prior isolates; examine graft course and distal perfusion without probing a sinus.
- Take multiple peripheral blood cultures and obtain CT angiography to assess graft, anastomoses, adjacent bowel and collections.