Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
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Rupture, fistula or septic vascular collapse
Sudden chest, back, abdominal or groin pain, shock, falling haemoglobin, sentinel gastrointestinal bleeding, haematemesis or a pulsatile infected mass may indicate rupture or aorto-enteric fistulation.
Action: Activate emergency vascular surgery, use major-haemorrhage and sepsis pathways, obtain blood cultures without delaying treatment, start locally approved broad intravenous antimicrobials and obtain arterial-phase CT angiography when physiology permits.
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.
Key red flags
Sentinel haematemesis or melaena in a patient with an aortic graft can precede catastrophic aorto-enteric haemorrhage.
Aortic pain syndrome
Persistent focal chest, back or abdominal pain with fever or bacteraemia suggests infected aneurysm or perigraft inflammation and warrants urgent CTA.
Investigation priorities
01
CT angiographyFirst step
Define aneurysm morphology, perigraft fluid or gas, pseudoaneurysm, fistula, thrombosis, branch perfusion and rupture.
Management branches
BLEEDControl suspected rupture or fistula
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.
STABLEConfirm indolent graft infection
There is chronic pain, sinus, constitutional illness, unexplained inflammation or recurrent bacteraemia without immediate rupture.
Key medicines
Empirical severe graft-infection regimenGive the locally approved intravenous combination after blood cultures, covering likely staphylococci and Gram-negative or enteric organisms according to anatomical site and healthcare exposure.
Flucloxacillin for MSSAGive 2 g intravenously every four hours for confirmed methicillin-susceptible Staphylococcus aureus bloodstream or deep graft infection, with specialist-defined total duration.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.