Synopsis
Recognise vascular graft and endograft infection, confirm it using combined clinical, microbiological and imaging evidence, control sepsis or haemorrhage, and plan definitive source control and reconstruction in a specialist multidisciplinary service.
- In a patient with vascular prosthetic material and unexplained sepsis, pain, bacteraemia or bleeding, obtain blood cultures and urgent CTA; involve a specialist vascular team early and do not wait for superficial wound changes.
- Active bleeding or anastomotic disruption requires resuscitation and proximal control; endovascular stent-grafting may bridge an unstable patient to definitive graft excision, reconstruction and repair of an enteric or bronchial defect.
- Whenever feasible, obtain multiple deep perigraft or explanted-graft specimens before antibiotics; avoid relying on superficial swabs, but never delay empirical broad-spectrum treatment in severe sepsis or shock.
Key red flags
A small self-limiting haematemesis or melaena in a patient with an aortic graft may be a herald bleed from graft-enteric fistulation.
Haemoptysis after thoracic aortic grafting can indicate an aorto-bronchial fistula and may precede catastrophic airway haemorrhage.
Groin bleeding, a pulsatile infected mass, acute limb ischaemia or sudden severe pain suggests anastomotic disruption or infected pseudoaneurysm.
Persistent fever, bacteraemia, back pain, weight loss or raised inflammatory markers with no source warrants graft-focused imaging even years after implantation.
A painful or pulsatile mass, new bruit, rapid enlargement, skin compromise, sentinel bleeding or acute limb ischaemia suggests infection-related anastomotic failure.
Haematemesis, melaena, sepsis or abdominal pain after aortic grafting may reflect enteric erosion; a small herald bleed can precede fatal haemorrhage.
Investigation priorities
Identify systemic infection and define graft integrity, collections, pseudoaneurysm, active bleeding, fistulation and distal perfusion.
Management branches
There is active bleeding, haemodynamic instability, anastomotic disruption, acute graft occlusion or uncontrolled sepsis.
- Resuscitate, activate massive-haemorrhage or sepsis pathways as indicated, obtain blood cultures when this causes no delay, start broad-spectrum intravenous antimicrobial therapy and arrange immediate specialist transfer.
- Secure proximal and distal arterial control before definitive exploration; an occlusion balloon or endograft may rapidly control bleeding when open exposure is unsafe or delayed.
Clinical, imaging and microbiological evidence supports infection without immediate rupture or shock.