Detection of aortic graft infection by 18-fluorodeoxyglucose positron emission tomography combined with computed tomography

Tegler, Gustaf; Sörensen, Jens; Björck, Martin; Savitcheva, Irina; Wanhainen, Anders

doi:10.1016/j.jvs.2006.12.018

Cited by 42 publications

(27 citation statements)

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“…1,[28][29][30][31][32][42][43][44][45][46] Three recent studies summarized the role of PET/CT for the diagnosis of VGI. [30][31][32] Although there were variables in imaging techniques and patient selection among these studies and other studies, the sensitivity and specificity of PET/CT were similar to those reported with standard CT for the diagnosis of VGI [28][29][30][31][32]39,[43][44][45][46] (Table 1 1 ). PET/ CT may be less precise than conventional CT to identify the anatomic location of VGI.…”

Section: Intra-abdominal Vgisupporting

confidence: 65%

“…Perigraft fluid is usually reabsorbed within 3 months postoperatively, and perigraft air is usually absorbed within the first week or so, although it can persist for as long as 2 months postoperatively. 1,28,[37][38][39] Intra-abdominal VGI can occur many months to years after surgery and might not have the CT findings typically seen in early infection. 28,39,40 In these patients, MRI can be considered if the CT findings are inconclusive.…”

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confidence: 99%

“…1,28,[37][38][39] Intra-abdominal VGI can occur many months to years after surgery and might not have the CT findings typically seen in early infection. 28,39,40 In these patients, MRI can be considered if the CT findings are inconclusive. 1,[40][41][42] MRI can be superior to CT to identify subtle perigraft inflammatory changes when CT images are degraded by metallic clips in the abdomen, and it can differentiate hematoma from inflammatory changes in the perigraft area.…”

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confidence: 99%

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Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: A Scientific Statement From the American Heart Association

Wilson¹,

Bower²,

Creager³

et al. 2016

Circulation

358

307

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The use of synthetic material for reconstructive vascular surgery was first reported during the early 1950s. Infection involving vascular graft prostheses is an infrequent but devastating complication of reconstructive vascular graft surgery and is associated with a high morbidity and, in some situations, mortality. Improvements in surgical techniques and graft design, including the use of native venous or arterial tissue, have reduced the frequency of infection and severity of complications from vascular graft infection (VGI). However, these advances have also led to more frequent vascular graft procedures occurring in a patient population with multiple underlying comorbidities that would have previously disqualified them as candidates for vascular reconstructive surgery. Underlying comorbidities, such as diabetes mellitus or immune compromise, increase the risk of infection and serious infection-related complications. The major complications of VGI include sepsis, amputation, disruption of infected anastomotic suture line with rupture or pseudoaneurysm formation, embolization of infected thrombi, reinfection of reconstructed vascular grafts, enteric fistulae to the small or large bowel, bacteremic spread of infection to other sites, and death. VGIs can be categorized broadly into those that occur in an extracavitary location, primarily in the groin or lower extremities, or in an intracavitary location, primarily within the abdomen or less commonly within the thorax. frequencyThe frequency of VGI depends on the anatomic location of the graft. The infection rate is 1.5% to 2% for most extracavitary grafts and as high as 6% with vascular grafts in the groin. [1][2][3][4][5][6][7][8][9] For intracavitary grafts, the infection rate is ≈1% to 5%. 1-6 Graft infection is most common after emergency procedures and after reoperation. [1][2][3][4]10 Aortic graft erosion or fistulous communication into the duodenum or other areas of the bowel reportedly occurs in 1% to 2% of patients after aortic reconstruction. 11,12 MicrobiologyThe microbiological cause of VGI has evolved over the years. 1 In early published studies, Staphylococcus aureus was the predominant microorganism recovered. 1,13 Improvements in surgical technique, administration of prophylactic antistaphylococcal antimicrobial therapy, and other factors have resulted in a changing microbiological epidemiology. Vascular graft surgery performed on patients with multiple underlying comorbidities and the increased frequency of emergency procedures have contributed to the changing spectrum of infection. Other factors such as changes in hospital flora, surgery in patients with complicated vascular anatomy, and multiple revisions of previous vascular surgery have resulted in a more diverse microbio- clInIcal stateMents anD GuIDelInes logical spectrum of infection, which includes multidrugresistant strains, polymicrobial infection, and Candida species. Gram-positive cocci accounts for at least two thirds of VGIs. 1,13 Infections caused by coagulase-negative staphylococ...

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Section: Intra-abdominal Vgisupporting

confidence: 65%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: A Scientific Statement From the American Heart Association

Wilson¹,

Bower²,

Creager³

et al. 2016

Circulation

358

307

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“…FDG-PET/CT imaging is used for diagnosis of mycotic aneurysms, aortic graft infections, and sometimes for evaluation of symptomatic aneurysms. [43][44][45] Increased FDG-uptake has been reported in symptomatic AAAs. 46 In an analysis of 12 asymptomatic AAAs with FDG-PET/CT imaging, no aneurysm wall-specific uptake could be identified in any patient.…”

Section: Positron Emission Tomographymentioning

confidence: 99%

Surrogate Markers of Abdominal Aortic Aneurysm Progression

Wanhainen

Mani

Golledge

2016

ATVB

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Abstract-The natural course of many abdominal aortic aneurysms (AAA) is to gradually expand and eventually rupture and monitoring the disease progression is essential to their management. In this publication, we review surrogate markers of AAA progression. AAA diameter remains the most widely used and important marker of AAA growth. Wanhainen et al Surrogate Markers of Aneurysm Progression 237in all studies when a standardized protocol is used. 7,8 One of the challenging aspects to assessing maximum AAA diameter is the variety of methods that can potentially be used and the lack of reporting of the exact techniques used in individual studies. Variations may occur in the plane of acquisition (eg, coronal or sagittal), the axis of measurement (eg, axial or orthogonal), the position of the measuring calipers (eg, inner to inner or outer to outer), the relationship with the cardiac cycle (systole versus diastole), and the selected region of the AAA. 9 It has been suggested that diameters measured perpendicular to the aorta centerline (orthogonal), rather than within the axial plane, are more representative of the true AAA diameter. 4,6 With ultrasound, measurements within the anteroposterior, rather than the transverse plane, have been reported to be more reproducible. 4 There is no current consensus on how to place the calipers when measuring the diameter with ultrasound. Methods used include the outer-to-outer method, where calipers are placed on the outer layer of the aortic wall; the inner-to-inner method, where calipers are placed on the inner layer of the aortic wall; and the leading edge-to-leading edge method, where calipers are placed on the outer layer of the anterior wall and the inner layer of the posterior wall ( Figure 1). Much of the reported variation in ultrasound measured AAA diameter is likely because of the variation in caliper placement. 5,10 The UK Small Aneurysm Trial 11 is based on the measurement of AAA diameter on the outer-to-outer method, and this method has been adopted into the current UK intervention criteria. 12 The inner-to-inner method was used in the Multicentre Aneurysm Screening Study, 13 and consequently it is used in the current UK National Health Service AAA screening programme.14 The leading edgeto-leading edge method is used in the current Swedish AAA screening programme.15 Studies comparing these methods show there is a significant difference in diameters measured with the different methods, which has an impact on the reported prevalence rates of AAA. 5,10 In a Swedish AAA screening study, the difference in mean diameter was 4 mm between inner-toinner and outer-to-outer, which resulted in an astonishing 77% difference in AAA prevalence (ie, 1.3% compared with 2.3%). 5A systematic review of 15 studies reported considerable variation in small AAA growth rates (mean, −0.3 to +4.0 mm/y). 15 The variation could not be explained by differences in initial AAA diameter alone. 16 The authors suggested that methodological issues, such as differences in imaging modalities, variation ...

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“…Given the high metabolic activity of inflammatory cells, 18 F-FDG is also a useful marker for various active infectious and inflammatory processes (11)(12)(13), including reports of a high sensitivity in the diagnosis of vascular prosthetic infections (14,15). Hybrid 18 F-FDG PET/CT has established the role of 18 F-FDG imaging for the assessment of suspected vascular graft infection, providing accurate anatomic localization of the site of infection with subsequent improved specificity (16)(17)(18)(19)(20).…”

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confidence: 99%

¹⁸F-FDG Uptake in Noninfected Prosthetic Vascular Grafts: Incidence, Patterns, and Changes over Time

et al. 2014

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18 F-FDG PET/CT is of value in the diagnosis of prosthetic vascular graft infection, but potential pitfalls related to tracer uptake in noninfected implants have been described. The current study assesses the incidence and patterns of 18 F-FDG uptake over time in noninfected grafts, in relationship to prosthetic material and location. Methods: A 12-y PET/CT database was retrospectively searched for cancer patients with prosthetic vascular grafts. Data retrieved from patient files included graft location, material, and time from surgery. Images were reviewed by 2 nuclear medicine physicians in consensus, with the presence and patterns (focal, diffuse homogeneous, inhomogeneous) of increased 18 F-FDG uptake in grafts recorded. The mean standardized uptake value in grafts (SUV-G) and mediastinum (SUV-M) was measured. The ratio of SUV-G to SUV-M (SUV-G/SUV-M) was calculated for each graft. Results: One hundred seven prostheses were identified in 102 studies in 43 cancer patients. Sixty-seven prostheses were made of Dacron, 33 of Gore-Tex, and 7 were native veins. No increased 18 F-FDG uptake was found in 9 grafts (native veins, 4; Gore-Tex, 3; Dacron, 2). There was diffuse homogeneous uptake in 68 and inhomogeneous uptake in 30 grafts. The homogeneous pattern was more prevalent in Gore-Tex whereas the inhomogeneous uptake was seen more in Dacron vascular grafts. None of the grafts demonstrated focal uptake. The SUV-G range was 0.4-6.3 (average, 1.9), and SUV-M range was 0.6-2.4 (average, 1.4). The intensity of uptake was significantly higher in Dacron (SUV-G 5 2.35 and SUV-G/ SUV-M 5 1.72) than in Gore-Tex (SUV-G 5 1.09, SUV-G/SUV-M 5 0.91) and native vein grafts (SUV-G 5 1.07, SUV-G/SUV-M 5 0.75) (P , 0.005). Native vein grafts showed a significant decrease in 18 F-FDG uptake over time whereas synthetic grafts showed no change in intensity for a follow-up of up to 16 y. Conclusion: Diffuse 18 F-FDG uptake was found in 92% of noninfected vascular prostheses, more in Dacron grafts than with other materials. The intensity of 18 F-FDG uptake of synthetic grafts did not change over time. With knowledge of the presence, patterns, and persistence of 18 F-FDG uptake in noninfected vascular prostheses, misinterpretation of PET/CT studies in patients referred for suspected prosthetic infection and in those assessed for diseases unrelated to their graft status can be avoided.

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Detection of aortic graft infection by 18-fluorodeoxyglucose positron emission tomography combined with computed tomography

Cited by 42 publications

References 5 publications

Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: A Scientific Statement From the American Heart Association

Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: A Scientific Statement From the American Heart Association

Surrogate Markers of Abdominal Aortic Aneurysm Progression

¹⁸F-FDG Uptake in Noninfected Prosthetic Vascular Grafts: Incidence, Patterns, and Changes over Time

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Detection of aortic graft infection by 18-fluorodeoxyglucose positron emission tomography combined with computed tomography

Cited by 42 publications

References 5 publications

Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: A Scientific Statement From the American Heart Association

Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: A Scientific Statement From the American Heart Association

Surrogate Markers of Abdominal Aortic Aneurysm Progression

18F-FDG Uptake in Noninfected Prosthetic Vascular Grafts: Incidence, Patterns, and Changes over Time

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¹⁸F-FDG Uptake in Noninfected Prosthetic Vascular Grafts: Incidence, Patterns, and Changes over Time