Early and late onset vascular graft infections

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Early and late onset vascular graft infections
Surgical dilemmas

• Pranav Somaiya
• Developmental Lead, Proteomics,NPIMR(affl. UCL)
• SpR, Vascular Surgery, Queens Hospital, Romford

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Talk content

• Definitions
• Diagnosis
• Treatment options
• The course ahead..

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Definitions

• difficult
• however there are well developed systems of
  classification of prosthetic vascular graft
  infections (PVGIs)
• for the purposes of todays talk I will be
  focusing on Samson Groups 3-5

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Diagnosis Existing tools

• Microbiology based techniques
• - culture
• - PCR and sonication techniques
• Imaging techniques
• - CT scans
• - PET scans

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CT scans
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CT scans
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Diagnosis - Microbiology

• Standard microbiology based techniques are
  woefully inadequate
• No standards are set nationally on methods for
  microbiology based diagnostics for clinical
  laboratories to follow
• No guidelines are agreed on tissue handling of
  PVGI explants

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Treatment Medical Management

• non-surgical treatment is reserved for patients
  who are surgically deemed unfit for surgery due
  to associated co-morbidities
• the standard treatment is long term oral
  antibiotic administration

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Treatment Surgical Management

• To explant or not to explant is the question?
• P Somaiya circa 2012

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Treatment Surgical Management

• Samson group 3 PVGIs respond best to graft
  salvage and muscle flaps for tissue cover
  (Zetrenne et al, 2006) with better limb salvage
  rates and lower mortality
• microbiology plays a major role in the salvage of
  these grafts and certain organisms like MRSA are
  thought to be associated with higher limb loss

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Treatment Surgical Management

• Data on explanting of Samson group 4 and 5 is
  patchy and there is clear management strategy for
  patients, although explantation of the graft is
  carried out in a majority of the situations
• microbiology plays a relatively minor role in
  management of these patients

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Treatment Surgical Management

• How now? Anatomic or extra anatomic? Dead
• P Somaiya circa 2012

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Treatment Surgical Management

• Extra Anatomic By pass after explanting of
  original graft

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Treatment Surgical Management

• Anatomic By pass after explanting of original
  graft

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the course ahead..
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Thanks

• Vascular Surgery Unit, Directorate of General
  Surgery, Queens Hospital, Romford
• Prof. Homer-Vanniasinkam, LGI, Leeds
• Prof. Valerie Edwards-Jones, MMU, Manchester
• Our Research Team, Centre for Investigational
  Proteomics, NPIMR( affl. UCL)