Current opinions about diagnosis and treatment strategy for aortic graft infections in The Netherlands

AIM: Aortic graft infection (AGI) is a dreaded complication in vascular surgery. Research on AGI is hampered by its rarity combined with a broad range of clinical presentation in critically ill patients. This report aims to explore the various current opinions on the diagnosis and treatment of AGI.

METHODS: A questionnaire was sent to all members of the Dutch Society of Vascular Surgery. Six weeks after the initial questionnaire a reminder was sent. A total of 306 questionnaires were sent. Data were analyzed for 124 vascular surgeons (VS) and 19 vascular surgeons in training (VT). Data analysis was performed in a descriptive manner.

RESULTS: Total response rate was 51.3%, Response rate of the VS and VT combined was 47%. 85% of the VS versus 58% of VT rely on computed tomography scanning (CT) scanning for diagnosing AGI. Positron emission tomography scanning with CT fusion was used by 40% of VS versus 58% of VT. Antibiotic treatment was started at the first suspicion of AGI by 52% of VS and 58% of VT. 13 different opinions were noted on total antibiotic duration. Extra-anatomic bypass (EAB) was used by and 42% of VT. In-situ reconstructions were used by 59% of VS versus % of VT. Venous reconstructions were the first reconstruction choice in 63% VS and 52% of VT. Antibiotic-bonded grafts were used by 17% of VS and 16% of VT.

CONCLUSION: This survey shows highly mixed opinions about clinical diagnosis, diagnostic imaging, and treatment of AGI, reflecting available literature. Further research is therefore desperately needed. More research and development of treatment guidelines is needed to reach uniformity and consensus for patients with infected vascular grafts.