90
Treatment
9.2.2. Diagnosis and Management of Prosthetic Aortic Graft
Infection
COR LOE
Recommendations
Diagnosis
2a B-NR 1. In patients with a prosthetic aortic graft, who have signs and
symptoms or culture evidence of unexplained infection or have
unexplained gastrointestinal bleeding, cross-sectional imaging is
reasonable to evaluate for an underlying aortic graft infection.
Treatment
2a B-NR 2. In patients with an infected prosthetic aortic graft who are
hemodynamically stable and have appropriate anatomy, it
is reasonable to perform open surgery with either in situ
reconstruction or extra-anatomic bypass.
2a B-NR 3. In patients with an infected prosthetic aortic graft who are
hemodynamically unstable, it is reasonable to perform open
surgery with either explant or in situ reconstruction.
2a C-LD 4. In patients with an infected prosthetic aortic graft,
endovascular therapy is reasonable, either as bridge therapy in
those with hemodynamic instability or as long-term therapy in
those who are unsuitable candidates for open surgery.
Late Management
1 C-LD 5. In patients who have undergone treatment of an acute
prosthetic aortic graft infection, targeted intravenous
antimicrobial therapy of at least 6 weeks' duration, with
prolonged suppressive oral therapy in select cases, plus a
consultation and follow-up with an infectious disease specialist,
is recommended.
2b C-LD 6. In patients with an infected prosthetic aortic graft and either
an extensive perigraft abscess or an infection caused by
methicillin-resistant S. aureus, Pseudomonas aeruginosa, or a
multidrug-resistant microorganism, or who have undergone
in situ reconstruction, lifelong suppressive oral antimicrobial
therapy may be considered after the initial course of therapy.
