Strategies for the diagnosis and treatment of limb graft infections
ZHANG Fu-xian
LIU Jun-le
Abstract：Limb arterial diseases,including vascular stenosis,occlusion,dilation,trauma,and external invasion,pose significant threats to limb function and patient survival.Treatment is typically based on pharmacological therapy,supplemented by traditional open surgery or endovascular interventions,with vascular grafts playing an indispensable role in vascular reconstruction.Modern vascular graft technologies encompass biological tissue,synthetic,bio-hybrid,tissue-engineered,and endovascular grafts.While significant progress has been made in biocompatibility,anti-infective properties,and long-term patency,graft infections remain a major challenge in vascular surgery.In traditional open surgery,autologous vein grafts are preferred due to their strong resistance to infection.However,when autologous veins are insufficient,synthetic grafts such as Dacron and expanded polytetrafluoroethylene(ePTFE)are used,though these carry an infection rate of 1％-6％,along with high amputation and mortality rates.Infections are commonly caused by streptococci or staphylococci at the surgical site,while multiple comorbidities and infected necrotic wounds are also significant risk factors.Endovascular procedures,due to their minimally invasive nature,have a lower infection rate,but rare cases have been reported,such as infections of drug-coated stents leading to severe complications like arterial thrombosis and pseudoaneurysms.The diagnosis of graft infections requires a combination of clinical presentation,laboratory tests,and imaging evaluations.Early infections typically manifest as fever,localized inflammation,and acute ischemia,while late-onset infections are often insidious.Among imaging modalities,positron emission tomography-computed tomography(PET/CT)demonstrates superior sensitivity(93％)and specificity(70％)compared to CT scans.The primary treatment strategy involves broad-spectrum antibiotics combined with surgical intervention,requiring thorough debridement of infected tissue,removal of infected grafts,and revascularization.Antibiotics should prioritize agents capable of penetrating biofilms,such as rifampin,with a treatment duration typically lasting 4-6 weeks or longer.Surgical reconstruction options include in situ reconstruction and extra-anatomic bypass,with autologous veins or allografts being the preferred materials.Through multidisciplinary collaboration,strict perioperative infection prevention measures,and the development of new materials,the diagnosis and treatment outcomes of limb vascular graft infections are expected to further improve.
Keywords：vascular graftslimb arterial reconstructioninfection prevention and controltraditional open surgeryendovascular proceduresantibiotic therapysurgical debridementbiofilm
Publication Date：2024-12-01
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：5( 1374-1378 )