¹⁸F-Fluorodeoxyglucose PET imaging in aortic graft infection: many more questions than answers

Excerpt

Aortic graft infection (AGI) is an uncommon complication of this increasingly popular treatment for aortic diseases. Aortic grafts placed by open surgical or endovascular stent-graft approaches are utilized to treat aortic aneurysms, stenosis, dissection, or occlusive disease. Device-related infection occurs in approximately 0.5%-4% of cases.1,2 Nevertheless, AGI is associated with high morbidity and mortality, and its diagnosis and treatment remain challenging.1,2 Optimal management with device removal, revascularization, and antimicrobial therapy is associated with up to 30% mortality.3,4 If the device is left in place, the 2-year mortality can approach 100% despite prolonged antimicrobial treatment.3,4 An accurate and expedient diagnosis of AGI are essential for optimal management. Unfortunately, sampling perigraft collections for microbial confirmation of infection is difficult and frequently not feasible. Thus, diagnosis of AGI depends on a combination of clinical/surgical, radiologic, and laboratory criteria. The overarching problems are: (1) determining that AGI is responsible for symptoms and signs of infection, (2) distinguishing sterile inflammation from infection at aortic graft site, and (3) identifying patients who would benefit from an initially conservative therapeutic strategy. …