Die europäischen Leitlinien zur Versorgung von Gefäßprothesen- und Stentgraftinfektionen: Kommentierte Zusammenfassung

Prosthesis infections occur with a frequency of 0.5–6% depending on the type of intervention, localization and stage of an accompanying arterial occlusive disease (AOD). There is a higher risk of infection (up to 6%) for operations on the lower extremities and the groin than for operations in the aortic segment (up to 3.6%). The management of aortic graft infection collaboration (MAGIC) criteria, consisting of clinical, radiological and laboratory investigations, are recommended for clinical confirmation of the diagnosis. In addition to an ultrasound examination, computed tomography (CT) angiography is recommended. In the case of insufficient information an 18F-fluorodesoxyglucose positron emission tomography CT (18-F-FDG PET/CT) can be useful. Microbiological detection should be attempted using three directly obtained samples. The treatment of first choice is a complete explantation and in situ reconstruction with autologous material. Bridging by stent grafts for acute hemorrhage should be considered in each individual case. The presence of aortobronchial, aortopulmonary and aortoenteric fistulas worsens the prognosis. An additional reconstruction of the fistula-bearing sections of the affected accompanying organs is recommended. A conservative approach can be considered as a palliative concept in patients who are unfit for surgery. In these cases additive measures, such as targeted drainage placement, irrigation and stent graft implantation should be individually applied to bridge life-threatening complications. The duration and type of antibiotic treatment must be determined individually and in interdisciplinary collaboration by including infectious disease specialists. Lifelong surveillance of patients after reconstruction is recommended.