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Vascular Infection and Inflammation
James Patrick Davidson, MD; Paige Bennett, MD
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KEY FACTS

  • Imaging

    • Clinical Issues

      • Diagnostic Checklist

        TERMINOLOGY

        • Definitions

          • Common vascular grafts include aortic or aortoiliac for aneurysm repair, peripheral grafts for dialysis access, or grafts placed for peripheral arterial disease
            • Infected graft
              • Inflammatory changes associated with graft, sometimes complicated by abscess
              • Proximal and distal graft anastomoses are most common sites of infection
            • Colonized graft
              • Bacteria living on graft without clinically significant inflammation
            • Graft incorporation
              • Ingrowth of normal host cells into vascular graft creating pseudoendothelium lining
            • Graft disincorporation
              • Loss of host pseudoendothelium resulting in areas of bare graft

        IMAGING

        • F-18 FDG PET/CT Findings

          • Imaging Recommendations

            DIFFERENTIAL DIAGNOSIS

              PATHOLOGY

              • Gross Pathologic & Surgical Features

                • Microscopic Features

                  CLINICAL ISSUES

                  • Presentation

                    • Natural History & Prognosis

                      • Treatment

                        DIAGNOSTIC CHECKLIST

                        • Consider

                          • Image Interpretation Pearls

                            Selected References

                            1. Berger P et al: Differential FDG-PET uptake patterns in uninfected and infected central prosthetic vascular grafts. Eur J Vasc Endovasc Surg. 50(3):376-83, 2015
                            2. Guenther SP et al: The relevance of 18F-fluorodeoxyglucose positron emission tomography/computed tomography imaging in diagnosing prosthetic graft infections post cardiac and proximal thoracic aortic surgery. Interact Cardiovasc Thorac Surg. 21(4):450-8, 2015
                            3. Pinaquy JB et al: Should white blood cell scan be replaced by (18)F-FDG PET-CT in the diagnosis of prosthetic vascular graft infection? Ann Vasc Surg. 29(6):1321.e1-4, 2015
                            4. Haroon A et al: Role of fluorine 18 fluorodeoxyglucose positron emission tomography-computed tomography in focal and generalized infectious and inflammatory disorders. Clin Infect Dis. 54(9):1333-41, 2012
                            5. Bruggink JL et al: Current role of imaging in diagnosing aortic graft infections. Semin Vasc Surg. 24(4):182-90, 2011
                            6. Cavalcanti Filho JL et al: PET/CT and vascular disease: current concepts. Eur J Radiol. 80(1):60-7, 2011
                            7. Bruggink JL et al: Accuracy of FDG-PET-CT in the diagnostic work-up of vascular prosthetic graft infection. Eur J Vasc Endovasc Surg. 40(3):348-54, 2010
                            8. Basu S et al: Positron emission tomography as a diagnostic tool in infection: present role and future possibilities. Semin Nucl Med. 39(1):36-51, 2009
                            9. Spacek M et al: Diagnostics of "non-acute" vascular prosthesis infection using 18F-FDG PET/CT: our experience with 96 prostheses. Eur J Nucl Med Mol Imaging. 36(5):850-8, 2009
                            10. Bleeker-Rovers CP et al: Imaging of infectious diseases using [18F] fluorodeoxyglucose PET. Q J Nucl Med Mol Imaging. 52(1):17-29, 2008
                            11. van der Vaart MG et al: Application of PET/SPECT imaging in vascular disease. Eur J Vasc Endovasc Surg. 35(5):507-13, 2008
                            12. Wassélius J et al: High 18F-FDG Uptake in synthetic aortic vascular grafts on PET/CT in symptomatic and asymptomatic patients. J Nucl Med. 49(10):1601-5, 2008
                            13. Keidar Z et al: Prosthetic vascular graft infection: the role of 18F-FDG PET/CT. J Nucl Med. 48(8):1230-6, 2007
                            Related Anatomy
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                            Related Differential Diagnoses
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                            References
                            Tables

                            Tables

                            KEY FACTS

                            • Imaging

                              • Clinical Issues

                                • Diagnostic Checklist

                                  TERMINOLOGY

                                  • Definitions

                                    • Common vascular grafts include aortic or aortoiliac for aneurysm repair, peripheral grafts for dialysis access, or grafts placed for peripheral arterial disease
                                      • Infected graft
                                        • Inflammatory changes associated with graft, sometimes complicated by abscess
                                        • Proximal and distal graft anastomoses are most common sites of infection
                                      • Colonized graft
                                        • Bacteria living on graft without clinically significant inflammation
                                      • Graft incorporation
                                        • Ingrowth of normal host cells into vascular graft creating pseudoendothelium lining
                                      • Graft disincorporation
                                        • Loss of host pseudoendothelium resulting in areas of bare graft

                                  IMAGING

                                  • F-18 FDG PET/CT Findings

                                    • Imaging Recommendations

                                      DIFFERENTIAL DIAGNOSIS

                                        PATHOLOGY

                                        • Gross Pathologic & Surgical Features

                                          • Microscopic Features

                                            CLINICAL ISSUES

                                            • Presentation

                                              • Natural History & Prognosis

                                                • Treatment

                                                  DIAGNOSTIC CHECKLIST

                                                  • Consider

                                                    • Image Interpretation Pearls

                                                      Selected References

                                                      1. Berger P et al: Differential FDG-PET uptake patterns in uninfected and infected central prosthetic vascular grafts. Eur J Vasc Endovasc Surg. 50(3):376-83, 2015
                                                      2. Guenther SP et al: The relevance of 18F-fluorodeoxyglucose positron emission tomography/computed tomography imaging in diagnosing prosthetic graft infections post cardiac and proximal thoracic aortic surgery. Interact Cardiovasc Thorac Surg. 21(4):450-8, 2015
                                                      3. Pinaquy JB et al: Should white blood cell scan be replaced by (18)F-FDG PET-CT in the diagnosis of prosthetic vascular graft infection? Ann Vasc Surg. 29(6):1321.e1-4, 2015
                                                      4. Haroon A et al: Role of fluorine 18 fluorodeoxyglucose positron emission tomography-computed tomography in focal and generalized infectious and inflammatory disorders. Clin Infect Dis. 54(9):1333-41, 2012
                                                      5. Bruggink JL et al: Current role of imaging in diagnosing aortic graft infections. Semin Vasc Surg. 24(4):182-90, 2011
                                                      6. Cavalcanti Filho JL et al: PET/CT and vascular disease: current concepts. Eur J Radiol. 80(1):60-7, 2011
                                                      7. Bruggink JL et al: Accuracy of FDG-PET-CT in the diagnostic work-up of vascular prosthetic graft infection. Eur J Vasc Endovasc Surg. 40(3):348-54, 2010
                                                      8. Basu S et al: Positron emission tomography as a diagnostic tool in infection: present role and future possibilities. Semin Nucl Med. 39(1):36-51, 2009
                                                      9. Spacek M et al: Diagnostics of "non-acute" vascular prosthesis infection using 18F-FDG PET/CT: our experience with 96 prostheses. Eur J Nucl Med Mol Imaging. 36(5):850-8, 2009
                                                      10. Bleeker-Rovers CP et al: Imaging of infectious diseases using [18F] fluorodeoxyglucose PET. Q J Nucl Med Mol Imaging. 52(1):17-29, 2008
                                                      11. van der Vaart MG et al: Application of PET/SPECT imaging in vascular disease. Eur J Vasc Endovasc Surg. 35(5):507-13, 2008
                                                      12. Wassélius J et al: High 18F-FDG Uptake in synthetic aortic vascular grafts on PET/CT in symptomatic and asymptomatic patients. J Nucl Med. 49(10):1601-5, 2008
                                                      13. Keidar Z et al: Prosthetic vascular graft infection: the role of 18F-FDG PET/CT. J Nucl Med. 48(8):1230-6, 2007