Examqo › Examqo library › Vascular surgery › Aorta · IMLE

Vascular graft infection and infected aortic aneurysm

Infection of a vascular graft or endograft is a rare but lethal complication; it is diagnosed by a combination of clinical findings, imaging (fluid or gas around the graft on CT, uptake on PET-CT) and microbiology — the MAGIC criteria — and curative treatment is removal of the infected graft, debridement and reconstruction (in situ or extra-anatomic), with prolonged antibiotics.

לקריאה בעברית

Why it matters in the exam

Infection can appear early (in the first months after surgery, usually from Staphylococcus aureus including MRSA, with fever, redness, discharge and groin swelling) or late (months to years, usually from coagulase-negative staphylococci, with a vague picture of low-grade fever, pain and weight loss). A groin infection sometimes shows as a non-healing wound or a sinus. On CT: fluid around the graft persisting beyond the first months, gas around the graft beyond the first weeks, or an anastomotic pseudoaneurysm. FDG PET-CT and labelled white cell scanning add sensitivity. An extreme situation is aortoenteric fistula — a connection between the graft or aorta and the duodenum (usually the third or fourth part) — which appears as a small "herald" gastrointestinal bleed followed by massive bleeding; any gastrointestinal bleeding in a patient with an aortic graft must raise this suspicion.

Treatment: complete removal of the infected graft, debridement of infected tissue and reconstruction. Reconstruction can be in situ — autologous femoral vein, a cryopreserved allograft, or a rifampicin-soaked or silver graft — or extra-anatomic, for example axillobifemoral bypass through clean tissue, followed by removal of the infected graft. In the groin the vessels are sometimes covered with a muscle flap (sartorius). A patient unfit for major surgery receives prolonged and sometimes lifelong antibiotics, accepting a lower chance of cure. An infected aortic aneurysm (formerly called "mycotic") is an aneurysm formed by infection of the aortic wall — usually Salmonella or Staphylococcus — in a patient with fever, abdominal or back pain and positive blood cultures; it is saccular, irregular and grows fast. Here too treatment is antibiotics and removal of the infected tissue with reconstruction, sometimes EVAR as a bridge in an unstable patient.

A patient with fever, abdominal pain and blood cultures positive for Salmonella, especially if immunosuppressed, needs a CT of the aorta to exclude an infected aneurysm.

Key points

• Early — S. aureus; late — coagulase-negative.
• CT and PET-CT for diagnosis; MAGIC criteria.
• Removal, debridement and reconstruction.
• Herald bleed — aortoenteric fistula.
• Infected aneurysm — Salmonella or Staphylococcus.

Summary table

In the full version for subscribers

• A simple algorithm
• Memory aid
• Exam traps
• 5 review cards
• Enough for IMLE

The full version is open to subscribers of: Vascular surgery, General surgery, Clinical microbiology, Medical licensing exam (IMLE).

Subscriber? Read the full topic Plans and prices 25 free questions

Sources

• ESVS Clinical Practice Guidelines on the Management of Vascular Graft and Endograft Infections, 2020 — Diagnosis (MAGIC criteria) and treatment
• AHA Scientific Statement: Vascular graft infections, mycotic aneurysms and endovascular infections, 2016 — Diagnosis and management
• Rutherford's Vascular Surgery and Endovascular Therapy, 10th edition (2022) — Graft infections and infected aneurysms

Sources are given for further reading; the text is written afresh and not copied from them.

Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.