Detection of prosthetic vascular graft infection using avidin/indium-111-biotin scintigraphy (original) (raw)
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Detection of Prosthetic Vascular Graft Infection Using Avidin/Indium-lll-Biotin Scintigraphy
Prosthetic vascular graft infection, though rare, carries high morbid ity and mortality rates; therefore, timely diagnosis is important. Patients, however, often present with vague symptoms, and radio logical investigations are frequently inconclusive. These factors may lead to prolonged periods of observation and hospitalization, with the resultant increase in costs and complication rates, before reach ing a final diagnosis. This prospective study evaluates the use of nonspecific avidin/111ln-biotin imaging in diagnosing prosthetic vas cular graft infection. Methods: Twenty-five patients with a total of 29 grafts were investigated. Eighteen patients (19 grafts) had low probability of disease, whereas the remaining 7 patients (10 grafts) warranted surgical exploration based on clinical, laboratory or radio logical evidence. Avidin was first injected intravenously and then followed 24 hr later by administration of 111ln-biotin. Whole-body images were obtained 10 min and 2 hr postinjection of1111n-labeled biotin. SPECT imaging was performed 1 hr postinjection. Increased uptake along part or the whole length of the graft was considered evidence of graft infection. Results: Avidin/111ln-biotin scintigraphy correctly identified all infected grafts, as confirmed by culturing surgical specimens. In contrast, infection was correctly excluded in all but one of the grafts, and long-term follow-up was used to assess the presence of infection in patients who did not undergo surgical intervention. Conclusion: Avidin/1111n-biotin scintigraphy is a simple and accurate imaging method for the routine diagnosis of vascular graft infection, and it may have a role in identifying the disease process in its initial stages, thus improving prognosis.
European Journal of Vascular and Endovascular Surgery, 1995
biotin sites of infection can be imaged, using avidin as a pre-target, followed by injection of 111In-labelled biotin. This technique is much simpler than the common scintigraphic methods which employ labelling of blood components and its target-to-background ratio is greater than the methods employing radiolabelled proteins. Design: Prospective clinical study. Setting A single department of vascular surgery and one of nuclear medicine of a Northern Italian hospital. Materials" Between May 1993 and May 1994, 31 grafts in 26 patients were studied; the series included 23 men and three women with a mean age of 65.5 years (range 54-76 years). The prosthetic graft were: aortoaortic 5, aortobifemoral 15, aortoiliac 1, and femoropopliteal 10.
Prosthetic Vascular Graft Infections: A Contemporary Approach to Diagnosis and Management
Current Infectious Disease Reports, 2011
Improvements in manufacturing and implantation techniques, coupled with an increasing prevalence of atherosclerosis in an aging population, have led to increased utilization of prosthetic vascular grafts. The infection rates of vascular grafts are low. However, when they do occur, high rates of morbidity and mortality can be expected. The purpose of this article is to review the published literature regarding
The clinical usefulness of Nuclear Medicine techniques in diagnosis of vascular graft infections
The infection of a vascular prosthesis (VGI) is the most serious complication in prosthetic vascular reconstructive surgery, burdened by a high rate of mortality and morbidity. The treatment of a VGI, in most cases, consists of its surgical removal, and therefore an accurate diagnosis of the infection, is of paramount importance in clinical practice since false-positive results may lead to unnecessary major surgery whereas false-negative results are related with high-risk morbidity. Furthermore, early diagnosis of infection permits a wider range of therapeutic options and a less aggressive surgical approach. On the basis of the documents and abstracts published in the last 25 years, the authors analyze and discuss the contribution of nuclear medicine in the management of these infections, evaluating the reliability of scintigraphy with labeled leukocytes, other gamma-emitting radiopharmaceuticals, PET and PET / CT with 18F-Fluorodeoxiglucose.
Journal of Clinical Medicine
Vascular graft infection (VGI) is a rare but severe complication of vascular surgery that is associated with a bad prognosis and high mortality rate. An accurate and prompt identification of the infection and its extent is crucial for the correct management of the patient. However, standardized diagnostic algorithms and a univocal consensus on the best strategy to reach a diagnosis still do not exist. This review aims to summarize different radiological and Nuclear Medicine (NM) modalities commonly adopted for the imaging of VGI. Moreover, we attempt to provide evidence-based answers to several practical questions raised by clinicians and surgeons when they approach imaging in order to plan the most appropriate radiological or NM examination for their patients.
Diagnosing prosthetic vascular graft infection with the antigranulocyte antibody 99mTc-fanolesomab
Nuclear Medicine Communications, 2007
Aim The objectives of this retrospective investigation were to determine the accuracy of 99m Tc-fanolesomab, an antigranulocyte antibody, for diagnosing prosthetic vascular graft infection, ascertain optimum imaging times for this indication, and assess safety of this agent. Methods Eighteen patients with 19 prosthetic vascular grafts were included. Indications for graft placement included peripheral vascular disease (8), haemodialysis (7), and aneurysm (4). Patients were imaged 2-5 h and 18-30 h after injection of 555-740 MBq (75-125 lg) 99m Tc-fanolesomab. One experienced nuclear physician reviewed images in three separate sessions, early alone, late alone and early plus late images together. When early and late images were read alone, graft activity more intense than native blood pool activity was classified as positive for infection. When early and late images were interpreted together, graft activity which persisted or which increased in intensity over time was classified as positive for infection. Patient records were reviewed for adverse events up to 30 days after injection. Results Five (26%) prosthetic grafts were infected. Early, late and early plus late imaging were equally sensitive (1.00). Early images were significantly less specific (0.50), than late and early plus late images (0.93) (P < 0.05, analysis of proportions). Accuracy of late imaging and early plus late imaging were the same: 0.93. No patient experienced adverse events following radiopharmaceutical injection. Conclusions 99m Tc-fanolesomab imaging, performed 18-30 h after injection, diagnosed prosthetic vascular graft infection safely and accurately (95%). (Although safety was not an issue in this investigation, following reports of serious, including two fatal, events after administration, 99m Tc-fanolesomab was withdrawn from the United States market.
Accuracy of FDG-PET–CT in the Diagnostic Work-up of Vascular Prosthetic Graft Infection
European Journal of Vascular and Endovascular Surgery, 2010
Objectives: To investigate the diagnostic accuracy of fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) compared with computed tomography (CT) scanning and added value of fused FDG-PETeCT in diagnosing vascular prosthetic graft infection. Design: Prospective cohort study with retrospective analysis. Materials: Twenty five patients with clinically suspected vascular prosthetic infection underwent CT and FDG-PET scanning.
Prosthetic Vascular Graft Infection: A Multi-Center Review of Surgical Management
The Yale Journal of Biology and Medicine, 2007
A multi-center retrospective review of major prosthetic graft infection outcomes was undertaken to determine graft preservation and limb salvage rates. The management of infected prosthetic vascular grafts continues to be controversial. The purpose of this study was to review the surgical management of major extracavitary prosthetic vascular graft infections and to correlate the outcomes on the basis of bacteriology and grade. The change in patient population seen by vascular surgeons and the recent emergence of more virulent bacterial strains should influence surgical management. Bacteriology and severity of infection based on grade must play a greater role in the selection criteria for graft salvage. Despite advancement in the understanding of these interactions and the emergence of new management algorithms, we are continuing to operate without a uniform standard in managing this difficult and rapidly evolving clinical problem.