Recommendations for Diagnosis and Management of Prosthetic Aortic Graft Infection

fmkReferenced studies that support the recommendations are summarized in the Online Data Supplement.

COR	LOE	Recommendations
Diagnosis
2a	B-NR	1. In patients with a prosthetic aortic graft, who have signs and symptoms or culture evidence of unexplained infection or have unexplained gastrointestinal bleeding, cross-sectional imaging is reasonable to evaluate for an underlying aortic graft infection.1–6
Treatment
2a	B-NR	2. In patients with an infected prosthetic aortic graft who are hemodynamically stable and have appropriate anatomy, it is reasonable to perform open surgery with either in situ reconstruction or extra-anatomic bypass.7–13
2a	B-NR	3. In patients with an infected prosthetic aortic graft who are hemodynamically unstable, it is reasonable to perform open surgery with either explant or in situ reconstruction.7
2a	C-LD	4. In patients with an infected prosthetic aortic graft, endovascular therapy is reasonable, either as bridge therapy in those with hemodynamic instability or as long-term therapy in those who are unsuitable candidates for open surgery.13–15
Late Management
1	C-LD	5. In patients who have undergone treatment of an acute prosthetic aortic graft infection, targeted intravenous antimicrobial therapy of at least 6 weeks’ duration, with prolonged suppressive oral therapy in select cases, plus a consultation and follow-up with an infectious disease specialist, is recommended.7,11,12,16,17
2b	C-LD	6. In patients with an infected prosthetic aortic graft and either an extensive perigraft abscess or an infection caused by methicillin-resistant S. aureus, Pseudomonas aeruginosa, or a multidrug-resistant microorganism, or who have undergone in situ reconstruction, lifelong suppressive oral antimicrobial therapy may be considered after the initial course of therapy.14,15,18,19