Postoperative graft incorporation after aortic reconstruction—comparison between computerised tomography and Tc-99m-HMPAO labelled leucocyte imaging
| Autor: | O.J. Rämö, Eila Lantto, R.E.M. Mokka, T. Lantto, M. Vorne, J. Lehtonen, M. Soiva |
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| Rok vydání: | 1993 |
| Předmět: |
Diagnostic Imaging
Male medicine.medical_specialty Periprosthetic Iliac Artery Postoperative Complications Technetium Tc 99m Exametazime Suture (anatomy) Oximes Leukocytes medicine Humans Surgical Wound Infection Prospective Studies Prospective cohort study Aged Aged 80 and over Wound Healing Polyethylene Terephthalates business.industry Graft Occlusion Vascular Organotechnetium Compounds Middle Aged Staphylococcal Infections Mycotic aneurysm medicine.disease Abdominal aortic aneurysm Blood Vessel Prosthesis Surgery Femoral Artery Tomography Radiology Foreign body Tomography X-Ray Computed Cardiology and Cardiovascular Medicine business Complication Aortic Aneurysm Abdominal Follow-Up Studies |
| Zdroj: | European Journal of Vascular Surgery. 7:122-128 |
| ISSN: | 0950-821X |
| DOI: | 10.1016/s0950-821x(05)80751-0 |
| Popis: | Aortic graft infection may result in high mortality ranging up to 88%. Therefore, early diagnosis is imperative in the treatment of this serious complication. Computerised tomography (CT) is considered as a sensitive tool in the diagnosis of aortic graft infection. Some findings used as the criteria for infection, such as periprosthetic gas and fluid are, however, normal postoperative findings. The aim of this prospective study was to compare CT-scan and Tc-99m-HMPAO labelled leucocytes in the early diagnosis of aortic graft infection. The present study includes 24 consecutive patients (all men, age 70 ± 8 years, range 55–85 years), who were operated on for abdominal aortic aneurysm. Prosthetic and suture materials were the same in all operations. Each patient was examined with the aid of CT-scan and imaged with Tc-99m-HMPAO labelled leucocytes 2 weeks and 3, 6 and 12 months after the reconstructive aortic surgery. Two radiologists and two specialists in nuclear medicine examined the data independently without knowing the clinical picture of the results of any other examinations of the patients. Seven patients (7/24; 29%) showed significant accumulation of labelled leucocytes in the first imaging (2 weeks postoperatively) with Tc-99m-HMPAO labelled leucocytes. Three months after the surgery only four patients (4/24; 17%) were positive in this respect. One of these patients had clinically proven aortic graft infection and another positive was a patient with resected and reconstructed mycotic aneurysm. CT-examination in all scans was suggestive for aortic graft infection in two cases (2/24; 8%), but neither of these patients showed any signs of infection. Furthermore, these patients did not have any accumulation of radioactive tracer. These preliminary results suggest that imaging with labelled leucocytes is more sensitive than CT-scan in the detection of aortic graft infection. The high incidence of significant accumulation of the tracer 2 weeks postoperatively is probably due to a foreign body reaction which diminishes during the first 3 months. The high sensitivity of Tc-99m-HMPAO leucocyte scan seems to detect also “inflammation”—not only true graft infection. Therefore, if there is a clinical suspicion of graft infection, imaging with leucocytes should be repeated, especially in the course of immediate postoperative period. |
| Databáze: | OpenAIRE |
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