Clinical usefulness of technetium-99m-HMPAO-labeled leukocyte scan in prosthetic vascular graft infection.
The infection of a prosthetic vascular graft (PVGI), although rare, is the most severe complication in reconstructive vascular surgery. The early diagnosis of this complication reduces the death rate from surgery. Aortofemoral graft infections differ clinically from peripheral graft infections in significant ways. The aim of this article is to evaluate separately the reliability of the 99mTc-HMPAO-labeled leukocyte scan or white blood cell count (WBC) in the early detection of both aortofemoral and peripheral graft infections.


METHODS
One hundred sixty-two WBCs were performed on 129 consecutive patients with suspected aortofemoral (122 scans) and peripheral (40 scans) graft infection and in a 12-patient control group. Patients with suspected PVGI were categorized into three groups on the basis of their signs and symptoms on readmission: (a) patients with specific signs of graft infection (Group A); (b) patients with nonspecific signs of graft infection (Group B); and (c) patients with anastomotic aneurysms (Group C). Gram's stains of the perigraft exudate and graft cultures were performed and used as the gold standard in patients who underwent surgery. An 18-mo clinical follow-up was done to assess the presence or absence of graft infection in patients who did not have surgery.


RESULTS
In patients with suspected aortofemoral graft infections, the overall sensitivity, specificity and accuracy of WBCs (Groups A, B, C) were 100%, 92.5% and 97.5%, respectively, whereas sensitivity, specificity and accuracy calculated in the patients with nonspecific signs of graft infection (Groups B, C) were 100%, 92.3% and 96.9%, respectively. In patients with suspected peripheral graft infections, sensitivity, specificity and accuracy were 100%.


CONCLUSIONS
The white blood cell scan seems a reliable diagnostic method for early diagnosis of PVGI, and it is more useful in aortofemoral graft infections.
Liberatore
M
M
Department of Experimental Medicine and Pathology, University of Rome La Sapienza, Italy.
Iurilli
A P
AP
Ponzo
F
F
Prosperi
D
D
Santini
C
C
Baiocchi
P
P
Rizzo
L
L
Speziale
F
F
Fiorani
P
P
Colella
A C
AC
D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007553:Isotope Labeling; D007958:Leukocyte Count; D007962:Leukocytes; D008297:Male; D008875:Middle Aged; D011093:Polyethylene Terephthalates; D011138:Polytetrafluoroethylene; D016459:Prosthesis-Related Infections / Q000097:blood / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000453:epidemiology; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D019690:Technetium Tc 99m Exametazime; D013997:Time Factors
D011093:Polyethylene Terephthalates; D019275:Radiopharmaceuticals; D019690:Technetium Tc 99m Exametazime; D011138:Polytetrafluoroethylene