White blood cell scintigraphy in the diagnosis of infection of endovascular prostheses within the first month after implantation.
Mauro Liberatore, Maria Misuraca, Enrico Calandri, Luigi Rizzo, Francesco Speziale, Anna Paola Iurilli, Cristos Anagnostou
Med Sci Monit 2006; 12(3): MT5-9
Background: 99mTc-HMPAO-labeled leukocyte scintigraphy (WBCs) is usefulin the diagnosis of vascular graft infection. However, false positives can occur in the early postoperativeperiod. There are no data concerning the usefulness of WBCs in detecting endovascular prosthesis infectionduring this period. The aim of our study was to assess the reliability of WBCs in the diagnosis of earlyinfection after endovascular prosthesis implantation. Material/Methods: 23 patients treated with endovasculargrafts were submitted to preoperative diagnostic screening and to 3 WBCs (1 week before, 1 week after,and 1 month after surgery). After the last WBCs, all patients underwent a 14-month follow-up (range 6-37months, median 12 months). Results: Three patients died, at 3, 4 and 5 months after surgery respectively.At the end of the follow-up, the presence of infection was demonstrated in one patient. Of the 70 WBCsperformed, 4 gave positive results. No positive scintigraphies were obtained in the preoperative period.A positive scintigraphy was found one week after surgery in a patient who showed lymphorrhage at thesite of surgical access. In the same patient, the scintigraphic result returned to normal at 1-monthscintigraphy. At 12-month follow-up the patient did not present signs of infection. Three positive scintigraphieswere obtained in the same patient. In this patient clinical symptoms of graft infection became evidentabout 19 months after surgery. WBCs was repeated and showed extension of the infection. The infectionwas confirmed at surgery. Conclusions: WBCs do not provide false-positives in the first month after endovascularprosthesis implantation.
Keywords: Aged, 80 and over, Male, Middle Aged, Prosthesis-Related Infections - radionuclide imaging, Radiography, Abdominal, Radiopharmaceuticals - diagnostic use, Technetium Tc 99m Exametazime - diagnostic use, Time Factors, Tomography, X-Ray Computed, Treatment Outcome, Leukocytes, Leukocyte Count, Infection - diagnosis, Aged, Angiography, Aorta - surgery, Blood Vessel Prosthesis - adverse effects, Blood Vessel Prosthesis Implantation - adverse effects, Female, Femoral Artery - surgery, Follow-Up Studies, Humans, Ultrasonography, Doppler, Color