Intersection of Infection Prevention and Vascular Health: Insights From William Shutze, MD, FACS

Photo of an unhealthy carotid artery with plaque in it.

(Photo credit: William Shutze, MD, FACS)

Infection prevention plays a critical role in maintaining vascular health and preventing severe complications. William Shutze, MD, FACS, secretary for the Society for Vascular Surgery and a vascular surgeon with Texas Vascular Associates in Plano, Texas, shares his insights with Infection Control Today (ICT) on the intersection of infection prevention and vascular health. He discusses the strategies for maintaining vascular health, the impact of various infections on the vascular system, and the proactive measures vascular surgeons take to ensure long-term vascular well-being. Shutze also highlights the importance of public awareness campaigns and the role of organizations like the Society for Vascular Surgery in promoting vascular health and preventing conditions such as strokes and central line-associated bloodstream infections (CLABSIs).

ICT: How does infection prevention intersect with vascular health, and what are some key strategies for maintaining vascular health to prevent infections?

William Shutze, MD, FACS: Infection intersects with vascular health in many ways. Infections with different types of organisms, such as salmonella, staphylococcus, and streptococcus, can spread to arteries and create a localized infection in the artery. This leads to an aneurysm (a bulging of the artery or a bubble on the artery) that is unstable and can rupture, leading to hemorrhage and death.

Many viruses can affect blood vessels as well. The most recent and notable example is the coronavirus, SARS-CoV-2, that caused COVID-19. COVID-19 infection was associated with damage to the blood vessels, and as it also caused hypercoagulability, many patients suffered from blood clots in the arteries and veins. Long COVID syndrome may result from chronic thrombosis of the small blood vessels in the body. Other viruses can also damage blood vessels, including cytomegalovirus, HIV, varicella zoster, Epstein-Barr virus, and Hepatitis C virus.

Patients with peripheral arterial disease have impaired blood flow to their feet and severe ulcers or sores that can open on the feet, which are then portals for germs to enter and create an infection. These infections can be quite severe and lead to amputation or even death. When these patients also have diabetes, especially if they have diabetic neuropathy or markedly elevated blood sugars, they are increasingly at risk for infection and severe infection.

Key strategies are to live a healthy lifestyle to the extent possible. This includes a heart-healthy diet, regular exercise, monitoring and controlling high blood pressure, diabetes, and cholesterol, and avoiding tobacco. Patients with peripheral arterial disease and diabetes should inspect their feet daily to look for an ulcer, sore, or crack that could lead to an infection and seek evaluation and treatment.

Infection Control Today's Topic of the Month: Long-Term Care

ICT: How can we raise awareness about maintaining healthy blood vessels to prevent strokes and other vascular-related conditions?

WS: It is important for the public to understand the connection between blood vessels and stroke. Over 80% of strokes are ischemic from lack of blood flow in a blood vessel, leading to the brain or in the brain. 70-80% of these are due to an unhealthy blood vessel. Having healthy blood vessels is very important in minimizing one’s risk of stroke. People who have a family history of stroke have an increased risk of stroke, and they must maintain the health of their blood vessels.

The sponsors of Stroke Awareness Month, observed every year in May, have done a great job increasing awareness of stroke with their FAST campaign and providing resources for reducing a second stroke, which addresses the risk factors for stroke correctly. However, they have not made clear that unhealthy arteries have led to stroke in the first place and that their recommendations are aimed at improving the health of blood vessels.

The Society for Vascular Surgery aims to increase public recognition that “Healthy Blood Vessels = Healthy Lives.” We hope this campaign will raise public awareness regarding the importance of their blood vessels and the importance of keeping them healthy.

ICT: Can you elaborate on the role of vascular surgeons in promoting vascular health beyond performing surgical interventions? What proactive measures do they take to prevent infections and ensure long-term vascular well-being?

WS: Vascular Surgery is a unique specialty. It is the only specialty with 100% of training, education, practice, research, and care delivery dedicated solely to vascular disease. As such, vascular surgeons take on the primary care and specialty physician role for their patient’s vascular condition from diagnosis, management, and long-term care. Vascular surgeons are trained in all facets of vascular care, including diagnostic imaging, optimal medical management, interventional and endovascular treatments (angioplasty, stents, etc), and surgical treatment when necessary. Vascular surgeons rely on national guidelines to provide scientifically based recommendations to their patients and participate in data registries with real-time feedback to continue to elevate the care they provide as long-term partners with their patients along the vascular care journey. One component of registry participation is tracking a patient’s medical management to ensure that it is optimal per recognized standards.

Vascular surgeons counsel their at-risk patients regarding the risk of infection, especially diabetic foot infection, and advise them on risk-reducing strategies and monitoring for early signs of infection risk or infection. They partner with podiatrists so that at-risk patients are in the right type of shoes and orthotics.

ICT: What initiatives or campaigns are being undertaken by organizations like SVS (Society for Vascular Surgery) to educate the health care workers and the public about the importance of vascular health and infection prevention related to central line-associated bloodstream infections (CLABSIs)?

WS: The Society for Healthcare Epidemiology of America and the Infectious Diseases Society of America are two professional organizations that have championed CLABSI awareness and reduction. The CDC and the World Health Organization have also issued guidelines. The Joint Commission has also made this one of the national patient safety goals and evaluates hospitals on CLABSI rates. Vascular surgeons are committed to CLABSI prevention and adhere to the national guidelines and local hospital standards for CLABSI prevention.

Fortunately, only a small minority of vascular patients will ever receive a central venous catheter and be at risk for CLABSI.

ICT: Is there anything else you’d like to add?

WS: Vascular surgeons are committed to reminding everyone that “Healthy Blood Vessels = Healthy Lives.”