Characteristics and Outcome of Vascular Graft Infections - A Risk Factor and Survival Analysis
Leonie Stockschläder, Donara Margaryan, Safwan Omran, Martin Schomaker, Andreas Greiner, Andrej TrampuzAbstract
Background
Vascular graft infection (VGI) is a serious complication after implantation of arterial vascular grafts. Optimal surgical and pathogen-specific antimicrobial treatment regimens for VGI are largely unknown. We evaluated patients with arterial VGI according to onset, location, microbiological and imaging characteristics, surgical and antimicrobial treatment and performed an outcome evaluation.
Methods
Consecutive patients with VGI treated in two hospitals from 2010 through 2020 were retrospectively analyzed. Uniform definition criteria and standardized outcome evaluation were applied. Logistic regression was used for multiple analysis, survival analysis was performed with Kaplan-Meier analysis and log-rank test.
Results
Seventy-eight patients with VGI were included, consisting of 30 early-onset (<8 weeks after graft implantation) and 48 late-onset cases, involving 49 aortic and 29 peripheral grafts. The median time from initial implantation to diagnosis of VGI was significantly longer in aortic than peripheral VGIs (363 days vs. 56 days, p = 0.018). Late-onset VGI (OR 7.3, p = 0.005) and the presence of surgical site infection/complication (OR 8.21, p = 0.006) were independent risk factors for treatment failure. Surgical site infection/complication was associated with higher risk for early-onset VGI (OR 3.13, p = 0.040). Longer infection-free survival was observed in cases where the infected graft was surgically removed (p = 0.037).
Conclusion
This study underlines the importance of timely diagnosis of VGI and preventing surgical site infections/complications at graft implantation. It highlights the complexity of infection eradication, especially of late-onset infections, and the importance of adequate antimicrobial and surgical treatment.