Characteristics and prognosis of patients following complete surgical removal of infected vascular graft

Abstract

Background Vascular graft infection (VGI) associates high rates of morbidity and mortality. We describe the characteristics and outcomes of patients who underwent complete surgical removal of an infected vascular prosthesis. Methods We conducted a retrospective single-center cohort study between January 2018 and October 2022. VGI was defined according to the criteria proposed by FitzGerald. We collected demographic, clinical, microbiological and therapeutic data, as well as all-cause mortality and the need for limb amputation during a 1-year follow-up. Results Fifthy-four patients were included, 83% were male and median age 68 (SD 9) years. The most common comorbidities were dyslipidemia (78%) and high blood pressure (70%). Median Charlson index was 5 (SD 1.7) points and body mass index 26 (SD 3.7). Graft location was extracavitary in 70% of cases, with the majority being synthetic (96%), and the onset of infection occurred late (>4 months after implantation) in 78% of cases. Clinical features of the infection included bypass obstruction (49%), surgical site infection (17%), fistula (15%), bleeding (13%), and fever (7%). Intraoperative samples were positive in 76% of patients isolating gram-positive bacteria (19), enterobacteria (16), Pseudomonas aeruginosa (7), anaerobes (7), and Candida albicans (5); 31% of the infections were polymicrobial and 29% of patients had associated bacteremia. Regarding surgical management, 69% required the implantation of a new prosthesis (75% homograft), while surgical removal alone was performed in the remaining cases. Empirical treatment was appropriate in 94%, mostly based on a broad-spectrum beta-lactam + methicillin-resistant Staphylococcus aureus treatment. Definitive antibiotic therapy was based on fluoroquinolone in 67% of cases. The median antibiotic duration was 38 (SD 17) days. After 1 year of follow-up, 14% experienced a VGI relapse, 19% died (37% related to infecion), and 20% required limb amputation. Conclusions Patients undergoing complete surgical removal of VGI were predominantly men with comorbidities. Infections mostly occurred in synthetic extracavitary grafts placed >4 months ago, manifesting in half of the cases with bypass obstruction. Many patients required implantation of a new prosthesis. After 1 year of follow-up, 80% of patients were alive without relapse of the infection.