Vascular graft and endograft infections (VEGI) have high morbidity and mortality. Suboptimal surgical management includes patients for whom long-term suppressive antimicrobial therapy (SAT) is recommended. Due to limited data, current guidelines do not stratify VEGI management for these patients. This study aims to describe outcomes and prognostic factors in VEGI patients treated with suboptimal surgery.
Methods:
A bicentric, retrospective study was conducted from August 2018 to December 2022 at two referral centers. VEGI diagnoses followed Management of Aortic Graft Infection Collaboration criteria. Four surgical strategies were assessed: no surgery or debridement, partial retention, early (<4 weeks) debridement, antibiotics and implant retention (DAIR), and late DAIR. The primary outcome was a composite of 1-year all-cause mortality or relapse.
Results:
Of 113 patients (mean age 67.8 ± 11.8 years; 19.5% female), 77% had a definitive VEGI diagnosis. Early DAIR was the most common strategy (31%). Monomicrobial documentation was retrieved in 60.2% of cases, with Staphylococcus aureus present in 31.9%. At 1-year follow-up, 28.3% of patients experienced death or relapse: 19 died, and 13 relapsed. SAT was used in 18.6% of cases. The probabilities of survival without relapse were 59% (CI95%, 36-76%) for patients without surgery or material debridement and 79% (CI95%, 62-90%) for early DAIR, with no statistical differences between groups. Conclusion: Early DAIR without SAT showed the most favorable prognosis, though further studies are needed to stratify patients within this suboptimal group.