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Publications

Journal Article Review Ahead of print

PubMed: 42627620 DOI: 10.1007/s15010-026-02908-6

Incidence and microbiological etiology of vascular graft and endograft infections: a systematic review and meta-analysis.

Infection

Authors: Nicholas Geremia, Alberto Enrico Maraolo, Andrea De Vito, Federico Giovagnorio, Agnese Colpani, Andreina Monfreda, Gianfranco Sanson, Stefano Di Bella, Sandro Lepidi, Mario D'Oria

Affiliations

  • Infectious Diseases Unit, Department of Clinical Medicine, Ospedale "dell'Angelo", Venice, Italy. Infectious Diseases Unit, Department of Clinical Medicine, Ospedale Civile "S.S. Giovanni e Paolo", Venice, Italy.
  • Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples ″Federico II″, Naples, Italy.
  • Unit of Infectious Diseases, Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy.
  • Department of Infectious Diseases, ASFO "Santa Maria degli Angeli" Hospital of Pordenone, Pordenone, Italy.
  • Unit of Infectious Diseases, Department of Medicine and Gastroenterology, San Francesco Hospital, Nuoro, Italy.
  • Azienda Sanitaria Universitaria Giuliano Isontina ASUGI, Trieste, Italy.
  • Department of Medical, Surgical and Health Science, University of Trieste, Trieste, Italy.
  • Infectious Diseases Unit, Trieste University Hospital (ASUGI), Trieste, Italy.
  • Division of Vascular and Endovascular Surgery, Cardiovascular Department, University of Trieste, Trieste, Italy.

Abstract

PURPOSE

Vascular graft and endograft infections (VGEIs) represent rare but severe complications following abdominal aortic aneurysm (AAA) repair. Reported incidence rates vary widely, and comparative estimates between surgical procedures remain limited.

METHODS

A systematic search was performed in PubMed and Scopus. The search covered human studies published up to 3rd May 2025. The protocol was conceived in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guideline. it was registered in PROSPERO (registration number CRD42024525824) on 18th March 2024.

RESULTS

Nineteen studies were included. The pooled incidence of infective events was 0.36 per 100 person-years (95% CI 0.21-0.64; I² = 93.3%) after endovascular aneurysm repair (EVAR) and 0.60 per 100 person-years (95% CI 0.22-1.60; I² = 96.3%) after open surgery (OS). In EVAR-related VGEI, Staphylococcus spp. were the most frequently reported pathogens (5 cases, 12.5%). Polymicrobial etiology was not infrequent (5 cases, 12.5%), and a high proportion of infections were culture-negative (18 cases, 45.0%). In OS, data did not permit an etiological analysis. In mixed-procedure studies, fungal infections (16 cases, 17.8%), Gram-negative bacteria (15 cases, 16.7%), and polymicrobial infections (14 patients, 15.6%) were frequently reported. Considerable heterogeneity across the included studies, particularly regarding the diagnostic criteria used to define VGEI, was identified. Univariable meta-regression analyses did not identify significant associations between incidence rates and study-level covariates, including mean age, sex distribution, or year of publication.

CONCLUSION

VGEIs remain uncommon but relevant complications after AAA repair, with a lower incidence after EVAR than after OS. Future studies should prioritize standardized diagnostic criteria and detailed etiological reporting to improve epidemiological and clinical understanding.

MeSH

Incidence, Aneurysm, Transplants, Infections, Endovascular Aneurysm Repair