Editor's Choice – Merits of Puncture and Drainage of Perigraft Material in Patients with Vascular and Endovascular Prosthetic Graft Infection

Abstract

Objective: Vascular graft or endograft infections (VGEIs) pose significant challenges due to their rarity and potential for severe complications. Direct identification of microorganisms is highly recommended by the European Society for Vascular Surgery guidelines, yet standardised approaches are limited in the literature. Percutaneous drainage followed by lifelong suppressive antimicrobial therapy offers a viable alternative for high risk patients. This study evaluated the diagnostic and therapeutic implications of percutaneous cultures in abdominal and peripheral VGEIs and assessed the efficacy of conservative treatment when surgery is not feasible. Methods: This was a retrospective cohort study of all patients admitted to a tertiary referral centre with suspected abdominal or peripheral VGEI, according to the Management of Aortic Graft Infection Collaboration (MAGIC) criteria, and who underwent percutaneous procedures between 2017 and 2023. The diagnostic accuracy of percutaneous cultures was evaluated by comparing their results with the final diagnosis of VGEI based on MAGIC criteria, and analysing the sensitivity, specificity, positive predictive value, and negative predictive value. Additionally, the influence of percutaneous cultures on antibiotic therapy adjustment and conservative treatment choice was investigated. Survival outcomes were compared between patients who were treated conservatively and those who underwent total or partial surgical graft removal. Results: The study included 69 patients: 45 with suspected abdominal VGEI and 24 with suspected peripheral VGEI. Percutaneous culture results statistically significantly correlated with VGEI diagnosis (p = .023 and p = .048, respectively), with a sensitivity and specificity of 50% and 70% in abdominal infections and 80% and 68% in peripheral infections, respectively. Percutaneous procedures statistically significantly impacted the choice of antibiotic therapy (p < .001 and p = .011). Overall survival for conservative treatment was comparable with surgical graft extraction (p = .61 and p = .25). Conclusion: Percutaneous cultures offer high specificity for VGEI diagnosis and can be used to guide effective personalised antibiotic therapy. For inoperable patients, drainage with lifelong antimicrobial treatment is a valuable conservative option.