Vascular graft and endograft infections: experiences and lessons learned from 8 years of prospective monitoring of the VASGRA cohort at the University Hospital Zurich

Abstract

Vascular graft and endograft infections (VGEI) after open surgery or after interventional treatment are dreaded complications with far-reaching consequences for the patients concerned. The morbidity and mortality rates of the golden standard, which is still largely valid today, namely radical prosthesis removal with in situ or extra-anatomical reconstruction, sometimes combined with plastic surgery coverage, are generally high. In 2013 we therefore initiated the prospective Vascular Graft (VASGRA) cohort study at the University Hospital Zurich (USZ) with the aim to investigate general uncertainties and ambiguities regarding VGEI and to develop a general management pathway for VGEI Szilagyi grade 3 and Samson grades 3–5. The new approach was to treat and research extracavitary and intracavitary VGEI with a minimally invasive prosthesis-preserving or partially preserving concept under local negative pressure wound therapy (NPWT) in an multidisciplinary manner. At present, we have comprehensive information on 180 prospective patients with VGEI in our database. Index surgery in these patients with proven VGEI was thoracic aortic surgery (n = 55), abdominal aortic and/or iliac artery surgery (n = 92) and infrainguinal vascular surgery (n = 33). The censored 2‑year mortality of intracavitary VGEI was 25%, that of extracavitary VGEI was slightly less (not significant). Long-term mortality in the VASGRA cohort study directly caused by a VGEI was 8%. In our opinion, the multidisciplinary overall concept lived from the beginning and newly gained knowledge in imaging and microbiological diagnostics have contributed to the low short-term and long-term mortality.