What is it about?

An abdominal aortic aneurysm is a dangerous bulge of the main artery in the abdomen. It can be repaired with open surgery or, less invasively, by inserting a stent-graft through the groin (EVAR). Rarely, these grafts become infected, a very serious complication. We pooled data from 19 studies to estimate how often this happens and which microbes are responsible. Infections occurred in about 0.36 per 100 patients per year after EVAR and 0.60 per 100 per year after open surgery. Staphylococci were the most common bacteria after EVAR, but many infections involved several germs, fungi or Gram-negative bacteria, and almost half had no identified cause because cultures were negative.

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Why is it important?

Reliable figures on graft infection are essential to counsel patients, plan follow-up and design prevention strategies, yet published rates vary widely. This meta-analysis provides pooled estimates for both surgical techniques and shows that infections are less frequent after EVAR. It also reveals major inconsistency in how these infections are defined and how microbiology is reported, calling for standardized diagnostic criteria and better use of molecular diagnostics.

Perspectives

Vascular graft infections are rare, but when they happen they are among the most difficult infections we treat, often requiring complex surgery and lifelong antibiotics. The high proportion of culture-negative cases struck me: improving microbiological diagnosis is a priority. This work grew from a fruitful collaboration between infectious diseases specialists and vascular surgeons in Trieste and beyond.

Professor Stefano Di Bella
Universita degli Studi di Trieste

Read the Original

This page is a summary of: Incidence and microbiological etiology of vascular graft and endograft infections: a systematic review and meta-analysis, Infection, August 2026, Springer Science + Business Media,
DOI: 10.1007/s15010-026-02908-6.
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