Clinical Presentation and Imaging Pathways in Peripheral Vascular Graft and Endograft Infection: A Dutch-German...

Peripheral vascular graft and endograft infections (pVGEIs) are rare but severe complications, and evidence on their clinical presentation and diagnostic work-up remains limited. To improve insight into this condition, hospitals in the cross-border Ems-Dollard Region combined their experience in a regional cohort. This multicentre, retrospective observational cohort study aimed to describe onset patterns, presenting features, and diagnostic imaging pathways for pVGEI in routine clinical practice.

All patients treated for confirmed pVGEI (2002-2023) in three hospitals were included: one in the Netherlands (NL) and two in Germany (DE). Diagnosis was established by multidisciplinary consensus supported by microbiological, imaging, and/or intra-operative evidence.

A total of 104 pVGEI patients were included (NL, 52; DE, 52). Median time from index graft placement to symptom onset was 141 days; 52 cases (50.0%) were classified as early pVGEI (<4 months) and 52 (50.0%) as late pVGEI (>4 months). Elevated C-reactive protein (CRP) (96%), local inflammatory signs (83%) and pain (72%) were the most frequent presenting features, whereas malaise (53%) and fever (32%) were less common. Computed tomography angiography (CTA) was the most frequently used imaging method (54%), followed by ultrasound (US) (35.6%), 18F-fluorodeoxyglucose positron emission tomography (¹⁸FDG-PET/CT) (27.9%), and magnetic resonance angiography (MRA) (4%). Findings considered suspicious for pVEGI were detected in all ¹⁸FDG-PET/CTA, 85.7% of CTA, 70.3% of US, and 50% of MRA.

pVGEI commonly presented with elevated CRP and local inflammatory signs, while systemic symptoms were often absent. ¹⁸FDG-PET/CT most frequently demonstrated findings considered suspicious for infection and may support diagnostic confidence.