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

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.

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.

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.

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.