Annals of vascular surgery · 2026
Clinical Presentation and Imaging Pathways in Peripheral Vascular Graft and Endograft Infection: A Dutch-German Cohort Study.
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Vos F, Bergmann F, Gareb B, Cöster A, Teβarek J, Werker P M N, de Vries J P P M, Saleem B R, Vascular Graft Infection Collaboration Ems-Dollard Region (VGIC-EDR)
Аннотация
BACKGROUND: 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 multicenter, retrospective observational cohort study aimed to describe onset patterns, presenting features, and diagnostic imaging pathways for pVGEI in routine clinical practice.
METHODS: All patients treated for confirmed pVGEI (2002-2023) in 3 hospitals were included: 1 in the Netherlands (NL) and 2 in Germany (DE). Diagnosis was established by multidisciplinary consensus supported by microbiological, imaging, and/or intraoperative evidence.
RESULTS: A total of 104 pVGEI patients were included (NL, 52; DE, 52). The 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%) were classified 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 MRAs.
CONCLUSION: 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.
METHODS: All patients treated for confirmed pVGEI (2002-2023) in 3 hospitals were included: 1 in the Netherlands (NL) and 2 in Germany (DE). Diagnosis was established by multidisciplinary consensus supported by microbiological, imaging, and/or intraoperative evidence.
RESULTS: A total of 104 pVGEI patients were included (NL, 52; DE, 52). The 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%) were classified 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 MRAs.
CONCLUSION: 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.