Management of Vascular Graft Infections and Aortic Aneurysms

Vascular graft infections and aortic aneurysms represent intertwined challenges in vascular medicine, combining the risks of prosthetic colonisation with the life-threatening potential of aneurysmal rupture. Management spans accurate diagnosis—often requiring multimodal imaging—to judicious selection between open surgical repair, endovascular techniques and conservative antimicrobial strategies. Surgical options range from complete graft excision and in situ reconstruction using autologous or xenopericardial materials to extra-anatomic bypass in anatomically complex settings. Endovascular aneurysm repair offers minimally invasive advantage but carries persistent risk of endograft infection and mycotic aneurysm formation. Optimal outcomes depend on multidisciplinary collaboration among vascular surgeons, infectious disease specialists and radiologists, guided by emerging consensus on diagnostic criteria, timing of interventions and antimicrobial regimens. Innovations in anti-infective graft coatings, refined imaging protocols and structured expert recommendations are shaping a more evidence-based, patient-centred approach to these high-risk conditions.

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Management of Vascular Graft Infections and Aortic Aneurysms publication trend

The graph below shows the total number of articles in management of vascular graft infections and aortic aneurysms across all publications each year (not limited to Nature Index journals).

Technical terms

Vascular graft infection (VGI): Colonisation of a prosthetic vascular conduit by microorganisms, leading to local inflammation, systemic sepsis or graft failure.

Aortic aneurysm: Focal dilation of the aortic wall exceeding 50% of the normal diameter, with risk of rupture if left untreated.

Endovascular aneurysm repair (EVAR): Minimally invasive placement of an endograft within an aneurysmal aorta to exclude the sac from blood flow.

Mycotic aneurysm: An aneurysm resulting from infection of the arterial wall or adjacent structures, often necessitating combined surgical and antimicrobial management.

Biofilm: Structured communities of bacteria enmeshed in extracellular matrix adherent to surfaces, conferring high tolerance to antibiotics.

Computed tomography angiography (CTA): X-ray imaging technique that visualises blood vessels in detail by combining CT scanning with intravenous contrast.

[18F]FDG PET/CT: Hybrid imaging using radiolabelled glucose analogue to detect metabolic activity, useful for identifying infection and inflammation around grafts.

References

1. Coaxial electrospun Ag-NPs-loaded endograft membrane with long-term antibacterial function treating mycotic aortic aneurysm. Materials Today Bio (2024).
2. Biofilm formation on endovascular aneurysm repair (EVAR) grafts—a proof of concept in vitro model. Clinical Microbiology and Infection (2023).
3. Infective Native Aortic Aneurysm: a Delphi Consensus Document on Treatment, Follow Up, and Definition of Cure. European Journal of Vascular and Endovascular Surgery (2023).