Multidisciplinary management and outcomes of abdominal vascular graft and endograft infections: a retrospective cohort study

Purpose: To describe the multidisciplinary management and outcomes of patients with vascular graft and endograft infections of the abdominal aorta (aVGEI) in Eastern Denmark. Methods: Retrospective cohort study of aVGEI patients between 1st July 2022 and 30th June 2025. Diagnosis and management were based on a multidisciplinary team (MDT) conference. The primary outcome was 90-day mortality. Secondary outcomes included one-year mortality, cure, remission, treatment failure, and re-hospitalization. Results: In 35 aVGEI patients, the median age was 73 years (IQR 69.5–79 years), and the median Charlson Comorbidity Index score was 5 (IQR 3–6). The Management of Aortic Graft Infection Collaboration (MAGIC) criteria were fulfilled in 27 cases (77%, ‘MAGIC positive aVGEI’). The remaining eight cases (23%) were based on conference consensus, often supported by positive PET-CT findings (n = 4/8). The most frequent monomicrobial infections were Staphylococcus aureus (n = 5/35, 14.3%) and coagulase-negative staphylococci (n = 4/35, 11.4%). Polymicrobial infections occurred in nine patients (25.7%). Five aVGEI patients were treated surgically (14.3%). The 90-day mortality was 8.6% (n = 3/35, 95%CI 1.8–3.1%); 4.2% among ‘MAGIC positive aVGEI’ patients (n = 1/24), 12.5% among those diagnosed on conference consensus (n = 1/8), and 33.3% among patients with an aortoenteric fistula (AEF) (n = 1/3). Among aVGEI patients with complete follow-up, cure was achieved in 31.8% (n = 7/22, 95%CI 13.9–4.9%), but none of the three patients with AEF. Conclusion: We report low short-term mortality and a cure rate of over 30% within a cohort of predominantly conservatively managed patients discussed at an MDT conference. These outcomes may reflect the benefits of individualized treatment decisions based on careful patient evaluation during MDT meetings as well as survivor bias.