Characteristics and risk factors for mortality of Vascular graft infections: a cohort study

Abstract Background Vascular graft infections (VGIs) are rare but severe complications associated with high morbidity and mortality. Method We conducted a retrospective study in a French reference center for vascular grafting, including all patients who underwent surgery for VGI between 2020 and 2025. Data on patient and infection characteristics, surgical and medical management, and follow-up up to one year after surgery were collected. Infection-related mortality was defined as death occurring within 1 year after surgery and directly attributable to the infection or its complications. Results We included 129 patients with a median age of 71 years (IQR 61-81); most were male (82%). Major comorbidities were smoking (82%), high blood pressure (64%), and diabetes (32%). VGIs were mostly extracavitary (85%) and occurred early (<4 months after surgery) in 57% of cases. Revision surgery mostly considered of a conservative approach, namely debridement without graft replacement (71%). Polymicrobial infections were common (49%), and Staphylococcus aureus was the predominant pathogen, accounting for 16% of isolates. The overall mortality rate reached 43% at one year. In univariate analysis, age >75 years, intensive care unit (ICU) admission, and infection with multidrug-resistant bacteria were associated with increased mortality. In multivariate analysis, age >75 years (p = 0.03) and ICU admission (p = 0.045) emerged as independent predictors of infection-related mortality. Conclusion VGIs carry a poor prognosis despite surgical management and targeted antimicrobial therapy. Advanced age and disease severity at presentation appear to be the main predictors of mortality. The respective impact of surgical strategy and microbiological profile requires further investigation in larger multicentric studies.