Systematic Review and Meta-analysis of Occurrence Rate, Treatments, and Outcomes of Vascular Graft and Stent Infections in the Supra-aortic Trunks

Objective: This study aimed to systematically review and synthesise the available evidence on the management of vascular graft and stent infections in the supra-aortic trunks (SATs). Data sources: MEDLINE, Scopus, Cochrane databases, and citation searching. Review methods: All study designs (case reports and series, cohort studies, and trials) addressing treatments for post-operative infections of prosthetic vascular grafts and stents in the SAT were included. GRADE methodology was used to assess the certainty of evidence. Results: Seventy one studies were included in this systematic review. Fifty four were case reports and case series (215 patients) describing SAT infections following surgery. Among these, 11 studies with 149 patients who initially underwent carotid endarterectomy (CEA) with patch closure were included in the meta-analysis. The estimated infection rate after CEA with patch closure was 0.7% (95% confidence interval [CI] 0.4 - 0.9%). Surgical treatment was mostly based on complete removal of the infected material and in situ arterial reconstruction (82.2%, 95% CI 71.4 - 92.9%). Post-operative complications occurred in 25.9% (95% CI 16 - 35.9%). Cranial nerve injury occurred in 12.5% (95% CI 5.7 - 19.4%), with 28.4% (95% CI 5.2 - 57.4%) of these being permanent. Re-infections during a mean follow up of 37.7 months occurred in 3.4% of patients. Seventeen studies were case reports documenting SAT infections in 21 patients following endovascular treatment. Stent explantation was performed in 18 of 21 cases. A reconstruction to restore SAT flow was performed in 11 of 18 cases. GRADE analysis determined the certainty of evidence for all outcomes to be very low. Conclusion: Vascular graft and stent infections in the SAT are uncommon. The preferred treatment was removal of the infected graft and autologous reconstruction. Alternatives included drainage, stent relining, and antibiotics. Cranial nerve injuries were common, with one third resulting in permanent damage.