Clinical Presentation and Imaging Pathways in Peripheral Vascular Graft and Endograft Infection: A Dutch-German Cohort Study.

OBJECTIVE: 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 multicentre, 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 three hospitals were included: one in the Netherlands (NL) and two in Germany (DE). Diagnosis was established by multidisciplinary consensus supported by microbiological, imaging, and/or intra-operative evidence. RESULTS: A total of 104 pVGEI patients were included (NL, 52; DE, 52). 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%) 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 MRA. CONCLUSIONS: 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.