Surgical site infections after vascular surgery - current strategies and future directions.

Abstract

Introduction: Surgical site infections (SSIs) in vascular surgery remain a major source of morbidity, mortality, graft failure, limb loss, and healthcare costs. Although many vascular procedures are classified as clean surgery, the frequent use of prosthetic material, high-risk anatomical sites such as the groin, and comorbid patient populations make infections particularly consequential.

Areas covered: This review summarizes the epidemiology, risk factors, microbiology, classification, diagnosis, prevention, and treatment of SSIs in vascular surgery. It discusses procedure-specific infection risks, including those associated with open and endovascular interventions, and examines current preventive strategies such as patient optimization, perioperative antibiotic prophylaxis, skin antisepsis, intraoperative measures, and incisional negative pressure wound therapy. Treatment approaches, including antimicrobial therapy, surgical debridement, graft explantation, reconstruction, and multidisciplinary care, are reviewed. Key challenges include antimicrobial resistance, inconsistent surveillance definitions, underreporting after discharge, diagnostic uncertainty, and limited evidence on cost-effectiveness and endovascular SSI management.

Expert opinion: Future progress requires vascular-specific risk stratification, standardized and objective surveillance systems, stronger post-discharge follow-up, and high-quality randomized trials on antibiotic prophylaxis duration and advanced wound therapies. Transparent reporting and interdisciplinary collaboration are essential to reduce SSI-related complications and improve patient outcomes.