Vascular Graft and Endograft Infections: A Delphi Consensus Document on Terminology, Definitions, Treatment, Outcomes, Follow Up, and Reporting Standards

There is a lack of consensus on certain terminology and definitions related to vascular graft and endograft infections (VGEIs) and secondary aorto-enteric erosion and or fistula and their treatment, outcome reporting, follow up, and reporting standards. The objective of this study was to complete a Delphi consensus study on these VGEI related issues. The Delphi methodology was used with a panel of 43 international experts (specialists in vascular or cardiovascular surgery, infectious diseases, nuclear medicine, and radiology). Four Delphi rounds were planned using an online questionnaire initially with 31 statements. Panellists rated the statements on a five point Likert scale. Comments on statements were analysed, statements were revised, and the results were presented in iterative rounds. Consensus was defined as ≥ 75% of the panel rating a statement as strongly agree or agree, and consensus on the final assessment was defined as Cronbach’s α > 0.80. All 43 panellists fulfilled all four rounds, resulting in 100% participation. Cronbach’s α increased through the rounds: round 1, 0.88; round 2, 0.89; round 3, 0.90; and round 4, 0.90. A final fifth round was performed among all surgeons (n = 27) defining secondary aorto-enteric erosion and or fistula, with 100% participation. Agreement was reached for 29 final statements: two on need for consensus, two on definition of multidisciplinary team, three on microbiology diagnosis, six on treatment, three on secondary graft-enteric partial erosion, secondary graft-enteric fistula, and secondary aorto-enteric fistula, three on treatment outcomes, nine on follow up, and one on reporting standards including 11 items. Consensus was achieved for 29 statements, which were developed to establish a common perception of VGEI and secondary aorto-enteric erosion and or fistula, with the potential to improve research in this field and ultimately patient care.