Citation: Costa, D.; Andreucci, M.; Ielapi, N.; Serraino, G.F.; Mastroroberto, P.; Bracale, U.M.; Serra, R. Infection of Vascular Prostheses: A Comprehensive Review. Prosthesis 2023, 5, 148–166. https://doi.org/10.3390/ prosthesis5010012 Academic Editor: Marco Cicciu Received: 3 January 2023 Revised: 23 January 2023 Accepted: 1 February 2023 Published: 2 February 2023 Copyright: © 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/). Review Infection of Vascular Prostheses: A Comprehensive Review Davide Costa 1,2 , Michele Andreucci 3 , Nicola Ielapi 4 , Giuseppe Filiberto Serraino 5 , Pasquale Mastroroberto 5 , Umberto Marcello Bracale 6 and Raffaele Serra 2,7, * 1 Department of Law, Economics, and Sociology, University “Magna Graecia” of Catanzaro, 88100 Catanzaro, Italy 2 Interuniversity Center of Phlebolymphology (CIFL), International Research and Educational Program in Clinical and Experimental Biotechnology, University “Magna Graecia” of Catanzaro, 88100 Catanzaro, Italy 3 Department of Health Sciences, University “Magna Graecia” of Catanzaro, 88100 Catanzaro, Italy 4 Department of Public Health and Infectious Disease, “Sapienza” University of Rome, 00185 Rome, Italy 5 Department of Experimental and Clinical Medicine, University “Magna Graecia” of Catanzaro, 88100 Catanzaro, Italy 6 Department of Public Health, University of Naples “Federico II”, 80138 Naples, Italy 7 Department of Medical and Surgical Sciences, University “Magna Graecia” of Catanzaro, 88100 Catanzaro, Italy * Correspondence: rserra@unicz.it Abstract: Vascular graft or endograft infection (VGEI) is a complex disease that complicates vascular- surgery and endovascular-surgery procedures and determines high morbidity and mortality. This review article provides the most updated general evidence on the pathogenesis, prevention, diagnosis, and treatment of VGEI. Several microorganisms are involved in VGEI development, but the most frequent one, responsible for over 75% of infections, is Staphylococcus aureus. Specific clinical, surgical, radiologic, and laboratory criteria are pivotal for the diagnosis of VGEI. Surgery and antimicrobial therapy are cornerstones in treatment for most patients with VGEI. For patients unfit for surgery, alternative treatment is available to improve the clinical course of VGEI. Keywords: VGEI; infection; vascular prosthesis; vascular graft; antibiotic 1. Introduction A vascular prosthesis is defined as a biological or artificial device meant to replace a segment of an arterial tree whose function is compromised by injury, occlusive disease, or aneurysmal degeneration. A prosthetic graft provides a substitute conduit for blood flow, allowing the diseased vessel segment to be repaired, excised, or bypassed [1–10]. Vascular prostheses include vascular grafts (VGs), generally implanted surgically, and vascular endografts (VEs) (or stent-grafts) implanted by endovascular procedure. VGs may be classified into biological grafts, which are composed of actual tissues, most often blood vessels (e.g., autologous grafts derived from the patient’s own vessel); allografts (from human vessels); xenografts (generally of bovine origins); and synthetic grafts made from either poly-ethylene-terephthalate (PET, or Dacron), a textile material, or expanded- polytetrafluoroethylene (ePTFE), a non-textile material. In textile VGs, the basic polymer is first made into a yarn, which is then used to construct a graft using various methods of knitting or weaving. Non-textile VGs are manufactured using the techniques of the precipitation or the extrusion of the polymer from solutions or sheets of the material. When the available length of an autogenous tissue graft is inadequate for the required recon- struction, composite VGs can be used. Such VGs are constructed by combining segments of an artificial prosthetic material with autogenous material to form a substitute-vessel conduit. VGs are generally positioned during open surgery and sutured both proximally and distally to the healthy artery by end-to-end or end-to-side anastomosis (Figure 1). An ideal VG should be impermeable, thromboresistant, compliant, biocompatible, durable, Prosthesis 2023, 5, 148–166. https://doi.org/10.3390/prosthesis5010012 https://www.mdpi.com/journal/prosthesis