Rifampicin-soaked versus bovine prostheses in the management of aortic graft infections: a retrospective single-center cohort study

Background Aortic vascular graft and endograft infections (aortic VGEI) remain a rare but life-threatening complication following aortic reconstruction. This retrospective study compares outcomes between bovine pericardial graft prostheses and rifampicin-soaked Dacron grafts. Methods In this retrospective single-center cohort study, we analyzed 62 patients between January 2018 and December 2025 for aortic vascular graft or endograft infection requiring graft explantation and in-situ reconstruction. Patients received either a bovine pericardial graft (n=21) or a rifampicin-soaked Dacron prosthesis (n=41). Survival, treatment failure, perioperative variables, and microbiology were analyzed. Results Patients in the bovine and rifampicin groups were comparable in terms of age (72.57 vs. 73.58 years, p = 0.685) and sex distribution (85.71% vs. 73.17% male, p = 0.346). BMI, preoperative dialysis, and aortic clamping time were higher in the bovine group. Four treatment failures, defined as persistent or recurrent infection of the reconstructed aortic segment, occurred during follow-up; all were observed after reconstruction with rifampicin-soaked Dacron (4/41, 9.8%), whereas no treatment failure occurred in the bovine pericardial group (0/21). In-hospital mortality was comparable between groups (n=3:14.3% vs. n=8: 19.5%, p = 0.735). Kaplan–Meier analysis demonstrated no significant difference in survival (p = 0.256) or treatment failure rate (p = 0.833). Candida spp. were the most frequent pathogens (27.8%) and significantly associated with secondary aorto-enteric fistula (p=0.003). Conclusion Survival and treatment failure rates were comparable, with a trend toward fewer infection-related complications after bovine pericardial grafting. Despite use in more complex cases, bovine grafts may represent a promising biological alternative.