Key messages

• Antibiotics seem to reduce surgical site infections in people undergoing aortic or aortoiliac surgery.

• Other interventions assessed appear to make little or no difference in reducing the incidence of surgical site infections.

• Other outcomes evaluated were minimally or not affected by the interventions studied.

What are peripheral arterial disease and aortic aneurysms?

Peripheral arterial disease happens when arteries narrow, and blood flow is reduced. Aortic aneurysms—abnormal bulges in the aorta wall—are also a serious concern. When severe, these conditions may require arterial reconstruction surgery. Often, this involves using a graft—a piece of biological or synthetic material moved from another body part or source to replace or support the damaged artery. A graft lacks its own blood supply and depends on nearby tissue to heal. Infections at the surgical site, especially involving the graft, are a major concern due to the risk of severe illness or death. These infections also burden healthcare systems globally. That is why it is crucial to assess whether our current infection-prevention strategies are effective.

What did we want to find out?

We wanted to find out how medicines such as antibiotics, other treatments, cleaning methods, different surgical techniques, and wound care affect the risk of infection in people who have surgery to repair their aorta or aortoiliac arteries, which are important blood vessels.

What did we do?

We looked at all types of randomised studies that tested different treatments to prevent infections after surgery of the aorta or aortoiliac arteries. We only included studies where people were randomly assigned to different treatments. We also looked at whether different treatments had an impact on other important outcomes, such as overall mortality, the rate of failed arterial reconstructions, the need for additional surgeries, the rate of amputations, the level of pain resulting from infection-prevention treatments, and any adverse events caused by these treatments. We assessed how well the studies were conducted and collected, and combined the data for analysis whenever we could, examined the quality of the evidence, and described the results we found.

What did we find?

We included a total of 21 studies involving 4952 participants in this review. Fifteen studies were found to have a high risk of bias in at least one area, and 19 studies had an unclear risk of bias in at least one area. We looked at 10 different comparisons for eight different outcomes. These comparisons included: antibiotics versus placebo or no treatment; short-duration antibiotics (≤ 24 hours) versus long-duration antibiotics (> 24 hours); different types of systemic antibiotics (one versus another); antibiotic-bonded implants versus standard implants; Dacron grafts versus polytetrafluoroethylene grafts; prophylactic closed suction drainage versus undrained wound; individualised goal-directed therapy versus fluid therapy based on losses, standard haemodynamic parameters, and arterial blood gas values; comprehensive geriatric assessment versus standard preoperative care; percutaneous versus open-access technique; and negative pressure wound therapy (NPWT) versus standard dressings. The main outcomes of interest were the rates of graft infections and surgical site infections (SSIs). We also looked at other outcomes, like overall mortality, how often the arterial reconstruction failed, the need for re-intervention, the amputation rate, pain, and any adverse events related to the treatments to prevent infections. We could not assess all the outcomes in each comparison and, due to the absence of available data, we could not measure or analyse many other outcomes quantitatively. Here is a summary of the main findings:

Antibiotics versus placebo (five studies): Antibiotics seem to reduce SSIs with very low-confidence evidence. There was no difference between the groups in the other outcomes that we could assess (all-cause mortality, re-intervention rate, and amputation rate), with very low- to low-confidence evidence.

Short-duration versus long-duration antibiotics (three studies): With very low-confidence evidence, we found no difference between short- or long-duration antibiotics to prevent graft infections or SSIs.

Different types of antibiotics (seven studies): With very low-confidence evidence, we did not find differences between the different types of antibiotics when compared with each other for graft infection rate, SSI rate, or all-cause mortality. The comparisons included beta-lactams versus cephalosporins, glycopeptides versus cephalosporins, and one cephalosporin versus another.

What are the limitations of the evidence?

There are not many studies that have focused on people having surgery on their aortic or aortoiliac segments. The few available studies involve small numbers of patients and not many events, which makes it hard to compare different treatments. Some studies included different types of people, and not all of them provided specific data for the groups of people of interest for this review. The length of time patients were followed up after surgery varied a lot between the studies. We also noticed that some studies had methodological problems that could lead to biased results. We listed these challenges when we looked at the results and took them into account before making our conclusions.

How up-to-date is this evidence?

The evidence is current as of November 2024.