Aortic vascular graft or endograft infection can compromise both open and endovascular aortic repair. Confirming the microbiological aetiology is critical to giving the best possible treatment for VGEI patients. The major goal of this study was to describe and report the diagnostic utility of Direct Aneurysm Sac Guided Aspiration (DASGA) in establishing the microbiological aetiology in a group of patients with VGEIs. This was a retrospective observational single-center research conducted in Malmö, Sweden, from 2011 to 2020. The research comprised patients who had a suspected aortic VGEI and had a DASGA conducted at the Vascular Centre. In all, 31 guided aspirations were conducted on 27 patients (25 males [93%]; median age 77 [range 57–82 years]). In 25/31 (81%) DASGAs, the combination of culture and 16S rRNA/18S rRNA revealed a microbial aetiology. Importantly, if three cases where infection was ruled out are excluded, the prevalence rises to 89 percent. Six (24 percent) of the patients had a polymicrobial aetiology. Cutibacterium spp. (n = 8) and Listeria monocytogenes (n = 4) were the most frequent bacteria detected. Overall, the major aetiology could be classified as either normal gut flora (n = 12; 48%) or skin commensals (n = 8; 32%). There was no long-term morbidity associated with the DASGA in any of the patients. The microbiological aetiology of open and endovascular graft infections may be determined by DASGA. This approach appears to be safe, with a high success rate for proving the microbiological aetiology of VGEIs, especially when paired with normal culture procedures and 16S rRNA/18S rRNA. Finding the causative microbial aetiology is critical, and trans lumbar puncture may be utilized without substantial problems in the great majority of instances.
