Bovine Pericardial Versus Synthetic Vascular Patch for Femoral Bifurcation Endarterectomy: Impact on Early Deep Surgical Site Infection (VASCUPATCH Study).

Abstract

In femoral bifurcation endarterectomy, bovine pericardial patches are often selected for patients considered at higher infectious risk, but comparative evidence remains limited. The VASCUPATCH study compared early deep surgical site infection (SSI) by patch type. This retrospective, multicentre cohort study included consecutive adults who underwent femoral bifurcation endarterectomy with patch angioplasty in two vascular centres (Brittany, France) and classified them as receiving a synthetic or bovine pericardial patch. The primary endpoint was early deep SSI within 90 days. Confounding was addressed using propensity score based inverse probability of treatment weighting (IPTW), and the primary adjusted analysis used an IPTW weighted Cox model. Among patients with SSI, infection severity was assessed using two composite endpoints (local and systemic) and compared with Fisher's exact test. Overall, 440 patients were included (277 synthetic, 163 bovine pericardial). Early deep SSI occurred in 38 of 440 patients (8.6%): 19 of 277 (6.9%) with synthetic patches and 19 of 163 (11.7%) with bovine pericardial patches (p = .051). In the IPTW weighted Cox model, patch type was not associated with early deep SSI (hazard ratio 1.67, 95% confidence interval 0.83 - 3.37; p = .15). Among patients with SSI, severe local infection was more frequent with synthetic patches (11 of 19, 57.9% vs. 4 of 19, 21.1%; p = .045), whereas systemic severity did not differ (21.1% in both groups; p = 1.0). Although bovine pericardial patches were preferentially used in higher risk patients, patch type was not associated with early deep SSI within 90 days after femoral bifurcation endarterectomy. However, a moderate increase in infection risk with bovine pericardial patches cannot be excluded, given the non-random patch allocation and limited statistical power. By contrast, synthetic patches were associated with greater local severity among patients with SSI.