11-Year Experience with Anatomical and Extra-anatomical Repair of Mycotic Aortic Aneurysms

Kyriakides, Constantinos; Kan, Yuanqing; Kerle, M.; Cheshire, Nick; Mansfield, Averil O.; Wolfe, John H.

doi:10.1016/j.ejvs.2004.02.024

Cited by 116 publications

(100 citation statements)

References 32 publications

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“…Most reports on open repair show a much worse outcome, with short-term mortality rates of 20% to 40% [6][7][8][15][16][17][18] and significant short-and long-term morbidity related to the operation. 7,9,19 Reports on long-term outcome after open repair are scarce.…”

Section: Discussionmentioning

confidence: 99%

Endovascular Treatment of Mycotic Aortic Aneurysms

et al. 2014

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Background-Mycotic aortic aneurysm (MAA) is a rare and life-threatening disease. The aim of this European multicenter collaboration was to study the durability of endovascular aortic repair (EVAR) of MAA, by assessing late infectionrelated complications and long-term survival. Methods and Results-All EVAR treated MAAs, between 1999 and 2013 at 16 European centers, were retrospectively reviewed. One hundred twenty-three patients with 130 MAAs were identified. Mean age was 69 years (range 39-86), 87 (71%) were men, 58 (47%) had immunodeficiency, and 47 (38%) presented with rupture. Anatomic locations were ascending/arch (n=4), descending (n=34), paravisceral (n=15), infrarenal aorta (n=63), and multiple (n=7). Treatments were thoracic EVAR (n=43), fenestrated/branched EVAR (n=9), and infrarenal EVAR (n=71). Antibiotic was administered for mean 30 weeks. Mean follow-up was 35 months (range 1 week to 149 months). Six patients (5%) were converted to open repair during follow-up. Survival was 91% (95% confidence interval, 86% to 96%), 75% (67% to 83%), 55% (44% to 66%), and 41% (28% to 54%) after 1, 12, 60, and 120 months, respectively. Infection-related death occurred in 23 patients (19%), 9 after discontinuation of antibiotic treatment. A Cox regression analysis demonstrated non-Salmonellapositive culture as predictors for late infection-related death. Conclusions-Endovascular

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Section: Discussionmentioning

confidence: 99%

Endovascular Treatment of Mycotic Aortic Aneurysms

et al. 2014

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“…Most series on mycotic aneurysms arelimited in numbers and they advocate excision of the infected arterial wall, drainage, over-sewing of the aorta and an extra-anatomical by-pass (29)(30)(31). However,mortality is high (36%) (30), blow-outs of the over-sewn aortic stump arefrequently seen, occlusion of the extra-anatomic by-pass is far too common and the risk of recurrent infection of the graft material is an additional hazard.…”

Section: Mycotic Pseudoaneurysmsmentioning

confidence: 99%

“…Gram-negative species arereported to be moreaggressive and at least demand al onger period of antibiotic treatment. However,a bout 25 %o fp atients with ac linically diagnosed mycotic aneurysm and an initial positive blood cultureh ave negative sterile cultures at operation (30,31).…”

Section: Mycotic Pseudoaneurysmsmentioning

confidence: 99%

What to Do When Evidence is Lacking — Implications on Treatment of Aortic Ulcers, Pseudoaneurysms and Aorto-Enteric Fistulae

et al. 2008

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“…MAAs are a rare, but life‐threatening entity with rapid clinical course and devastating outcomes without surgical intervention 2. Even with adequate treatment, mortality remains as high as 18% to 43% 3, 4, 5, 6, 7…”

Section: Introductionmentioning

confidence: 99%

Open Repair of Mycotic Abdominal Aortic Aneurysms With Biological Grafts: An International Multicenter Study

Heinola

Sörelius

Wyss

et al. 2018

JAHA

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BackgroundThe treatment of mycotic abdominal aortic aneurysm requires surgery and antimicrobial therapy. Since prosthetic reconstructions carry a considerable risk of reinfection, biological grafts are noteworthy alternatives. The current study evaluated the durability, infection resistance, and midterm outcome of biological grafts in treatment of mycotic abdominal aortic aneurysm.Methods and ResultsAll patients treated with biological graft in 6 countries between 2006 and 2016 were included. Primary outcome measures were 30‐ and 90‐day survival, treatment‐related mortality, and reinfection rate. Secondary outcome measures were overall mortality and graft patency. Fifty‐six patients (46 males) with median age of 69 years (range 35–85) were included. Sixteen patients were immunocompromised (29%), 24 (43%) had concomitant infection, and 12 (21%) presented with rupture. Bacterial culture was isolated from 43 (77%). In‐situ aortic reconstruction was performed using autologous femoral veins in 30 patients (54%), xenopericardial tube‐grafts in 12 (21%), cryopreserved arterial/venous allografts in 9 (16%), and fresh arterial allografts in 5 (9%) patients. During a median follow‐up of 26 months (range 3 weeks–172 months) there were no reinfections and only 3 patients (5%) required assistance with graft patency. Thirty‐day survival was 95% (n=53) and 90‐day survival was 91% (n=51). Treatment‐related mortality was 9% (n=5). Kaplan–Meier estimation of survival at 1 year was 83% (95% confidence interval, 73%–94%) and at 5 years was 71% (52%–89%).ConclusionsMycotic abdominal aortic aneurysm repair with biological grafts is a durable option for patients fit for surgery presenting an excellent infection resistance and good overall survival.

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11-Year Experience with Anatomical and Extra-anatomical Repair of Mycotic Aortic Aneurysms

Abstract: In the absence of uncontrolled sepsis, repair of mycotic aortic aneurysms using prosthetic grafts can achieve durable results.

Cited by 116 publications

References 32 publications

Endovascular Treatment of Mycotic Aortic Aneurysms

Endovascular Treatment of Mycotic Aortic Aneurysms

What to Do When Evidence is Lacking — Implications on Treatment of Aortic Ulcers, Pseudoaneurysms and Aorto-Enteric Fistulae

Open Repair of Mycotic Abdominal Aortic Aneurysms With Biological Grafts: An International Multicenter Study

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