Endovascular Treatment of Mycotic Aortic Aneurysms

Abstract

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

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

“…Similar results were seen in an international multicenter study with 3‐month survival of 86% and reinfection rate of 27% 10. Biological grafts showed no reinfections, nor graft‐related fatal complications; 5‐year survival of 71% was superior to previous studies with prosthetic grafts, but graft durability and overall superiority need longer follow‐up and further studies 10, 11, 15…”

“…Rapid aneurysmal growth induces pain and infection, which may promptly evolve to sepsis. Patients are often immunosuppressed and/or have concomitant infections; therefore, early diagnosis, adequate antimicrobial therapy, and surgery are crucial for favorable outcomes 3, 9, 10…”

“…The feasibility of in‐situ prosthetic grafting or endovascular aortic repair (EVAR) of mycotic abdominal aortic aneurysms (MAAA) has been acknowledged by previous studies 10, 11, 12, 13, 14, 15. Minimally invasive EVAR provides a favorable early survival rate at 3 months, but the risk of reinfection and associated late mortality remains a problem 10, 11, 12, 13.…”

“…Minimally invasive EVAR provides a favorable early survival rate at 3 months, but the risk of reinfection and associated late mortality remains a problem 10, 11, 12, 13. Because of poor outcomes in graft patency, aortic stump blow‐out and numerous reinfections, extra‐anatomical bypass has been abandoned as a treatment of choice in many centers 16.…”

“…Because of poor outcomes in graft patency, aortic stump blow‐out and numerous reinfections, extra‐anatomical bypass has been abandoned as a treatment of choice in many centers 16. In‐situ prosthetic alignment is the preferred alternative to EVAR, yet a substantial rate of mortality persists because of infectious complications 10, 11, 15…”