Outcome after endovascular stent graft treatment for mycotic aortic aneurysm: A systematic review

Abstract

EVAR seems a possible alternative method for treating mycotic aortic aneurysms. Identification of the risk factors for persistent infection may help to decrease surgical morbidity and mortality. EVAR could be used as a temporary measure; however, a definite surgical treatment should be considered for patients present with aneurysm rupture or fever.

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

“…Although consecutive patients were included, only 12 (21%) of them presented with rupture and 6 (11%) of MAAAs encompassed suprarenal aorta. Rupture and suprarenal aneurysm location are known to be associated with increased risk of aneurysm‐related death 3, 4, 11, 12. Suprarenal location in combination with systemic inflammatory response system diminishes survival even further.…”

“…Articles published on prosthetic reconstructions emphasize preoperative antimicrobial therapy at least 1 week for stable patients to eliminate bacteremia and impregnate surrounding tissue with antibiotics, yet the evidence for less postoperative infectious complications is lacking 7, 12, 35. The duration of antimicrobial therapy remains unclear, depending on the surgical method and postoperative course, varying from 6 weeks to lifelong 10, 11, 12, 35, 36. With close surveillance, antibiotics may be discontinued in selected cases, provided there is no clinical, hematological, or radiological prove of ongoing infection.…”

“…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.…”

Infectious Thoracic Aortitis: A Literature Review

“…In patients with fever and ruptured MA, EVAR should be considered only as a temporary measure to achieve hemodynamic stability. 19 Endovascular techniques need further studies and longer follow-up periods in order to better define their role in IA management. 14 …”