Endovascular treatment of mycotic aortic aneurysms: a European multicenter study

Karl Srelius, Kevin Mani, Martin Bjrck, Petr Sedivy, Carl Magnus Wahlgren, Peter Taylor, Rachel Clough, Oliver Lyons, Matt Thompson, Jack Brownrigg, Krassi Ivancev, Meryl Davis, Michael P. Jenkins, Usman Jaffer, Matt Bown, Zoran Rancic, Dieter Mayer, Jan Brunkwall, Michael Gawenda, Tilo KölbelElixène Jean-Baptiste, Frans Moll, Paul Berger, Christos D. Liapis, Konstantinos G. Moulakakis, Marcus Langenskiöld, Håkan Roos, Thomas Larzon, Artai Pirouzram, Anders Wanhainen*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

196 Citations (Scopus)

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 infection-related 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-Salmonella-positive culture as predictors for late infection-related death.

Conclusions-Endovascular treatment of MAA is feasible and for most patients a durable treatment option. Late infections do occur, are often lethal, and warrant long-term antibiotic treatment and follow-up. Patients with non-Salmonella-positive blood cultures were more likely to die from late infection.

Original languageEnglish
Pages (from-to)2136-2142
Number of pages7
JournalCirculation (Baltimore)
Volume130
Issue number24
Early online date5 Nov 2014
DOIs
Publication statusPublished - 9 Dec 2014

Keywords

  • aneurysm
  • aorta
  • infection
  • surgery

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