Endovascular Treatment of Mycotic Aortic Aneurysms A European Multicenter Study
2014 (English)In: Circulation, ISSN 0009-7322, E-ISSN 1524-4539, Vol. 130, no 24, 2136-2142 p.Article in journal (Refereed) Published
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-Salmonellapositive blood cultures were more likely to die from late infection.
Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2014. Vol. 130, no 24, 2136-2142 p.
aneurysm, aorta, infection, surgery
Cardiac and Cardiovascular Systems
IdentifiersURN: urn:nbn:se:oru:diva-56723DOI: 10.1161/CIRCULATIONAHA.114.009481ISI: 000346141900011PubMedID: 25378548ScopusID: 2-s2.0-84918510456OAI: oai:DiVA.org:oru-56723DiVA: diva2:1083863
Medical Research Council G10003272017-03-222017-03-222017-03-23Bibliographically approved