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Endovascular Treatment of Mycotic Aortic Aneurysms A European Multicenter Study
Dept Vasc Surg, Inst Surg Sci, Uppsala Univ, Uppsala, Sweden.
Dept Vasc Surg, Inst Surg Sci, Uppsala Univ, Uppsala, Sweden.
Dept Vasc Surg, Inst Surg Sci, Uppsala Univ, Uppsala, Sweden.
Dept Vasc Surg, Na Homolce Hosp, Prague, Czech Republic.
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2014 (English)In: Circulation, ISSN 0009-7322, E-ISSN 1524-4539, Vol. 130, no 24, p. 2136-2142Article in journal (Refereed) Published
Abstract [en]

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, p. 2136-2142
Keywords [en]
aneurysm, aorta, infection, surgery
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:oru:diva-56723DOI: 10.1161/CIRCULATIONAHA.114.009481ISI: 000346141900011PubMedID: 25378548Scopus ID: 2-s2.0-84918510456OAI: oai:DiVA.org:oru-56723DiVA, id: diva2:1083863
Note

Funding Agency:

Medical Research Council  G1000327

Available from: 2017-03-22 Created: 2017-03-22 Last updated: 2018-09-12Bibliographically approved

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