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Endovascular treatment of mycotic aortic aneurysms: a European multicenter study
Karl Sörelius1, Kevin Mani1, Martin Björck1
1From the Institution of Surgical Sciences, Department of Vascular Surgery, Uppsala University, Sweden (K.S., K.M., M.B., A.W.); Department of Vascular Surgery, Na Homolce Hospital, Prague, Czech Republic (P.S.); Department of Vascular Surgery, Karolinska Hospital, Stockholm, Sweden (C.-M.W.); Department of Vascular Surgery, Guy's & St. Thomas' Hospital, London, United Kingdom (R.E.C., P.T., O.L.); St. George's Vascular Institute, London, United Kingdom (M.T., J. Brownrigg); Department of Vascular Surgery, Royal Free London NHS Foundation Trust, London, United Kingdom (K.I., M.D.); Regional Vascular Unit, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom (M.P.J., U.J.); Department of Cardiovascular Sciences and the NIHR Leicester Cardiovascular Biomedical Research Unit, University of Leicester, Leicester, United Kingdom (M.B.); Clinic for Cardiovascular Surgery, University Hospital Zürich, Zürich, Switzerland (Z.R., D.M.); Department of Vascular Surgery, University of Cologne, Cologne, Germany (J. Brunkwall, M.G.); Department for Vascular Medicine, University Heart Center, University Hospital Eppendorf Hamburg, Hamburg, Germany (T.K.); Division of Vascular Surgery, University of Nice-Sophia Antipolis, Nice, France (E.J.-B.); Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands (F.M., P.B.); Department of Vascular Surgery, Attikon University Hospital, Athens, Greece (C.D.L., K.G.M.); Department of Vascular Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden (M.L., K.R.); and Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden (T.L., A.P.).
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.
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