Clinical Characteristics and Longitudinal Outcomes of Primary Mycotic Aortic Aneurysms

Area of Science:

• Vascular Surgery
• Infectious Disease
• Aortic Aneurysm Treatment

Background:

• Mycotic aortic aneurysms (MAA) present significant treatment challenges with high mortality rates for medical therapy and high morbidity/mortality for surgical interventions.
• Optimal management strategies for MAA remain debated due to the limited data and complex patient profiles.

Purpose of the Study:

• To compare the outcomes of endovascular repair, open surgery, and medical therapy in patients diagnosed with mycotic aortic aneurysms.
• To identify risk factors associated with mortality in MAA patients.

Main Methods:

• A retrospective review of patient records identified 38 individuals with MAA.
• Patients were stratified into three treatment groups: endovascular repair (n=21), open surgery (n=10), and medical therapy (n=7).
• Primary outcomes included aneurysm-related mortality and overall survival, analyzed using time-to-event analysis.

Main Results:

• Overall mortality was 47%, with 94% of deaths being aneurysm-related.
• Median survival was significantly longer for endovascular repair (747 days) compared to open surgery (507.5 days) and medical therapy (66 days) (P = .02).
• Endovascular repair demonstrated a lower perioperative complication rate (43%) versus open surgery (80%) (P < .01), but with a higher rate of reinfection (4 patients). Medical therapy and larger aneurysm size were identified as mortality risk factors.

Conclusions:

• Endovascular repair is associated with superior long-term survival and reduced perioperative complications for mycotic aortic aneurysms.
• The increased risk of reinfection with endovascular repair necessitates careful consideration alongside its benefits.
• Treatment decisions for MAA should weigh the tradeoffs between endovascular repair, open surgery, and medical management based on individual patient factors.