Infections of the aorta

Area of Science:

• Vascular Surgery
• Infectious Diseases
• Cardiology

Background:

• Aortic infections present significant morbidity and mortality, with increasing rates of graft infections, particularly endograft infections.
• Staphylococcus species are the most common pathogens, but gram-negative bacteria and rare agents are also implicated.
• Diverse clinical presentations necessitate a high index of suspicion for timely diagnosis.

Purpose of the Study:

• To review the current understanding of aortic infections, including diagnosis, management, and outcomes.
• To highlight the challenges in treating these complex infections and the need for integrated treatment strategies.

Main Methods:

• Literature review of aortic infection diagnosis and management.
• Analysis of causative agents, clinical presentations, and treatment modalities.
• Discussion of surgical and endovascular approaches, including aortic substitutes.

Main Results:

• Diagnosis relies on clinical features, microbial cultures, and imaging.
• Antibiotics alone are rarely curative; surgical management involving debridement and reconstruction is the standard of care.
• Pericardial tube grafts show promise, while endovascular options serve as a bridge to surgery. Aortic fistulation to the gut/airway has very high mortality.

Conclusions:

• Aortic infections require a multidisciplinary, customized approach due to a lack of guideline-directed treatments.
• The 30-day mortality remains high (around 30%), influenced by patient factors, diagnosis, and treatment strategy.
• Integrated surgical management offers the best outcomes, though challenges persist in optimizing patient care.