Navigating Infective Native Aortic Aneurysms in Tropical Regions: Insights from a Five-Year Malaysian Experience

To describe the clinical characteristics, microbiological profiles, anatomic distribution, operative strategies, and outcomes of patients with infective native aortic aneurysms (INAAs) managed at a high-volume vascular center in Southeast Asia.

We conducted a retrospective cohort study of 70 patients with INAAs treated surgically or endovascularly between January 2018 and December 2023. Demographics, clinical presentation, microbiological findings, operative data, antibiotic regimens, and follow-up outcomes were analyzed. Primary outcomes included early mortality, postoperative complications, reintervention rates, and long-term survival. Kaplan-Meier analysis was used to estimate survival; Cox regression identified predictors of mortality.

The cohort had a mean age of 62.7 ± 9.3 years, with 90% male. Comorbidities included diabetes (77%) and hypertension (84%). The most frequently isolated organisms were Salmonella spp. (28.6%) and Burkholderia pseudomallei (17.1%). Infrarenal aortic involvement predominated. Thirty-eight patients underwent open repair, and 32 had endovascular repair. Endoleaks (36.4%) and aortoenteric fistulas (6.1%) were more common after endovascular repair. Reintervention rates were higher in the open group (26.3% vs. 18.8%). Early mortality was 2.8%, and 2-year estimated survival was 89%. Increasing age and ischemic heart disease were independent predictors of mortality (P < 0.05).

Both open and endovascular repair are effective modalities for INAA management when tailored to patient anatomy, stability, and resource availability. In tropical regions, endemic organisms such as B pseudomallei and Mycobacterium tuberculosis warrant consideration. Long-term antibiotic therapy, imaging surveillance, and multidisciplinary care are critical to optimizing outcomes.